Division of Reproductive Health

Neonatal Sepsis

DRH/MOH

Division of Reproductive Health

 Learning Objectives
• Describe ways of preventing neonatal infections.

• Identify Risk factors for neonatal infections.

• Identify signs of neonatal infections.

• Describe management of neonatal infections.

• Describe the management of congenitally

transmitted specific infections.

Division of Reproductive Health

Risk factors for neonatal infections
Maternal factors Newborn Factors
• High fever (temperature • Prematurity and low birth
>37.9 C before delivery weight
or during labour).
• Ruptured membranes • Asphyxia
more than 18 hours
before delivery. • Hypothermia
• Foul smelling amniotic
fluid.
• Failure to observe
universal infection
prevention procedures
Division of Reproductive Health
 Signs of severe infection in a newborn
• Unable to breastfeed.
• Convulsions.
• Drowsy or unconscious.
• Respiratory rate less than
20/min or apnea (cessation
of breathing for >15 secs).
• Respiratory rate greater
than 60/min.
• High pitched cry.
• Fever > 37.50C.
• Grunting
• Severe chest in-drawing
• Central cyanosis
• Generalized body stiffness
• Severe skin pustules
• Others
 Deep jaundice
 Severe abdominal
distension
 Bulging anterior fontanel

• Low temperature <35.50C.

Division of Reproductive Health

 Signs of Localized Infections
• Less than 10 skin pustules

• Redness extending to the peri-umbilical area

• Umbilicus draining pus

• Oral thrush

• Painful/warm swollen joints

• Eye discharge

Division of Reproductive Health

 Prevention of neonatal infections

• Observe universal precaution for prevention

• Routine care of the newborn

• Early diagnosis and management

Division of Reproductive Health

 Management
• Admit/Refer to hospital if any of the danger signs are
present.
• Provide antibiotics therapy- Refer to basic paediatric
protocol.
• Treatment for local infections- Refer to basic
paediatric protocol.
• Treatment for eye infections- Refer to basic
paediatric protocol.
• Provide supportive care including vital signs and
feeding.
Division of Reproductive Health
 Other Treatments
• Vitamin K: must be given to all sick infants
• If weight below 1.5kg’s give 0.5 mg
• If above 1.5kg’s give 1 mg of vitamin K (IM).

• Convulsions treat with IM phenobarbital:

• Loading dose of 20 mg/kg).
• If needed, continue with oral phenobarbital 5 mg/kg once
daily.

Division of Reproductive Health

 Feeding
• Encourage the mother to • Increase the amount of fluid
breastfeed frequently to given over the first 3–7 days
prevent hypoglycemia. (total amount, oral or IV).
• If unable to feed orally, give
expressed breast milk by DAY MLS/KG/DAY
nasogastric tube. 1 60
• Withhold oral feeding and give 2 80
IV fluids in the following acute 3 100
phase in babies:
1 60
• Those having frequent
convulsions
• Those with severe • Then slowly increase to 150
abdominal distension ml/kg/day.

Division of Reproductive Health

 Insertion of a Nasogastric Tube - I
• Hold tip of tube against child’s nose.
• Measure distance from nose to ear lobe, then to epigastrium.
Mark tube at this point.
• Hold child firmly.
• Lubricate tip with water. Pass it directly into one nostril,
pushing slowly.
• It should pass easily down into stomach without resistance.
• When measured distance is reached, fix tube with tape at
nose.

Division of Reproductive Health

 Insertion of a Nasogastric Tube - 2
• Aspirate small amount of stomach contents with syringe
to confirm tube is in place (check that it turns blue litmus
paper pink).
• If no aspirate is obtained, inject air down the tube and
listen over the abdomen with a stethoscope.
• If in doubt about location of tube, withdraw and start
again.
• When tube is in place, fix 20-ml syringe (without the
plunger) to end of tube.
• Pour food or fluid into syringe, allowing it to flow by
gravity.
Division of Reproductive Health
 Oxygen Therapy

Oxygen is needed in young infants with any of the

following signs:
• Central cyanosis
• Respiratory distress

Division of Reproductive Health

Methods of Oxygen Administration

Division of Reproductive Health

SPECIAL TREATMENT NEEDS FOR
BABIES AT RISK - HIV/ TB/ SYPHILIS.

Division of Reproductive Health

 Learning Objectives

By the end of this session, the participant should be

able to:
• Identify babies at risk of congenitally transmitted
HIV, TB and Syphilis.
• Describe the management of these babies.

Division of Reproductive Health

 Risk Identification

Ask, check, record if RISK

mother:

Tested VDRL Positive. CONGENITAL SYPHILIS

Tested HIV Positive. HIV TRANSMISSION

Receiving TB treatment TUBERCULOSIS

which began <2 months ago

Division of Reproductive Health

 Management

Division of Reproductive Health

 Summary
• Use universal precautions to prevent newborn
infections.
• Risk factors of neonatal sepsis are maternal
infection, prolonged rupture of membranes, Small-
for-age, asphyxia, hypothermia.
• Important to know the danger signs!!
• Must discriminate between localized and generalized
infection and treat appropriately.
• Important to identify babies at risk for congenitally
transmitted infections.

Division of Reproductive Health

Division of Reproductive Health