Integrated Maternal and Newborn Care Basic Skills Course ...
Integrated Maternal and Newborn Care Basic Skills Course ...
Integrated Maternal and Newborn Care Basic Skills Course ...
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
cases, it is very useful to have easily accessible job aids available (which could be adapted from<br />
Table 16 below).<br />
Use of Antibiotics<br />
Administer antibiotics using these guidelines:<br />
• Ampicillin 50 mg/kg IM/IV every 12 hours in first 7 days <strong>and</strong> every 8 hours after day 8.<br />
• Gentamycin IM/IV once daily – 3 mg/kg for babies < 2500 grams. <strong>and</strong> 5 mg/kg in babies<br />
> 2500 grams.<br />
• Duration of treatment: 10 days.<br />
• At the peripheral health center, give the first doses IM prior to transfer to a higher level of<br />
care.<br />
• Continue to provide additional support such as feeding where feasible, temperature<br />
maintenance <strong>and</strong> cleanliness/avoidance of superadded or secondary infection.<br />
Danger Signs<br />
Table 16: Practical Guidelines for Identifying <strong>and</strong> Treating<br />
Major Infections at Peripheral Centers<br />
Note: The first five danger signs are the most important.<br />
Management of the newborn at risk for early infection:<br />
For a newborn with maternal infections <strong>and</strong> premature rupture of membranes of 18 hours or<br />
more, even in the absence of symptoms, give intramuscular antibiotic treatment (ampicillin <strong>and</strong><br />
gentamycin), for at least 3 days <strong>and</strong> preferably for 5 days, as blood cultures are not feasible at<br />
peripheral centers. Observe the baby at the facility. If there are no danger signs, discharge the<br />
infant. If there are danger signs, transfer to a higher level of care.<br />
DANGER<br />
SIGNS<br />
IDENTIFICATION<br />
(Ask <strong>and</strong> look for/verify)<br />
MANAGEMENT<br />
Sucking less,<br />
or poorly, or<br />
not sucking at<br />
all<br />
Lethargy/<br />
inactivity<br />
Fever/low<br />
body<br />
temperature<br />
Rapid<br />
breathing/<br />
Not sucking at all; sucking less than<br />
usual; not opening the mouth when<br />
offered feeds; not dem<strong>and</strong>ing feeds.<br />
Not as active as usual, sleeping<br />
excessively, difficult to arouse,<br />
moving only when stimulated, not<br />
waking up for feeds, lying limp,<br />
“loose-limbed,” excessively quiet or<br />
“too good.”<br />
Fever: Body hot to touch, history of<br />
the mouth feeling excessively hot<br />
during breastfeeding; temperature<br />
more than 37.5 °C<br />
Hypothermia: Body colder than<br />
normal; temperature less than 36.5<br />
°C.<br />
Respiration more than 60/minute<br />
(verify by counting a second time),<br />
• Administer (a) First doses of the two<br />
antibiotics: ampicillin <strong>and</strong><br />
gentamycin; (b) vitamin K 1 mg if it<br />
was not given at birth; (c) Diazepam<br />
if convulsions: 0.5 mL rectally, or IM<br />
(thigh) or slow IV .<br />
• Send the baby to the referral<br />
hospital.<br />
• Explain to the mother why the baby<br />
needs referral <strong>and</strong> advise her to go<br />
along with another attendant.<br />
• Advise how to care for the baby<br />
during transport:<br />
o Keep the baby warm by skin-toskin<br />
contact (see chapter 12 on<br />
LBW <strong>and</strong> KMC).<br />
o To prevent hypoglycemia, if the<br />
baby can accept feeds give<br />
direct breastfeeding or<br />
expressed breast milk with cup.<br />
152<br />
<strong>Integrated</strong> maternal <strong>and</strong> newborn care<br />
<strong>Basic</strong> skills course