Sick Newborn Baby

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

  1. Birth asphyxia
  2. Prematurity
  3. Neonatal infections
  4. Congenital malformations e.g. heart, central nervous system, bowel etc
  5. Birth injury
  6. Maternal sedation or analgesia during labour
  7. Metabolic e.g. hypoglycaemia, hypocalcaemia

Symptoms of a sick newborn baby

The following are the symptoms of q sick newborn baby:

  1. Weak cry or inability to cry
  2. Difficulty in breathing or recurrent cessation of breathing (apnoea)
  3. Reduced spontaneous movements or being very floppy
  4. Refusal of feeds
  5. Vomiting
  6. Abdominal distension
  7. Convulsions
  8. Blood in stools
  9. Reduced urine output

Signs of a sick newborn baby

The signs of a sick newborn baby include the following:

  1. Raised body temperature (> 37.5 °C axillary)
  2. Low body temperature (< 36.5 °C axillary)
  3. Pallor
  4. Cyanosis
  5. Jaundice
  6. Bradycardia (<100 beats/minute)
  7. Tachycardia (> 160 beats/minute)
  8. Heart murmurs
  9. Respiratory distress (>60 breaths per minute, chest indrawing)
  10. Respiratory rate < 20 breaths per minute
  11. Apnoea
  12. Abdominal distension
  13. Drowsiness or unconsciousness
  14. Seizures
  15. 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

  1. To diagnose and treat underlying cause appropriately
  2. To identify and urgently correct hypoglycaemia
  3. 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.