Neobook — clinical reference

Ask

Has the infant had convulsions?
Has the infant had any attacks where he stops breathing, or becomes stiff or blue (apnoea)?

Look, Listen, Feel

Is the infant convulsing now?
Count the breaths in one minute
Repeat the count if elevated
Look for severe chest indrawing (Young infant must be calm)
Look for nasal flaring (Young infant must be calm)
Listen for grunting (Young infant must be calm)
Look and feel for bulging fontanelle
Measure temperature (or feel for fever or low body temperature)
Look at the young infant’s movements. Does he/ she only move when stimulated?
Look for discharge from the eyes. Is there a purulent or sticky discharge? Is there abundant pus? Are the eyelids swollen?
Look at the umbilicus. Is it red or draining pus? Does the redness extend to the skin?
Look for skin pustules. Are there many or severe pustules?
Look for jaundice (yellow eyes or skin)
Look at the young infant’s palms and soles. Are they yellow?

For Possible Bacterial Infection

Possible Serious Bacterial Infection
Any of these Convulsions with this illness Apnoea or breathing < 30 per minute Fast breathing (> 60 per minute), severe chest indrawing, nasal flaring or grunting Bulging fontanelle Fever (37.5°C or above or feels hot) or low body temperature (less than 35.5°C or feels cold) Only moves when stimulated Abundant pus/purulent discharge from eyes, or swollen eyelids Umbilical redness extending to the skin and/or draining pus Many or severe skin pustules.	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
Local Bacterial Infection
Any of these Purulent (small amount) or sticky discharge of eyes OR Red umbilicus OR Skin pustules	Treat skin pustules and a red umbilicus with cephalexin or flucloxacillin Give chloramphenicol eye ointment if sticky or purulent discharge of eyes is present If the discharge is purulent, give one dose of Ceftriaxone Follow-up after one day Teach the caregiver to treat local infections at home and counsel on home care for the young infant Follow-up in 2 days
No Bacterial Infection
Any of these None of the above signs	Counsel the caregiver on home care for the young infant

For Possible Jaundice

Severe Jaundice
Any of these Any jaundice if age less than 24 hours OR Yellow palms and soles	Test for low blood sugar, and treat or prevent Keep the infant warm Refer URGENTLY
Jaundice
Any of these Jaundice appearing after 24 hours of age AND Palms and soles not yellow	Advise the caregiver to return immediately if palms and soles appear yellow Follow-up in 1 day If the young infant is older than 14 days, refer for assessment
No Jaundice
Any of these No jaundice	Counsel the caregiver on home care for the young infant

Integrated Management of Childhood Illness 2022; Young Infant (Birth up to 2 months); Assess, Classify and Identify Treatment: Possible Bacterial Infection, Jaundice

Last checked for updates: June 2023

Possible Bacterial Infection & Jaundice (Birth up to 2 months)

Ask

Look, Listen, Feel

For Possible Bacterial Infection

For Possible Jaundice

Drugs mentioned