[ Pobierz całość w formacie PDF ]
cup.
" Is the infant well attached? Advise the mother how to feed and keep
" ow weight for age, or
the low weight infant warm at home
not well attached good attachment
If thrush, teach the mother to treat thrush
TO CHECK ATTACHMENT, LOOK FOR: " Thrush (ulcers or white
at home.
patches in mouth)
- More areola seen above infant s top lip than below
bottom lip
- Mo th wide open
Advise mother to give home care for the
- Lower lip t rned o twards
young infant.
- Chin to ching breast
Follow up any feeding problem or thrush
(All of these signs should be present if the attachment is good).
in 2 days.
Follow up low weight for age in 14 days.
" Is the infant suckling effectively (that is, slow deep sucks,
Advise mother to give home care for
" Not low weight for age
NO FEEDING
sometimes pausing)?
the young infant.
and no other signs of
PROBLEM
not s ckling effectively s ckling effectively
inadequate feeding.
Praise the mother for feeding the
Clear a blocked nose if it interferes with breastfeeding.
infant well.
27
THEN CHECK THE YOUNG INFANT S IMMUNIZATION AND VITAMIN A STATUS:
AGE
VACCINE VITAMIN A
Birth
IMMUNIZATION
BCG OPV 0 200 000 IU to the mother within 6 weeks of delivery
6 weeks
SCHEDULE:
DPT+HIB 1 OPV 1 Hepatitis B 1
10 weeks
DPT+HIB 2 OPV 2 Hepatitis B 2
Give aII missed doses on this visit.
Immunize sick infants unless being referred.
Advise the caretaker when to return for the next dose.
ASSESS OTHER PROBLEMS
28
TREAT THE YOUNG INFANT AND COUNSEL THE MOTHER
Give First Dose of Intram sc lar Antibiotics
Give first dose of ampicillin intramuscularly and
Give first dose of gentamicin intramuscularly.
AMPICILLIN GENTAMICIN
Dose: 50 mg per kg
To a vial of 250 mg Undiluted 2 ml vial containing 20 mg = 2 ml at 10 mg/ml
OR
WEIGHT Add 1.3 ml sterile water = Add 6 ml sterile water to 2 ml vial containing 80 mg* = 8 ml at 10 mg/ml
250 mg/1.5 ml
AGE 7 days
Dose: 5 mg per kg Dose: 7.5 mg per kg
1
1.5
2
2.5
3
3.5
4
*Avoid sing ndil ted 40 mg/ml gentamicin.
Referral is the best option for a young infant classified as VERY SEVERE DISEASE. If referral is not possible, continue to
give ampicillin and gentamicin for at least 5 days. Give ampicillin two times daily to infants less than one week of age and 3
times daily to infants one week or older. Give gentamicin once daily.
Treat the Yo ng Infant to Prevent Low Blood S gar
If the yo ng infant is able to breastfeed:
Ask the mother to breastfeed the young infant.
If the yo ng infant is not able to breastfeed b t is able to swallow:
Give 20 50 ml (10 ml/kg) expressed breast milk before departure. If not possible to give expressed breast milk, give 20 50 ml (10
ml/kg) sugar water (To make s gar water: Dissolve 4 level teaspoons of s gar (20 grams) in a 200-ml c p of clean water).
If the yo ng infant is not able to swallow:
Give 20 50 ml (10 ml/kg) of expressed breast milk or sugar water by naso gastric tube.
29
TREAT THE YOUNG INFANT
Teach the Mother How to Keep the Yo ng Infant Warm on the Way to the Hospital
Provide skin to skin contact, OR
Keep the young infant clothed or covered as much as possible all the time. Dress the young infant with extra clothing
including hat, gloves, socks and wrap the infant in a soft dry cloth and cover with a blanket.
Give an Appropriate Oral Antibiotic for local infection
For local bacterial infection:
First line antibiotic :
Second line antibiotic:
COTRIMOXAZOLE AMOXICILLIN
(trimethoprim + sulphamethoxazole) Give two times daily for 5 days
Give two times daily for 5 days
Adult Tablet Paediatric Tablet Syrup Tablet Syrup
AGE or WEIGHT single strength (20 mg trimethoprim (40 mg trimethoprim
(80 mg trimethoprim + 400 +100 mg +200 mg 250 mg 125 mg in 5 ml
mg sulphamethoxazole) sulphamethoxazole) sulphamethoxazole)
Birth up to 1 month (
1 month up to 2 months (4
* Avoid cotrimoxazole in infants less than 1 month of age who are premat re or ja ndiced.
30
TREAT THE YOUNG INFANT AND COUNSEL THE MOTHER
Teach the Mother How to Treat Local Infections at Home
Explain how the treatment is given.
Watch her as she does the first treatment in the clinic.
Tell her to return to the clinic if the infection worsens.
To Treat Skin PustuIes or UmbiIicaI Infection To Treat Thrush (uIcers or white patches in mouth)
The mother should do the treatment twice daily for 5 days: The mother should do the treatment four times daily for 7 days:
Wash hands Wash hands
Gently wash off pus and crusts with soap and water Paint the mouth with half strength gentian violet (0.25%) using a
clean soft cloth wrapped around the finger
Dry the area
Wash hands again
Paint the skin or umbilicus/cord with full strength gentian
violet (0.5%)
Wash hands again
To Treat Diarrhoea, See TREAT THE CHILD CHART
Imm nize Every Sick Yo ng Infant, as needed
31
COUNSEL THE MOTHER
Teach Correct Positioning and Attachment for Breastfeeding
Show the mother how to hold her infant
with the infant s head and body in line
with the infant approaching breast with nose opposite to the nipple
with the infant held close to the mother s body
with the infant s whole body supported, not just neck and shoulders.
Show her how to help the infant to attach. She should:
touch her infant s lips with her nipple
[ Pobierz całość w formacie PDF ]