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Care priority and warning signs
Care priority
Treat with Oral Antibiotic
Red flags
- Development of severe chest indrawing.
- Development of any sign of PSBI/Very Severe Disease (feeding problem, convulsions, fever, low temp, reduced movement).
- Worsening respiratory distress or apnea.
- Failure to improve after 2-3 days of treatment.
Assessment
- Confirm Age is 7 days up to 2 months (59 days).
- Look/Feel: Count the breaths in one minute. Repeat if >= 60. Ensure infant is calm/quiet.
- Confirm absence of Severe Chest Indrawing.
- Confirm absence of all signs listed for PSBI / Very Severe Disease (feeding problem, convulsions, fever, low temp, abnormal movement).
Classification
- Fast breathing (>= 60 breaths/minute) AND Age 7 days to 59 days AND No severe chest indrawing AND No other signs of PSBI/Very Severe Disease -> PNEUMONIA
Key features
- Fast breathing (>= 60 breaths/minute) is the key sign.
- Applies ONLY to infants aged 7 days to 59 days.
- Absence of severe chest indrawing and other signs of PSBI/Very Severe Disease is crucial for this classification.
- Requires treatment with oral Amoxicillin.
Management
Non-pharmacological management
- Advise mother on keeping infant warm.
- Advise on continued exclusive breastfeeding.
- Advise on clearing blocked nose if interfering with feeding.
- Advise mother on signs to return immediately.
Pharmacological treatment
- Give oral Amoxicillin twice daily for 7 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 (1/2 of 250mg DT or 2.5ml of 250mg/5ml syrup). Weight 4.0-5.9kg: 250mg per dose (1 of 250mg DT or 5ml of 250mg/5ml syrup). (Note: Dosages derived from page 42, aiming for mid-range).
- Give Paracetamol if fever >=38°C (Dosing needs careful calculation for neonates, often 10-15mg/kg/dose q6-8h - refer to specific neonatal dosing guidelines, IMCI chart doesn't specify neonatal paracetamol dose here).
Follow-up
- Follow up on day 4 (Page 47).
- At follow-up (Day 4): Reassess for PSBI/VSD signs, pneumonia signs. Check feeding.
- If PSBI/VSD signs develop -> Refer URGENTLY.
- If improving (breathing slower, feeding well): Continue Amoxicillin to complete 7 days.
- If not improving or worse: Refer URGENTLY (consider treatment failure/alternative diagnosis).
Counselling points
- Explain the diagnosis (pneumonia) and the need for antibiotic.
- Teach mother how to give oral Amoxicillin: correct dose (demonstrate measurement), frequency (twice daily), full duration (7 days).
- Advise on keeping infant warm.
- Advise on exclusive breastfeeding.
- Advise on WHEN TO RETURN IMMEDIATELY: Breathing becomes difficult, breathing becomes faster, feeding poorly, becomes sicker, develops fever or feels cold.
- Advise on follow-up visit on day 4.
Differential diagnosis
- Possible Serious Bacterial Infection / Very Severe Disease (if any severe signs present)
- Transient Tachypnea of the Newborn (usually resolves <72 hours)
- Bronchiolitis (often associated with wheeze, cough)
- Congenital heart disease
- Aspiration
- Metabolic acidosis
Complications
- Progression to severe pneumonia/PSBI
- Respiratory failure
- Apnea
- Treatment failure
Prevention
- Maternal health (immunization, nutrition).
- Exclusive breastfeeding.
- Avoiding exposure to smoke and sick contacts.
- Handwashing.
References
IMCI Chart Booklet - Page 33, Page 42 (Amoxicillin Dosing), Page 47 (Follow-up)