Doctors Revision

IMCI · Age: 0 - 2 months

Possible Serious Bacterial Infection or Very Severe Disease

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.

View images for Possible Serious Bacterial Infection or Very Severe Disease (Google Images, opens in a new tab)
On this page

Care priority and warning signs

Care priority

Refer URGENTLY

Red flags

  • 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

Assessment

  • Ask: Is the infant having difficulty in feeding?
  • Ask: Has the infant had convulsions?
  • Look/Feel: Count the breaths in one minute. Repeat if >= 60.
  • Look/Feel: Look for SEVERE chest indrawing.
  • Look/Feel: Measure axillary temperature. Is it ≥38°C or <35.5°C?
  • Look/Feel: 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

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.

Management

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.

Pre-referral treatment

  • Give first dose of intramuscular antibiotic: Gentamicin (5 mg/kg, or 4 mg/kg if low birth weight <2.5kg) AND Ampicillin (50 mg/kg). Prepare Gentamicin (40mg/2ml vial): Dilute 1ml Gentamicin with 1ml sterile water -> 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.

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)

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).

References

IMCI Chart Booklet - Page 33, Page 40 (Pre-referral)

For learning and professional reference. Use current local guidance and clinical judgement.

Browse imci entries
Scroll to Top