Cough and difficulty in breathing

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 2–3 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

 

ANNEX 1 Management of neonatal jaundice

Cough and difficulty in breathing