Prevention, Identification and Management of Infection in - PowerPoint Presentation

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Prevention, Identification and Management of Infection in

Newborn

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y the end of this session, learners will be able to:Discuss various risk factors for newborn infectionExplain the identification and management of neonatal infection with or without symptomsDescribe infection prevention practices and giving antibiotics to reduce deaths of newborns due to sepsisDescribe the doses of antibiotics when FBNC is available or notDescribe antiretroviral prophylaxis for newborns born to HIV+ve mother

Learning

Objectives

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Deaths from neonatal sepsis can be reduced by

Strict hand-washing practices while handling the babyReducing un-necessary PV examinationsMaintaining hygiene during deliveryEarly initiation of exclusive breast feedingTimely and judicious use of antibioticsInfection in Neonatal Period is a Leading Cause of Deaths in NewbornSmall babies (Pre term and SGA) are at a higher risk of acquiring infection and may require higher focus

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Risk

Factors for Newborn InfectionRelated to mother and deliveryFailure to follow Infection prevention practicesPoor monitoring of mother’s temperature during 1st and 2nd stages of laborFrequent vaginal examinationsPROM >18 hrsProlonged labour>24 hrs/obstructed labour Pre-existing STIs/RTIsRelated to Newborn careVery low birth weight, prematurityLack of exclusive breastfeeding Poor hygiene and frequent handlingUnneeded newborn interventions such as routine suctioning of newborn

Appropriately manage maternal infections and use antibiotic prophylaxis wherever needed

Do not do un-necessary PV examinations during labour

Maintain “Six Cleans” during deliveryPerform hand hygiene every time before handling the babyEnsure early initiation of breast feeding and exclusive breast feeding, avoid pre-lacteal feedsEnsure dry cord careAvoid unnecessary interventions for the baby such as routine suctioning of newborns after birthPreventing Infection in Newborns5

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Principles for Antibiotics

Use in NewbornsWhen to use antibiotics: Clinical signs of neonatal sepsisMother had uterine infection during intrapartum period and upto 3 days (in these cases sepsis can develop)Way to use: Therapeutic: Newborn with symptoms of infectionProphylactic: Asymptomatic newborns whose mother had infectionNeonatal sepsis can be:Early onset– within 72 hours (source of infection genital tract or delivery area)Late onset– after 72 hours (source of infection hospital or community)For the purposes of this presentation, we will focus only on early onset neonatal sepsis

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If following conditions were present at the time of delivery:

Mother had foul smelling discharge Mother had fever (temp 380C)Baby born <35 weeks of gestation with ROM >18 hours before birthFBNC available? YesNoShift to FBNC for antibiotics and further managementBlood culture possible ?NoYesDraw blood for culture, start antibiotics and refer to FBNCstart antibiotics and refer to FBNCAsymptomatic Newborns with Maternal Conditions

Newborns

with Symptoms of InfectionBaby has very fast breathing (>60 per minute) or very slow breathing of newborn (<30 per minute) chest in drawing, gruntingConvulsionsSick looking babyBaby has stopped breastfeedingExcessive crying or lethargic babyFever (Temperature above 38°C)Hypothermic baby, not responding to warmth (Temperature below 36°C)Umbilical redness extending to skin or draining pus8YesNoShift to FBNC for antibiotics and further managementBlood culture possible ?NoYesDraw blood for culture, start antibiotics and refer to FBNCstart antibiotics and refer to FBNCFBNC available?

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Weight

Dose of Inj GentamicinDose of AmoxicillinLess than 1.5 kgTo be referred to higher facilityAbove 1.5 kg – upto 2.0 kg0.2 ml2 mlAbove 2.0 kg – upto 3.0 kg0.3 ml2.5 mlAbove 3.0 kg – upto 4.0 kg0.4 ml3 mlRoute of administrationIntramuscularOralDosage5 mg/kg/doseOnce a day25mg/kg/doseTwice a dayDose and Type of Antibiotic Before Referral if FBNC is Not Available

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Full Dose of Antibiotics to

Newborn (FBNC) AntibioticEach doseFrequencyRouteDuration<7 days age>7 days ageInj. Ampicillin or50 mg/kg/dose12 hourly8 hourlyIV, IM7-10 daysInj. Cloxacillin50 mg/kg/dose12 hourly8 hourlyIV7-10 daysAND Inj. Gentamicin or2.5 mg/kg/dose12 hourly8 hourlyIV, IM7-10 daysInj. Amikacin7.5 mg/kg/dose12 hourly8 hourlyIV, IM7-10 days

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Provide warmth

, ensure consistently normal temperatureStart intravenous lineInject Vitamin K (according to the weight) intramuscularly if not given immediately after birthProvide bag and mask ventilation with oxygen if breathing is inadequateProvide gentle physical stimulation, if apnoeicAvoid enteral feed if hemodynamically compromisedSupportive Care for Newborn with Signs of Infection

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All the babies born to HIV

positive mothers should receive 6 weeks of once daily* Nevirapine syrupSuch newborns should be referred to ART centers after delivery after appropriate careAnti Retroviral Prophylaxis for NewbornBirth Weight of infantDose (mg )Dose (in ml )DurationBirth weight >2.5 Kg 15 mg once daily1.5 ml once a dayUpto 6 weeksirrespective ofexclusivelybreast fed or exclusiveReplacement fedBirth weight >2Kg to <2.5 Kg10 mg once daily1 ml once a dayInfants with birth weight <2 Kg 2 mg/kg once daily0.2 ml/kg once daily

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eonatal sepsis is the leading cause of neonatal deaths which can be reduced by simple evidence based practicesRisk factors for newborn infections may be related to mother and delivery or to newborn and his/her careAll the babies born to HIV infected mothers must be given Nevirapine syrup daily upto 6 weeks.Key Messages