1. 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

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

4. 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’

5. 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

6. 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

7. 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

8. 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

9. 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

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

14. 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.

16. 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

17. 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.

18. 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.