Malaria

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Malaria in the newborn period masquerades as sepsis in most instances as the clinical features are very similar.

Investigations

• Rapid Diagnostic Tests for rapid detection of Plasmodium falciparum in situations of poor laboratory services
• Peripheral blood film microscopy with Giemsa staining which most frequently reveals Plasmodium falciparum.
• Full blood count: anaemia and leucocytosis.
• Blood culture is expected to be negative.

Treatment

• Every symptomatic infant and asymptomatic infants in whom parasitaemia persists beyond 72 hours of life should be treated.
• Due to the extreme similarities in the clinical manifestations of malaria and sepsis in the newborn, it may be safer to start acutely ill babies with probable malaria on anti-malarial drugs as well as antibiotics until sepsis could be confidently excluded.
  • Oral quinine 20mg/kg stat, followed with 10mg/kg 8 hourly for 5 to 7 days is recommended.
  • Oral amodiaquine as 25mg/kg total dose administered as 10mg/kg/day on the first two days and 5mg/kg on the third day may be used when quinine is contraindicated.

In areas of high resistance to the 4-aminoquinolines, amodiaquine may not be useful.

Treat infants weighing <5 kg with uncomplicated P. falciparum malaria with ACT at the same mg/kg bw target dose as for children weighing 5kg  with close monitoring of response

See also full malaria guidelines