IMCI 5

• Following birth, all newborns need air, warmth, breastfeeding, love and safety, infection control, management of complications after birth, and appropriate clothes.
• Look inside the infant’s mouth, including the tongue and the inside of the cheek.
• Thrush looks like milk curds on the inside of the cheek or a thick white coating of the tongue.
• Determine weight for age using a weight for age chart to determine whether the young infant has low weight for age.
• To ensure the needs of all newborns, it is important to wipe and dry the newborn, give stimulation as needed, keep the newborn warm, promote KMC for LBW infants, and ensure the normal body temperature of the newborn is 36.5-37.5 ◦ C.
• If the body temperature of a newborn decreases, the newborn becomes less active, lethargic, hypotonic, and sucks poorly.
• If low body temperature becomes still lower (hypothermia), the changes in body metabolism result in impaired heart function, bleeding (especially in the lungs), severe jaundice and ultimately death.
• Determine weight for age using a weight for age chart to determine whether the young infant has low weight for age.
• Look inside the infant’s mouth, focusing on the tongue and the inside of the cheek.
• Thrush looks like milk curds on the inside of the cheek or a thick white coating of the tongue.
• Look for ulcers or white patches in the mouth, which could be a sign of thrush.
• The normally frequent or semi-solid stools of a breastfed baby are not diarrhea.
• If there are not enough signs to classify as some or severe dehydration, it is considered no dehydration.
• Assess all young infants for the signs of dehydration: General condition, sunken eyes, reaction to skin pinch.
• Two of the following signs: movement only when stimulated or no movement at all, sunken eyes, skin pinch goes back slowly, is classified as some dehydration.
• The eyes of a dehydrated infant may look sunken.
• Skin pinch goes back very slowly or does not go back at all is a sign of severe dehydration.
• A young infant has diarrhea if the stools have changed from usual pattern to many watery
• The normally frequent or loose stools of a breastfed infant are not diarrhea.
• Diarrhea is also called loose watery stool and is common in babies under 6 months who are drinking cow’s milk or infant formula.
• In a low weight infant the eyes may always look sunken even if the young infant is not dehydrated.
• A mother of a breastfed infant can recognize diarrhea because the consistency or frequency of the stools is different from normal.
• Clinical Assessment: Assess all young infants for jaundice by looking for yellow discoloration in the eyes or skin, and in natural light.
• Culture should be done first before starting antibiotic treatment for diarrhea.
• Antibiotics should not be used routinely for treatment of diarrhea as they might not be effective for viruses.
• If jaundice is present, ask when it first appeared and if the young infant is more than 14 days old.
• To rewarm a cold young infant, make sure the room is warm, remove the infant’s cold clothes and replace with warm clothes, place the infant skin to skin contact with the mother in a pre-warmed shirt opening at the front, a nappy, hat and socks, cover the infant on the mother’s chest with her clothes and additional warmed blanket, and check the infant’s temperature every hour.
• After birth, the mother and newborn should stay together to ensure breastfeeding on demand, prevent hypothermia, prevent many infections, and help the mother and any family members who come to care for the newborn.
• Observe the young infant’s movements while doing the assessment.
• An infant who cannot be woken up even after stimulation can also have this sign.
• Hypothermia (35.5 ◦ C) is a medical emergency.
• Ask the mother if the young infant has fast breathing, defined as more than 60 breaths in 1 minute.
• If you watch an awake young infant closely for a minute, you will normally see several movements of the arms or legs or turning of the head.
• The young infant may lose consciousness during convulsions.
• Serious Jaundice occurs when bilirubin in the blood becomes very high, common in infants with blood disease or sepsis, infants with low birth weight (less than 2500g) or premature, not sucking well or not passing stool, they may not get rid of the bilirubin.
• Check young infant for jaundice, which is common in 50% of normal newborns and 80% of preterm infants.
• Not being able to feed or not feeding well should be referred urgently to the hospital.
• The young infant may stop breathing and become blue during convulsions.
• Many times there may be rhythmic movements of a part of the body such as twitching of the mouth or blinking of eyes during convulsions.
• The breathing rate of a healthy young infant is commonly more than 50 bpm.