Neonatal Infections

Indications for doing a blood culture and starting antibiotics in first 48 hours

Any Major Criteria or two or more minor criteria do a blood culture and start antibiotics.
Suspected sepsis - give antibiotics as soon as possible, within 1hr
One minor criterion present - observe the baby on postnatal wards for 12h. Start antibiotics if the baby not feeding well, has respiratory distress or appears lethargic or sick in any other way.

Major Criteria (Start antibiotics if any of these present)	Minor Criteria (Start antibiotics if any two available)
Confirmed sepsis or chorioamnionitis in mother	Antenatal: ROM >18h Spontaneous Preterm Birth
Confirmed or suspected sepsis in twin	GBS Sepsis in previous baby or documents GBS carriage in this pregnancy (urine or vaginal swab)
Seizures
Severe Respiratory Distress in a term infant	Natal Born Before Arrival Meconium Stained Liquor
Respiratory distress starting more than 4h after birth	Postnatal Respiratory distress that is not obviously related to: environmental hypothermia "delayed transition to extra uterine life" i.e. mild to moderate respiratory distress apparent soon after birth that is improving with lime. Hypoxia Apnoea Hypoglycaemia/Hyperglycaemia not otherwise explained Temperature instability not explained by environmental factors Acidosis not obviously related to HIE Unexplained bleeding or thrombocytopenia Mild encephalopathy/Altered responsiveness Altered tone not otherwise explained Feed intolerance/feeding difficulty Abnormal heart rate (<90 or >160) Jaundice in first 24h

There are usually few localising signs in infants, and accurate diagnosis may not be possible. The following regimens are recommended for suspected sepsis.

Suspected sepsis in first 48hrs:

	Medicine	Paed Dose	Frequency	Duration
	benzylpenicillin im/iv	0.1MU/kg	As per ‘Frequency of Medicines for Infants Under 1 Month’	10 days
and	gentamicin im/iv	2.5mg/kg	As per ‘Frequency of Medicines for Infants Under 1 Month’	10 days

Suspected sepsis after 48hrs:

	Medicine	Paed Dose	Frequency	Duration
	cloxacillin im/iv	30mg/kg	As per ‘Frequency of Medicines for Infants Under 1 Month’	10 days
and	gentamicin im/iv	2.5mg/kg	As per ‘Frequency of Medicines for Infants Under 1 Month’	10 days

Kanamycin 7.5mg/kg/dose BD can be used if gentamicin unavailable

Meningitis:

	Medicine	Paed Dose	Frequency	Duration
	benzylpenicillin im/iv	0.1MU/kg	As per ‘Frequency of Medicines for Infants Under 1 Month’	14-21 days
and	gentamicin im/iv	2.5mg/kg
and	chloramphenicol iv	12.5mg/kg

Ampicillin can be used if benzyl penicillin is not available: dose= 50mg/kg

For meningitis ceftriaxone can be used as an alternative: dose = 50mg/kg/dose

Necrotising Enterocolitis

Give nothing by mouth.

Supportive care is vital: oxygen, intravenous fluids, warmth, and nasogastric continuous drainage. Anticipate complications such as bleeding, vomiting, perforation, seizures.

Refer for specialist diagnosis and care.

	Medicine	Paed Dose	Frequency	Duration
	benzylpenicillin im/iv	0.1MU/kg	As per ‘Frequency of Medicines for Infants Under 1 Month’	10 days
and	gentamicin im/iv	2.5mg/kg
and	metronidazole iv	7.5mg/kg

Neonatal tetanus

The important principle in treating these babies is minimal handling.

Give:

	Medicine	Paed dose	Freq.	Duration
	benzylpenicillin im/iv	0.05MU per kg	12hrly	5-7days
or	procaine penicillin im	50mg/kg	once a day	5-7 days
and	anti-tetanus immunoglobulin im	500-1000 units	once only	single dose

Control of muscle spasms:

	Medicine	Paed Dose	Frequency	Duration
	diazepam iv	0.25-1mg/kg [to a max total dose of 10mg]	4-8 hourly (titrated according to response)
or	chlorpromazine iv/im/nasogastric	2mg/kg/24hrs	in 4-6 divided doses
and	phenobarbitone iv/im/nasogastric	2.5-5mg/kg	12 hourly for as long as necessary

Congenital syphilis

Also see section on Sexually Transmitted Infections

Medicine	Paed Dose	Frequency	Duration
procaine penicillin im	50mg/kg	once a day	10 days