POCKET BOOK UPDATE 2012
New Recommendations
Newborn conditions
| # | Strength of the recommendation | Quality of the evidence | |
| Vitamin K prophylaxis in newborns | |||
| a) All newborns should be given 1 mg of vitamin K intramuscularly (IM) after birth (i.e. after the first hour by which the infant should be in skin-to-skin contact with the mother and breastfeeding should be initiated). | Strong | Moderate | |
| b) Neonates requiring surgical procedures, those with birth trauma, preterm newborns, and those exposed in utero to maternal medication known to interfere with vitamin K are at especially high risk of bleeding and must be given vitamin K (1 mg IM). | Strong | Moderate | |
| Prophylactic antibiotics in newborns with risk factors for infection | |||
| A neonate with risk factors for infection (i.e. membranes ruptured > 18 hours before delivery, mother had fever > 38 C before delivery or during labour, or amniotic fluid was foul smelling or purulent) should be treated with the prophylactic antibiotics ampicillin (IM or intravenously, IV) and gentamicin for at least 2 days. After 2 days, the neonate should be reassessed and treatment continued only if there are signs of sepsis (or a positive blood culture). | Weak | Very low | |
| Skin-to-skin contact in the first hour of life | |||
| Newborns without complications should be kept in skin-to-skin contact with their mothers during the first hour after birth to prevent hypothermia and promote breastfeeding. | Strong | Low | |
| Management of neonatal jaundice | |||
| a) Term and preterm newbors with hyperbilirubinaemia should be treated with phototherapy or exchange transfusion guided by the following cut-off levels of serum hyperbilirubinaemia: SEE ANNEX 1 | Weak | Very Low | |
| b) Clinicians should ensure that all newborns are routinely monitored for the development of jaundice and that serum bilirubin should be measured in those at risk: in all babies if jaundice appears on day 1 in preterm babies (<35 weeks) if jaundice appears on day 2 in all babies if palms and soles are yellow at any age | Strong | Very low | |
| c) Phototherapy should be stopped once serum bilirubin is 50 mmol/l (3 mg/dl) or below the phototherapy threshold. | Weak | expert opinion | |
| Empirical antibiotics for suspected neonatal sepsis | |||
| a) Neonates with signs of sepsis should be treated with ampicillin (or penicillin) and gentamicin as the first line antibiotic treatment for at least 10 days. | Strong | Low | |
| b) If a neonate with sepsis is at greater risk of staphylococcus infection (e.g. extensive skin pustules, abscess, or omphalitis in addition to signs of sepsis), they should be given cloxacillin and gentamicin instead of penicillin and gentamicin. | Strong | expert opinion | |
| c) Where possible, blood cultures should be obtained before starting antibiotics. If an infant does not improve in 23 days, antibiotic treatment should be changed, or the infant should be referred for further management. | Strong | expert opinion | |
| Head or whole body cooling in management of hypoxic ischaemic encephalopathy | |||
| Head or whole body cooling should not be done outside well-resourced, tertiary neonatal intensive care units, because there is potential for harm from this therapy in low-resource settings. | Strong | Moderate | |
| Antibiotics for treatment of necrotizing enterocolitis | |||
| Young neonates with suspected necrotizing enterocolitis (NEC) should be treated with IV or IM ampicillin (or penicillin) and gentamicin as first line antibiotic treatment for 10 days. | Strong | Low | |
| Kangaroo Mother Care | |||
| Low birth weight (LBW) neonates weighing < 2000 g who are clinically stable should be provided Kangaroo Mother Care (KMC) early in the first week of life. | Strong | Moderate | |
| Prevention of hypothermia immediately after birth in LBW infants | |||
| LBW neonates weighing >1200g who do not have complications and are clinically stable should be put in skin-to-skin contact with the mother soon after birth and after drying them thoroughly to prevent neonatal hypothermia. | Weak | Low |
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ANNEX 1 Management of neonatal jaundice
Cough and difficulty in breathing
| Treatment of non-severe pneumonia with wheeze | |||
| Antibiotics are not routinely recommended for children aged 259 months with non-severe pneumonia (i.e. fast breathing with no chest indrawing or danger sign) with a wheeze but no fever (< temperature 38 C), as the cause is most likely to be viral. | Strong | Low | |
| Antibiotic treatment for non-severe pneumonia with no wheeze | |||
| a) Children with non-severe pneumonia (i.e. fast breathing with no chest indrawing or danger sign) should be treated with oral amoxicillin. The exception is in patients with HIV: With low HIV prevalence, give amoxicillin at least 40mg/kg/dose twice daily for 3 days. With high HIV prevalance, give amoxicillin of at least 40mg/kg/dose twice daily for 5 days. | Weak | Moderate | |
| b) Children with non-severe pneumonia who fail on the first line treatment with amoxicillin should have the option of referral to a facility where there is appropriate second line treatment. | Weak | expert opinion | |
| Antibiotics treatment for severe pneumonia | |||
| a) Children aged 259 months with severe pneumonia (chest indrawing) should be treated with oral amoxicillin at least 40mg/kg/dose twice daily for 5 days. | Strong | Moderate | |
| b) In HIV/AIDS infected children, specific guidelines for treatment of severe pneumonia in the context of HIV should be followed. | Strong | Low | |
| Antibiotic treatment for very severe pneumonia | |||
| a) Children aged 259 months with very severe pneumonia should be treated with parenteral ampicillin (or penicillin) and gentamicin as a first line treatment. Ampicillin: 50 mg/kg, or Benzyl penicillin: 50,000 units per kg IM/IV every 6 hours for at least 5 days Gentamicin: 7.5 mg/kg IM/IV once a day for at least 5 days | Strong | Moderate | |
| b) Ceftriaxone should be used as a second line treatment in children with severe pneumonia with failure on the first line treatment. | Strong | expert opinion | |
| Inhaled salbutamol for treatment of acute wheeze/asthma and bronchoconstriction | |||
| a) Children with acute wheeze/asthma and bronchoconstriction should be treated with inhaled salbutamol using a metered dose inhaler (MDI) with spacer devices to relieve bronchoconstriction. | Strong | Low | |
| b) Oral salbutamol should not be used for treatment of acute or persistent wheeze except where inhaled salbutamol is not available. Oral salbutamol is not useful in testing response to bronchodilators. | Strong | Low |
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