Sick newborn

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The term newborn (neonate) refers to a baby in the first month of life. At birth all healthy newborns are active with a strong cry. Any baby born ill will show signs of poor activity or may be described as “being flat” or floppy in severe cases. The newborn with one or more abnormal vital signs is unwell. These include colour, activity, temperature, respiration, heart rate, blood sugar, urine output, nature of bowel movements, signs of distress (pain).

Investigations

  • FBC
  • Random blood glucose
  • Blood urea and electrolytes
  • Blood cultures
  • Urine culture
  • Swab of any lesions for culture and sensitivity
  • Chest X-ray
  • Plain abdominal X-ray, erect and supine if indicated
  • Cerebrospinal fluid biochemistry and culture and sensitivity

Pharmacological treatment of infections

To treat sepsis (other than cord sepsis)

  • Ampicillin, IM/IV,

Neonates

> 7 days of age; 50 mg/kg 8 hourly for 5-7 days

< 7 days of age; 50 mg/kg 12 hourly for 5-7 day

And

  • Gentamicin, IM/IV, 4 mg/kg daily for 7 days (irrespective of age after birth)

Or

  • Ampicillin, IM/IV,

Neonates

> 7 days of age; 50 mg/kg 8 hourly for 5-7 days

< 7 days of age; 50 mg/kg 12 hourly for 5-7 days

And

  • Cefotaxime, IV, 25-50 mg/kg 8 hourly for 7 days  (irrespective of age after birth)

For cord sepsis

  • Cloxacillin, IM/IV,

Neonates

> 7 days of age; 25-50 mg/kg 8 hourly

< 7 days of age; 25-50 mg/kg 12 hourly 

And

  • Gentamicin, IM/IV, 4 mg/kg 24 hourly for 7 days (irrespective of age after birth)

For bowel related sepsis

  • Ampicillin, IM/IV,

Neonates

> 7 days of age; 50 mg/kg 8 hourly for 5-7 days

< 7 days of age; 50 mg/kg 12 hourly for 5-7 days

And

  • Gentamicin, IM/IV, 4 mg/kg daily for 7 days (irrespective of age after birth)

And

  • Metronidazole, IV (over 20–30 minutes)

Neonate 

> 34 weeks corrected gestational age; 15 mg/kg as a single loading dose followed after 8 hours by 7.5 mg/kg every 8 hours

26-34 weeks corrected gestational age; 15 mg/kg as a single loading dose followed after 12 hours by 7.5 mg/kg every 12 hours

< 26 weeks corrected gestational age; 15 mg/kg as a single loading dose followed after 24 hours by 7.5 mg/kg daily 

Referral Criteria

  • Refer the patient urgently to a specialist for further investigations and treatment if no improvement after 48 hours.