Possible Serious Bacterial Infection or Very Severe Disease 0 - 2 months
Refer URGENTLY
High match
Cha kumwambia mlezi
- Explain that the baby is very sick and needs urgent hospital care.
- Explain treatments given (antibiotics, sugar/milk).
- Teach the mother how to keep the infant warm on the way to the hospital (skin-to-skin contact or warm wrapping).
- Advise mother to continue trying to breastfeed if possible.
- Write a detailed referral note including all signs, classification, and treatments given (drug, dose, time).
Classification for a young infant (birth to 2 months) presenting with specific signs indicating a high risk of severe bacterial infection (like sepsis, meningitis, pneumonia) or other very severe conditions. Requires immediate pre-referral treatment and urgent referral to hospital.
Key Features
- ANY ONE of the specified signs indicates PSBI or Very Severe Disease.
- Signs include severe feeding problems, convulsions, respiratory distress (severe chest indrawing or fast breathing <7d), temperature instability (high or low), or significantly reduced movement.
- This is a life-threatening emergency in young infants.
Red Flags (Warning Signs)
- Stopped feeding completely
- Convulsions
- Severe chest indrawing
- Apnea (periods of stopped breathing - implied by severe illness)
- Temperature instability (high or low)
- No movement at all / deep lethargy
- Cyanosis
Tathmini
Uliza
- Is the infant having difficulty in feeding?
- Has the infant had convulsions?
Tazama, sikiliza, hisi
- Count the breaths in one minute. Repeat if >= 60.
- Look for SEVERE chest indrawing.
- Measure axillary temperature. Is it ≥38°C or <35.5°C?
- Look at the young infant's movements. Does the infant move on his/her own? Stimulate if not moving. Does the infant move only when stimulated? Does the infant not move at all?
- Check specific signs listed in classification criteria.
Classification
- Any ONE of the following signs:
- Not able to feed since birth, stopped feeding well, or not feeding at all
- Convulsions
- Severe chest indrawing
- Fast breathing (>= 60 breaths/minute) in infants LESS THAN 7 DAYS OLD
- Fever (>= 38°C axillary)
- Low body temperature (< 35.5°C axillary)
- Movement only when stimulated or no movement at all
- -> POSSIBLE SERIOUS BACTERIAL INFECTION OR VERY SEVERE DISEASE
Urgency / Refer urgently
Refer URGENTLY
Tiba kabla ya rufaa
- Give first dose of intramuscular antibiotic: Gentamicin (5 mg/kg, or 4 mg/kg if low birth weight concentration becomes 20mg/ml. Dose based on weight (refer to local dosing charts or calculate carefully). Ampicillin (prepare 500mg vial): Dose based on weight. (Refer to Page 40 for general statement, precise dosing usually requires local protocol/weight chart).
- Treat to prevent low blood sugar (Hypoglycemia): If infant can breastfeed, ask mother. If cannot feed but can swallow, give 20-50ml (approx 10ml/kg) EBM. If cannot swallow, give EBM via NG tube. (Sugar water is not the first option for neonates, EBM preferred, page 40 focuses on EBM).
- If referral is refused or not possible: Continue antibiotic treatment (e.g., Gentamicin OD + Ampicillin BD/QDS based on protocol) for 7 days. Continue warmth, feeding support (NG if needed), oxygen if available/indicated. This is high-risk care outside referral center.
Usimamizi
Non-Pharmacological Management
- Quickly complete assessment for all necessary pre-referral treatments.
- Keep the infant warm: Initiate skin-to-skin contact (Kangaroo Mother Care) if possible OR wrap infant in warm, dry clothes, including hat/socks, cover with blanket. Ensure no draughts.
- Handle gently.
Monitoring & Follow-Up
- To be managed at referral hospital facility.
Counselling Points
- Explain that the baby is very sick and needs urgent hospital care.
- Explain treatments given (antibiotics, sugar/milk).
- Teach the mother how to keep the infant warm on the way to the hospital (skin-to-skin contact or warm wrapping).
- Advise mother to continue trying to breastfeed if possible.
- Write a detailed referral note including all signs, classification, and treatments given (drug, dose, time).
Differential Diagnosis
- Neonatal Sepsis
- Bacterial Meningitis
- Severe Pneumonia
- Birth Asphyxia complications
- Congenital Heart Disease
- Metabolic disorders
- Hypoglycemia
- Severe Jaundice complications (kernicterus)
Potential Complications
- Septic shock
- Meningitis with neurological sequelae
- Respiratory failure
- Apnea
- Hypoglycemia complications (brain damage)
- Hypothermia complications
- Death
Prevention
- Clean delivery practices.
- Maternal health (screening/treatment of infections like GBS).
- Early and exclusive breastfeeding.
- Thermal care at birth.
- Handwashing.
- Prompt recognition and care seeking for newborn illness.
- Cord care (clean and dry, or chlorhexidine where recommended).
Reference: IMCI Chart Booklet - Page 33, Page 40 (Pre-referral)