Prevention, Identification and Management of Infection in Newborn

1. Prevention, Identification and Management of Infection in Newborn

2. Learning Objectives Bytheendof thissession,learnerswill beable to: • Discussvarious riskfactorsfor newborninfection • Explain the identification and management of neonatal infection with or without symptoms • Describe infection prevention practices and giving antibiotics to reduce deaths of newbornsdue tosepsis • DescribethedosesofantibioticswhenFBNC isavailableornot • Describeantiretroviral prophylaxis for newbornsborntoHIV+ve mother

3. Infection in Neonatal Period is a Leading Cause of Deaths in Newborn Deaths from neonatal sepsis can be reduced by • Strict hand-washing practices while handling the baby • Reducing un-necessary PV examinations • Maintaining hygiene during delivery • Early initiation of exclusive breast feeding • Timely and judicious use of antibiotics Small babies (Pre term and SGA) are at a higher risk of acquiring infection and may require higher focus

4. Risk Factors for Newborn Infection Related to mother and delivery • Failure to follow Infection prevention practices • Poor monitoring of mother’s temperature during 1st and 2nd stages of labor • Frequent vaginal examinations • PROM >18 hrs • Prolonged labour>24 hrs/obstructed labour • Pre-existing STIs/RTIs Related to Newborn care • Very low birth weight, prematurity • Lack of exclusive breastfeeding • Poor hygiene and frequent handling • Unneeded newborn interventions such as routine suctioning of newborn

5. Preventing Infection in Newborns • Appropriately manage maternal infections and use antibiotic prophylaxis wherever needed • Do not do un-necessary PV examinations during labour • Maintain “Six Cleans” during delivery • Perform hand hygiene every time before handling the baby • Ensure early initiation of breast feeding and exclusive breast feeding, avoid pre-lacteal feeds • Ensure dry cord care • Avoid unnecessary interventions for the baby such as routine suctioning of newborns after birth

6. Principles for Antibiotics Use in Newborns When to use antibiotics: • Clinical signs of neonatal sepsis • Mother had uterine infection during intrapartum period and upto 3 days (in these cases sepsis can develop) Way to use: • Therapeutic: Newborn with symptoms of infection • Prophylactic: Asymptomatic newborns whose mother had infection • Neonatal sepsis can be: • Early onset– within 72 hours (source of infection genital tract or delivery area) • Late onset– after 72 hours (source of infection hospital or community) • For the purposes of this presentation, we will focus only on early onset neonatal sepsis

7. Asymptomatic Newborns with Maternal Conditions • If following conditions were present at the time of delivery: • Mother had foul smelling discharge • Mother had fever (temp 380C) • Baby born <35 weeks of gestation with ROM >18 hours before birth FBNC available? Yes No Blood culture possible ? Shift to FBNC for antibiotics and further management Yes No Draw blood for culture, start antibiotics and refer to FBNC start antibiotics and refer to FBNC

8. Newborns with Symptoms of Infection FBNC available? Yes No Blood culture possible ? Shift to FBNC for antibiotics and further management Yes No Draw blood for culture, start antibiotics and refer to FBNC start antibiotics and refer to FBNC

9. Dose and Type of Antibiotic Before Referral if FBNC is Not Available

10. Full Dose of Antibiotics to Newborn(FBNC)

11. Supportive Care for Newborn with Signs of Infection • Provide warmth, ensure consistently normal temperature • Start intravenous line • Inject Vitamin K (according to the weight) intramuscularly if not given immediately after birth • Provide bag and mask ventilation with oxygen if breathing is inadequate • Provide gentle physical stimulation, if apnoeic • Avoid enteral feed if hemodynamically compromised

12. Anti Retroviral Prophylaxis for Newborn • All the babies born to HIV positive mothers should receive 6 weeks of once daily* Nevirapine syrup • Such newborns should be referred to ART centers after delivery after appropriate care

13. Key Messages • Neonatal sepsisis theleadingcauseofneonatal deathswhichcanbe reducedbysimple evidencebasedpractices • Riskfactorsfornewborninfectionsmayberelatedtomotheranddeliveryortonewborn andhis/her care • AllthebabiesborntoHIVinfectedmothersmustbegivenNevirapinesyrupdailyupto6 weeks.