Introduction
The term newborn (neonate) refers to a baby in the first month of life.
At birth all healthy newborns are active with a strong cry.
Any baby born ill will show signs of poor activity or may be described as “being flat” or floppy in severe cases.
The newborn with one or more abnormal vital signs is unwell.
These include colour, activity, temperature, respiration, heart rate, blood sugar, urine output, nature of bowel movements, signs of distress (pain).
Causes of sickness is a newborn baby
The causes of sickness in newborn babies include the following
- Birth asphyxia
- Prematurity
- Neonatal infections
- Congenital malformations e.g. heart, central nervous system, bowel etc
- Birth injury
- Maternal sedation or analgesia during labour
- Metabolic e.g. hypoglycaemia, hypocalcaemia
Symptoms of a sick newborn baby
The following are the symptoms of q sick newborn baby:
- Weak cry or inability to cry
- Difficulty in breathing or recurrent cessation of breathing (apnoea)
- Reduced spontaneous movements or being very floppy
- Refusal of feeds
- Vomiting
- Abdominal distension
- Convulsions
- Blood in stools
- Reduced urine output
Signs of a sick newborn baby
The signs of a sick newborn baby include the following:
- Raised body temperature (> 37.5 °C axillary)
- Low body temperature (< 36.5 °C axillary)
- Pallor
- Cyanosis
- Jaundice
- Bradycardia (<100 beats/minute)
- Tachycardia (> 160 beats/minute)
- Heart murmurs
- Respiratory distress (>60 breaths per minute, chest indrawing)
- Respiratory rate < 20 breaths per minute
- Apnoea
- Abdominal distension
- Drowsiness or unconsciousness
- Seizures
- Tenderness of any part of the body.
Investigations
- FBC
- Random blood glucose
- Blood urea and electrolytes
- Blood cultures
- Urine culture
- Swab of any lesions for culture and sensitivity
- Chest X-ray
- Plain abdominal X-ray, erect and supine if indicated
- Cerebrospinal fluid biochemistry and culture and sensitivity
Treatment for a sick newborn baby
Objectives
- To diagnose and treat underlying cause appropriately
- To identify and urgently correct hypoglycaemia
- To prevent permanent organ damage
Non-pharmacological treatment
- Establish airway, ensure breathing and adequate circulation (ABC)
- Keep baby warm either wrapped up in dry clothes or an incubator
Pharmacological treatment
Evidence Rating: [A]
A. Oxygen Therapy
Oxygen by face mask or nasal prongs, 1-2 L/minute if available, (monitor and maintain oxygen saturation between 92-95%)
B. Maintenance Fluid
Dextrose 10%, IV, on day of delivery, 2 drops/minute/kg (60 ml/kg/ day).
Normal Saline 0.18% with Dextrose 10% (60-150 ml/kg/day after day 1)
C. Correction of Hypoglycemia
If hypoglycaemic, correct (See ‘Neonatal Hypoglycaemia’)
D. For neonates having seizures (convulsions)
Phenobarbitone, IV/IM, 10 mg/kg stat. then 5 mg/kg hourly
E. To treat sepsis (other than cord sepsis)
Ampicillin, IM/IV,
Neonates
- > 7 days of age; 50 mg/kg 8 hourly for 5-7 days
- < 7 days of age; 50 mg/kg 12 hourly for 5-7 days
And
Gentamicin, IM/IV,
- 4 mg/kg daily for 7 days (irrespective of age after birth)
Or
Ampicillin, IM/IV,
Neonates
- > 7 days of age; 50 mg/kg 8 hourly for 5-7 days
- < 7 days of age; 50 mg/kg 12 hourly for 5-7 days
And
Cefotaxime, IV,
- 25-50 mg/kg 8 hourly for 7 days (irrespective of age after birth)
F. For cord sepsis
Cloxacillin, IM/IV,
Neonates
- > 7 days of age; 25-50 mg/kg 8 hourly
- < 7 days of age; 25-50 mg/kg 12 hourly
And
Gentamicin, IM/IV,
- 4 mg/kg 24 hourly for 7 days (irrespective of age after birth)
G. For bowel related sepsis
Ampicillin, IM/IV,
Neonates
- > 7 days of age; 50 mg/kg 8 hourly for 5-7 days
- < 7 days of age; 50 mg/kg 12 hourly for 5-7 days
And
Gentamicin, IM/IV,
4 mg/kg daily for 7 days (irrespective of age after birth)
And
Metronidazole, IV (over 20-30 minutes)
Neonate
- > 34 weeks corrected gestational age; 15 mg/kg as a single loading dose followed after 8 hours by 7.5 mg/kg every 8 hours
- 26-34 weeks corrected gestational age; 15 mg/kg as a single loading dose followed after 12 hours by 7.5 mg/kg every 12 hours
- < 26 weeks corrected gestational age; 15 mg/kg as a single loading dose followed after 24 hours by 7.5 mg/kg daily
Referral Criteria
Refer the patient urgently to a specialist for further investigations and treatment if no improvement after 48 hours.