Integrated Maternal and Newborn Care Basic Skills Course ...

Reference Manual
Major infections in the newborn period are identified by the presence of one or more danger
signs, as noted below in Table 16 (on practical guidelines for identifying and treating major
infections at peripheral centers).
Minor Infections
The most common minor infections are:
• thrush
• conjunctivitis
• skin infections
• umbilical infection (localized)
While the focus in this manual will be on the most common major and minor infections listed
above, other newborn infections include syphilis, HIV/AIDS, Hepatitis B, and tetanus.
IDENTIFYING AND TREATING MAJOR INFECTIONS
Very early signs of major infection/neonatal sepsis are vague and sometimes difficult to
recognize, but early detection is needed as it takes time to effect referral to suitable centers.
These early features include vague signs such as the baby just “not looking well” or appearing
as if “he/she is just not well,” at times described as a “facial grimace.” However, these early
features are more difficult to detect and require careful daily observation. Mothers, family
members, and health care providers should be encouraged to view the baby in adequate light at
least once a day, especially in the first week or two.
More conventional clinical features labeled as “danger signs” used to identify newborn sepsis
include the following (the first five are the most important):
• sucking less or poor/no sucking
• lethargy or diminished activity/inactivity
• fever (body too hot) or hypothermia (body feeling too cold)
• rapid breathing/difficulty in breathing
• convulsions
• repeated or persistent vomiting and/or abdominal fullness
• features of severe umbilical infection (peri-umbilical redness, swelling and/or foul
smelling, with or without pus discharge and/or foul smell)
The first five danger signs are the most important. Although these are standard danger signs, it
is essential that health workers should look at babies carefully at least once a day in adequate
light while they remain in the facility. Even if they do not detect a specific danger sign, health
workers should take care if they feel the baby is “not looking or doing well”. In this way, sick
newborns can be identified and treated early which is particularly important in the newborn
period when the condition can deteriorate rapidly. Mothers should also be counseled on these
points to promote early careseeking.
Training personnel in good follow-up supervision is necessary to identify these danger signs.
Since they are difficult to remember, especially when health workers do not see very many
Integrated maternal and newborn care
Basic skills course
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