Congenital Problems (Birth up to 2 months)

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Ask

• Ask the mother if she has any concerns
• Ask for any identified birth defects or other problems
• Was the mother’s RPR tested in pregnancy?
• If yes, was it positive or negative?
• If positive, did she receive treatment?
• If yes, how many doses?
• How long before delivery did she receive the last dose?

Look and Feel

• Measure head circumference,

Look for priority signs

• Cleft lip or palate
• Imperforate anus
• Nose not patent
• Macrocephaly (birth head circumference more than 39cm)
• Ambiguous Genitalia
• Abdominal distention
• Very low birth weight (≤ 2kg)

Look for Other Abnormal Signs

Head and neck

• Microcephaly (Birth head circumference less than 32 cm)
• Fontanelle or sutures abnormal
• Swelling of scalp, abnormal shape
• Neck swelling or webbing
• Face, eyes, mouth or nose abnormal
• Unusual appearance

Limbs and trunk

• Abnormal position of limbs
• Club foot
• Abnormal fingers and toes, palms
• Abnormal chest, back and abdomen
• Undescended testis or hernia

Signs of Congenital Syphilis

• Oedema
• Pallor or jaundice
• Reduced movements or irregular, jerky movements
• Full fontanelle
• Large lymph nodes
• Large liver and/ or spleen
• Respiratory distress
• Small red or purple spots in the skin (petechiae)
• Blisters on hands and feet

Classify the Congenital Problem

Major Abnormality or Serious Illness
Any one of the priority signs   Cleft palate or lip Imperforate anus Nose not patent Macrocephaly Ambiguous genitalia Abdominal distention Very low birth weight (≤ 2kg)	Give diazepam rectally if convulsing at present  Give oxygen if indicated  Give first dose of ceftriaxone IM  If fast breathing, chest indrawing or grunting, give cotrimoxazole 2.5 ml if older than 1 month  If there is abundant pus or purulent discharge or eyelids are swollen, irrigate with normal saline immediately. Repeat hourly until referral. Test for low blood sugar, and treat or prevent    Breastfeed if possible Keep the infant warm on the way Refer URGENTLY
Birth Abnormality
One or more abnormal signs	Keep warm, skin to skin  Assess breastfeeding  Address any feeding problems and support mother to breastfeed successfully Refer for assessment If not able to breastfeed, give EBM 3ml/kg per hour on the way
Possible Congenital Syphilis
Any one of the priority signs   Mother’s RPR positive and she is - Untreated - Partially treated (fewer than three doses) - Treatment completed less than 1 month before delivery OR  Mother’s RPR is not known, and it is not possible to get the result now	Check for signs of congenital syphilis and if present refer to hospital If no signs of congenital syphilis, give intramuscular penicillin Ask about the caregiver’s health, and treat as necessary Ensure that the mother receives full treatment for positive RPR.
No Birth Abnormalities
No risks nor abnormal signs	Counsel the caregiver on home care for the young infant

 

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Integrated Management of Childhood Illness 2022; Young Infant (Birth up to 2 months); Assess, Classify and Identify Treatment: Congenital Problems 

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Last checked for updates: June 2023