This publication on WHO recommendations related to newborn health is one of four in a series; the others relate to maternal, child and adolescent health. The objective of this document is to make available WHO recommendations on newborn health in one easy-to-access document for WHO staff, policy-makers, programme managers, and health professionals. The compilation can also help better define gaps to prioritize guideline updates.
This document is meant to respond to the questions:
 What health interventions should be the newborn and young infants < 2 months of age receive and when should s/he receive it?
 What health behaviours should a mother/caregiver practise (or not practise)?
WHO produces guidelines according to the highest international standards for guideline development. The main principles are transparency and minimizing bias in every step of the process. The process of developing guidelines is documented in WHO Handbook for guideline development. 1 The development process includes the synthesis and assessment of the quality of evidence, and is based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. GRADE categorizes the quality (or certainty) of the evidence underpinning a recommendation as high, moderate, low or very low.
 High: further research is very unlikely to change our confidence in the estimate of effect;
 Moderate: further research is likely to have an impact on our confidence in the effect;
 Low: further research is very likely to have an important impact on our confidence in the effect and is likely to change the estimate of effect;
 Very low: any estimate of effect is very uncertain.
Once the quality of the body of evidence on benefits and harms has been assessed, an expert group formulates the recommendations using a structured evidence to decision framework. When determining whether to recommend an intervention or not, the expert group carefully considers the balance of benefits and harms of an intervention, and other factors such as values and preferences of persons affected by the recommendation, stakeholders' perceptions of the acceptability and feasibility of the options and interventions, resource implications, the importance of the problem, and equity and human rights considerations.
The expert group then decides on the strength of the recommendation -strong or conditional. A strong recommendation is one where the desirable effects of adhering to the recommendation outweigh the undesirable effects. Recommendations that are conditional or weak are made when the expert group is less certain about the balance between the benefits and harms or disadvantages of implementing a recommendation. Conditional recommendations generally WHO RECOMMENDATIONS ON NEWBORN HEALTH include a description of the conditions under which the end-user should or should not implement the recommendation.
The quality of evidence and strength of the recommendation, as well as the link to the source, are included in this publication. Different expert groups may employ different terminology in the guideline processes. We suggest the Reader refer to the Source where more details are available.
In this publication we have indicated publications which are New -published after 2013 and Update -to indicate that the recommendation has been revised since 2013.

# Infant prophylaxis
  Infants born to mothers with HIV who are at high risk of acquiring HIV2 should receive dual prophylaxis with AZT (twice daily) and NVP (once daily) for the first 6 weeks of life, whether they are breastfed or formula fed (Strong recommendation, moderate-quality evidence).
  Breastfed infants who are at high risk of acquiring HIV, including those first identified as exposed to HIV during the postpartum period, should continue infant prophylaxis for an additional 6 weeks (total of 12 weeks of infant prophylaxis) using either AZT (twice daily) and NVP (once daily) or NVP alone (Conditional recommendation, low-quality evidence). Source

# Infant feeding 3
The duration of breastfeeding by mothers living with HIV For how long should a mother living with HIV breastfeed if she is receiving ART and there is no evidence of clinical, immune or viral failure?   Mothers living with HIV should breastfeed for at least 12 months and may continue breastfeeding for up to 24 months or longer (similar to the general population) while being fully supported for ART adherence (see the WHO consolidated guidelines on ARV drugs for interventions to optimize adherence). (Strong recommendation, low quality of evidence 12 months, very low quality of evidence 24 months).
The Guideline Development Group agreed that recommendation 1 should be framed by the following statement.
In settings where health services provide and support lifelong ART, including adherence counselling, and promote and support breastfeeding among women living with HIV, the duration of breastfeeding should not be restricted.
"Mothers known to be HIV-infected (and whose infants are HIV uninfected or of unknown HIV status) should exclusively breastfeed their infants for the first six months of life, introducing appropriate complementary foods thereafter and continue breastfeeding."

# Congenital syphilis
Symptomatic or high risk infants   In infants with confirmed congenital syphilis or infants who are clinically normal, but whose mothers had untreated syphilis, inadequately treated syphilis (including treatment within 30 days of delivery) or syphilis that was treated with non-penicillin regimens, the WHO STI guideline suggests aqueous benzyl penicillinor procaine penicillin.
-Aqueous benzyl penicillin 100 000-150 000 U/kg/day intravenously for 10-15 days -Procaine penicillin 50 000 U/kg/day single dose intramuscularly for 10-15 days Remarks: If an experienced venipuncturist is available, aqueous benzyl penicillin may be preferred instead of intramuscular injections of procaine penicillin. (Conditional recommendation, very low quality evidence). Source Asymptomatic or low risk infants   In infants who are clinically normal and whose mothers had syphilis that wasadequately treated with no signs of reinfection, the WHO STI guideline suggestsclose monitoring of the infants.
Remarks: The risk of transmission of syphilis to the fetus depends on a number of factors, including maternal titres from non-treponemal tests (e.g. RPR), timing of maternal treatment and stage of maternal infection, and therefore this recommendation is conditional. If treatment is provided, benzathine penicillin G 50 000 U/kg/day single dose intramuscularly is an option. (Conditional recommendation, very low quality evidence). Source

# Ophthalmia neonatorum
Treatment of eye infection   In neonates with gonococcal conjunctivitis, the WHO STI guideline suggests one of the following treatment options:
ceftriaxone 50 mg/kg (maximum 150 mg) IM as a single dose kanamycin 25 mg/kg (maximum 75 mg) IM as a single dose spectinomycin 25 mg/kg (maximum 75 mg) IM as a single dose.
Remarks: Due to the large net benefit with treatment, good practice dictates that neonates should be treated for gonococcal conjunctivitis. The choice of treatment may depend on the cost and quality of the medicine in different settings and on equity considerations. Side-effects should be monitored in neonates. (Conditional recommendation, very low quality evidence). Source   In neonates with chlamydial conjunctivitis, the WHO STI guideline recommends treatment with azithromycin 20 mg/kg/day orally one dose daily for 3 days over erythromycin 50 mg/ kg/ day orally in 4 divided doses daily for 14 days.
Remarks: This is a strong recommendation given the potential for the risk of pyloric stenosis with the use of erythromycin in neonates. In some settings, azithromycin suspension is not available and therefore erythromycin may be used. Side effects should be monitored with the use of either medication. (Strong recommendation, very low quality evidence). Source Prevention of ophthalmia neonatorum   For all neonates, the WHO STI guideline recommends topical ocular prophylaxis for the prevention of gonococcal and chlamydial ophthalmia neonatorum. (Strong recommendation, low quality evidence). Source For ocular prophylaxis, the WHO STI guideline suggests one of the following options for topical application to both eyes immediately after birth:
tetracycline hydrochloride 1% eye ointment erythromycin 0.5% eye ointment povidone iodine 2.5% solution (water-based)
silver nitrate 1% solution chloramphenicol 1% eye ointment.
Remarks: Recommendations 5 and 6 apply to the prevention of both chlamydial and gonococcal ophthalmia neonatorum. Cost and local resistance to erythromycin, tetracycline and chloramphenicol in gonococcal infection may determine the choice of medication. Caution should be taken to avoid touching eye tissue when applying the topical treatment and to provide a water-based solution of povidone iodine. DO NOT USE ALCOHOL-BASED POVIDONE IODINE SOLUTION.
(Conditional recommendation, low quality evidence). Source