Integrated Maternal and Newborn Care Basic Skills Course ...

• maternal infections, including urinary tract infection during the last months of pregnancy
• premature rupture of the membranes (>18 hours)
• unhygienic delivery practices, including poor cord care
These risk factors are significant and have important practical implications:
• Babies with these maternal risk factors may appear normal at birth.
• The signs may appear after the baby has returned home.
• Identification of the maternal risk factors can lead to prophylactic antibiotic treatment that
may be life saving.
• These babies need careful follow-up and should benefit from a longer stay at the health
center.
• Even in the absence of laboratory tests in peripheral health centers, just taking a good
maternal history may help identify these risk factors and enable suitable actions.
Late-onset infections (day 4-28) are usually acquired from the environment in the home or
facility. They are caused by several factors including:
• Unhygienic use of formulas, other milk, and fluids instead of exclusive breastfeeding.
• Poor newborn care practices, such as lack of proper hand washing, contact with unclean
clothes and other items, infected persons, use of improperly cleaned/sterilized
supplies/equipment (the last mentioned is particularly common at the facility level).
• Excessive, invasive hospital procedures with poor infection control practices.
TYPES OF NEONATAL INFECTION
Major Infections
Specific entities such as pneumonia, diarrhea, septicemia, and meningitis are difficult to
diagnose in the newborn, as the signs may be nonspecific and the disease spreads rapidly to
involve several organs. Hence, the catch-all term “neonatal sepsis” is used in the public health
area.
Relevant to diarrheas in the newborn period, babies receiving breast milk pass loose stools
with separate watery and “curdy” portions several times a day, being particularly frequent in
days 3-5. These are termed “transitional stools” and may be wrongly diagnosed as diarrhea,
and oral rehydration solution/therapy may be given. The latter is not only needless, but it may
also carry a risk of causing real infection if given in an unhygienic manner.
The risk of diarrheas and other major infections is particularly high if initiation of breastfeeding is
delayed and the newborn and the infant under six months receive other milks and fluids. Thus,
even when the mother is HIV-positive and opts to give formula feeds, the health workers should
counsel and support the family adequately to ensure that the feeds are given in a clean manner.
Otherwise there is a real risk of the baby developing diarrhea with spread of infection that can
result in complications and even death. Where appropriate care is not taken, especially in
illiterate, low socio-economic groups, there will actually be a greater chance of babies dying of
such infections than from HIV/AIDS.
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Integrated maternal and newborn care
Basic skills course