Special care of preterm babies Queen Dube Consultant Paediatrician Queen Elizabeth Hospital Blantyre Doug Simkiss Associate Professor of Child Health Warwick Medical School University of Warwick

Special care of preterm babies Care of babies with signs of infection Care of babies with jaundice Babies with respiratory distress syndrome

Neonatal infections ‘rapid reductions in mortality are possible’ ‘prevention of infection is mainly dependent on maternal health packages and programs such as antenatal care, hygienic care during childbirth and the postnatal period and early and exclusive breast feeding’

Prevention of neonatal infections Many early neonatal infections can be prevented by: Good basic hygiene and cleanliness during delivery of the baby Special attention to cord care Eye care

Prevention of neonatal infections Many late neonatal infections are acquired from the health care facility. These can be prevented by: Exclusive breast feeding Strict procedures for hand washing for all staff and for families before and after handling babies Strict sterility for all procedures

Prevention of neonatal infections Avoiding incubators (using Kangaroo mother care instead) or not using water for humidification in incubators (Pseudomonas often colonises in these devices) Clean injection procedures Removing intravenous drips when no longer needed Avoiding unnecessary blood transfusions

Serious bacterial infections Risk factors are: Maternal fever (temperature >37.9°C before delivery or during labour) Membranes ruptured more than 24 hours before delivery Foul smelling amniotic fluid

Danger signs in newborns Neonates and young infants often present with non-specific symptoms and signs which can indicate serious bacterial infection. Signs include: Unable to breast feed Convulsions Drowsy or unconscious Respiratory rate < 20/minute

Danger signs in newborns Bleeding Central cyanosis (blueness) Hypothermia Hyperthermia Hypoglycaemia Dehydration

Neonatal jaundice Premature babies are an increased risk of jaundice as well as infection. Severe jaundice peaks at around day 3 and babies may be home by then. Implementing a systematic pre-discharge check of mothers and babies is an opportunity to prevent complications or increase careseeking.

Supportive care for the sick infant Oxygen therapy Give oxygen to infants with any of Central cyanosis Grunting with every breath Difficulty in feeding due to respiratory distress Severe lower chest wall indrawing Head nodding - indicates severe respiratory distress

Supportive care for the sick infant Pulse oximetry, use if available and give oxygen if saturation < 90%. Aim for 92-95% saturation levels. Stop oxygen if baby can maintain oxygen saturations above 90% in air . Nasal prongs is preferred method for oxygen delivery. Use flow of 0.5 litre / minute. Use suction to remove thick secretions from nose and throat if baby is too weak to clear them.

Supportive care for the sick infant In Malawi, a CPAP device is being trialed in babies with respiratory distress who are over 1000g. Early results are encouraging and an important outcome will be to assess the nursing time required and costs.