Integrated Maternal and Newborn Care Basic Skills Course ...

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