SERIOUS BACTERIAL INFECTIONS
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Localizing signs of infection are:
- Signs of pneumonia
- Many or severe skin pustules
- Umbilical redness extending to the peri-umbilical skin
- Umbilicus draining pus
- Bulging fontanelle
- Painful joints, joint swelling, reduced movement and irritability if these parts are handled
Risk factors for developing serious infections are:
- Convulsions
- Apnoea
- Inability to suck
- Poor motor tone: floppy or with limb stiffening (spasticity)
Non-pharmacological and pharmacological treatment
Antibiotic therapy
- Empirical antibiotics should be given to children with suspected neonatal sepsis.
- Admit to hospital.
- When possible, do a lumbar puncture and obtain blood cultures before starting antibiotics.
New-borns with signs of serious bacterial infection or sepsis administer for 7-10 days:
Ampicillin IM or IV
|
Age |
Dose |
Frequency of administration |
|
First week of life |
50mg/kg |
Every 12 hours |
|
Weeks 2-4 of life |
50mg/kg |
Every 8 hours |
OR
Procaine benzylpenicillin IM
50,000U/kg once a day
OR
Benzathine benzylpenicillin IM
50,000U/kg once a day
PLUS
Gentamicin
|
Birthweight |
Age |
Dose |
Frequency of administration |
|
Low birthweight |
First week of life |
3mg/kg |
Once a day |
|
Normal birthweight |
First week of life |
5mg/kg |
Once a day |
|
|
Weeks 2-4 of life |
7.5mg/kg |
Once a day |
If the new-born is at a greater risk of staphylococcus infection (extensive skin pustules, abscess or omphalitis in addition to signs of sepsis), give
Cloxacillin IV
|
Age |
Dose |
Frequency of administration |
|
First week of life |
25-50mg/kg |
Every 12 hours |
|
Weeks 2-4 of life |
25-50mg/kg |
Every 8 hours |
PLUS
Gentamicin IM/IV
|
Birthweight |
Age |
Dose |
Frequency of administration |
|
Low birthweight |
First week of life |
3mg/kg |
Once a day |
|
Normal birthweight |
The first week of life |
5mg/kg |
Once a day |
|
|
Weeks 2-4 of life |
7.5mg/kg |
Once a day |
NoteIf an infant is not improving within 2–3 days, change the antibiotic treatment or refer the infant for further management.
Other treatments
- If the infant is drowsy or unconscious, ensure that hypoglycaemia is not present. If infant is hypoglycaemic, give IV Glucose 2 ml/kg of 10% glucose
- Treat convulsions with phenobarbital (see section on convulsion)
- Treat conjunctivitis if present (see section on conjunctivitis)
- Take a blood film to check for malaria. Neonatal malaria is very rare. If confirmed, treat with artesunate or quinine (see section on malaria)