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Care priority and warning signs
Care priority
Treat with Oral Antibiotic / Local Care
Red flags
- Umbilical redness extending to the abdominal wall skin (sign of spreading infection -> PSBI).
- Development of any sign of PSBI/Very Severe Disease.
- Multiple or large skin pustules/bullae.
- Failure of local infection to improve after 2-3 days.
Assessment
- Look/Feel: Look at the umbilicus. Is it red or draining pus? Look for redness extending to the abdominal wall skin.
- Look/Feel: Look at the skin. Are there skin pustules (bumps containing pus)?
- Confirm absence of all signs listed for PSBI / Very Severe Disease.
Classification
- (Umbilicus red or draining pus) OR (Skin pustules) AND No signs of PSBI/Very Severe Disease -> LOCAL BACTERIAL INFECTION
Key features
- Presence of Umbilical redness OR Pus draining from umbilicus OR Skin pustules.
- Absence of any sign of PSBI/Very Severe Disease.
- If umbilical redness extends to the skin, treat as PSBI and refer urgently.
- Requires oral antibiotic and local antiseptic care.
Management
Non-pharmacological management
- Teach mother how to treat the local infection at home:
- For Umbilical Infection: Clean gently with soap and water, dry thoroughly. Apply antiseptic (e.g., 0.5% gentian violet or chlorhexidine solution if recommended locally) to the cord/umbilicus twice daily. Keep cord dry and exposed to air or loosely covered with clean cloth. Fold diaper below cord.
- For Skin Pustules: Gently wash off pus and crusts with soap and water twice daily. Apply antiseptic (e.g., 0.5% gentian violet) to pustules twice daily.
- Advise on handwashing before and after care.
- Advise on keeping infant warm and continuing exclusive breastfeeding.
Pharmacological treatment
- Give oral Amoxicillin twice daily for 5 days. Dosage (using 75-100mg/kg/day range, divided twice daily): Weight 1.5-2.4kg: 125mg per dose (1/2 of 250mg DT or 2.5ml of 250mg/5ml syrup). Weight 2.5-3.9kg: 125mg per dose. Weight 4.0-5.9kg: 250mg per dose. (Note: Dosages derived from page 42).
- Antiseptic for local application: Gentian Violet 0.5% or Chlorhexidine where recommended.
Follow-up
- Follow up on day 3 (Page 47).
- At follow-up (Day 3): Reassess umbilicus/skin pustules. Check for PSBI/VSD signs.
- If redness/pus same or worse, or if PSBI/VSD signs develop -> Refer URGENTLY.
- If improving: Continue antibiotic for full 5 days. Continue local care until healed.
Counselling points
- Explain the diagnosis (local infection) and the need for antibiotic and local cleaning.
- Teach mother how to give oral Amoxicillin: correct dose, frequency (twice daily), full duration (5 days).
- Teach mother how to perform local care (cleaning, antiseptic application) twice daily.
- Emphasize handwashing.
- Advise on keeping infant warm and exclusively breastfed.
- Advise WHEN TO RETURN IMMEDIATELY: Umbilical redness spreads, feeding poorly, becomes sicker, develops fever or feels cold.
- Advise on follow-up visit on day 3.
Differential diagnosis
- PSBI/Very Severe Disease (if systemic signs or spreading umbilical redness)
- Umbilical granuloma (moist, pinkish tissue, usually not red/pus)
- Normal umbilical cord separation
- Diaper rash
- Milia / Erythema toxicum (normal newborn rashes, not pustular)
- Candidal skin infection
Complications
- Progression to PSBI/Sepsis (especially from omphalitis)
- Abscess formation
- Necrotizing fasciitis (rare but severe complication of omphalitis)
Prevention
- Clean cord care (keep clean and dry, use chlorhexidine where recommended by national policy).
- Handwashing.
- Clean delivery.
- Avoiding harmful traditional substances on cord.
- Good skin hygiene.
References
IMCI Chart Booklet - Page 33, Page 42 (Amoxicillin Dosing), Page 44 (Local Care Details), Page 47 (Follow-up)