Special care of preterm babies
Queen Dube
Consultant Paediatrician
Queen Elizabeth Hospital
Blantyre
Doug Simkiss
Associate Professor of Child Health
Warwick Medical School
University of Warwick
Special care of preterm babies
• Care of babies with signs of infection
• Care of babies with jaundice
• Babies with respiratory distress syndrome
Neonatal infections
• ‘rapid reductions in mortality are possible’
• ‘prevention of infection is mainly dependent
on maternal health packages and programs
such as antenatal care, hygienic care during
childbirth and the postnatal period and
early and exclusive breast feeding’
Prevention of neonatal infections
• Many early neonatal
infections can be
prevented by:
– Good basic hygiene
and cleanliness during
delivery of the baby
– Special attention to
cord care
– Eye care
Prevention of neonatal infections
• Many late neonatal infections are acquired
from the health care facility. These can be
prevented by:
– Exclusive breast feeding
– Strict procedures for hand washing for all staff
and for families before and after handling
babies
– Strict sterility for all procedures
Prevention of neonatal infections
– Avoiding incubators (using
Kangaroo mother care instead) or
not using water for
humidification in incubators
(Pseudomonas often colonises in
these devices)
– Clean injection procedures
– Removing intravenous drips
when no longer needed
– Avoiding unnecessary blood
transfusions
Serious bacterial infections
• Risk factors are:
– Maternal fever (temperature >37.9°C before
delivery or during labour)
– Membranes ruptured more than 24 hours
before delivery
– Foul smelling amniotic fluid
Danger signs in newborns
• Neonates and young infants often present
with non-specific symptoms and signs
which can indicate serious bacterial
infection. Signs include:
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Unable to breast feed
Convulsions
Drowsy or unconscious
Respiratory rate < 20/minute
Danger signs in newborns
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Bleeding
Central cyanosis (blueness)
Hypothermia
Hyperthermia
Hypoglycaemia
Dehydration
Neonatal jaundice
• Premature babies are an increased risk
of jaundice as well as infection.
• Severe jaundice peaks at around day 3
and babies may be home by then.
• Implementing a systematic predischarge check of mothers and babies
is an opportunity to prevent
complications or increase careseeking.
Supportive care for the sick infant
• Oxygen therapy
– Give oxygen to infants with any of
• Central cyanosis
• Grunting with every breath
• Difficulty in feeding due to respiratory distress
• Severe lower chest wall indrawing
• Head nodding - indicates severe respiratory distress
Supportive care for the sick infant
– Pulse oximetry, use if available and give oxygen
if saturation < 90%. Aim for 92-95% saturation
levels. Stop oxygen if baby can maintain
oxygen saturations above 90% in air .
– Nasal prongs is preferred method for oxygen
delivery. Use flow of 0.5 litre / minute. Use
suction to remove thick secretions from nose
and throat if baby is too weak to clear them.
Supportive care for the sick infant
• In Malawi, a CPAP device is being trialed in
babies with respiratory distress who are
over 1000g.
• Early results are encouraging and an
important outcome will be to assess the
nursing time required and costs.