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31
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
If there is muscle weakness, give pralidoxime (cholinesterase reactivator)
at 25–50 mg/kg diluted in 15 ml water by IV infusion over 30 min, repeated
once or twice or followed by IV infusion of 10–20 mg/kg per h, as necessary.(?<=[.!?])\s+(?=[A-Z0-9])Paracetamol
In paracetamol... | 55 | 100 | 0 | WHO-0001 | 1 | who_corpus.pdf | 341 |
Note that the fl uid volumes used in the standard regimen
are too large for young children.
•
For children < 20 kg give the loading dose of 150 mg/kg in 3 ml/kg of 5%
glucose over 15 min, followed by 50 mg/kg in 7 ml/kg of 5% glucose over
4 h, then 100 mg/kg IV in 14 ml/kg of 5% glucose over 16 h.(?<=[.!?])\s+(?=[A... | 55 | 101 | 1 | WHO-0001 | 1 | who_corpus.pdf | 386 |
Note that salicylate tablets tend to
form a concretion in the stomach, resulting in delayed absorption, so it is
worthwhile giving several doses of charcoal.(?<=[.!?])\s+(?=[A-Z0-9])If charcoal is not available and
a severely toxic dose has been ingested, perform gastric lavage or induce
vomiting, as above.(?<=[.!?... | 55 | 102 | 2 | WHO-0001 | 1 | who_corpus.pdf | 107 |
32
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
Give IV sodium bicarbonate at 1 mmol/kg over 4 h to correct acidosis and to
raise the pH of the urine above 7.5 so that salicylate excretion is increased.(?<=[.!?])\s+(?=[A-Z0-9])Give oral supplementary potassium too (2–5 mmol/kg per day in three or
four divided doses).(?<=[.!... | 56 | 103 | 0 | WHO-0001 | 1 | who_corpus.pdf | 352 |
In severe poison-
ing, there may be gastrointestinal haemorrhage, hypotension, drowsiness,
convulsions and metabolic acidosis.(?<=[.!?])\s+(?=[A-Z0-9])Gastrointestinal features usually appear
within the fi rst 6 h, and a child who has remained asymptomatic for this time
probably does not require an antidote.
Acti... | 56 | 104 | 1 | WHO-0001 | 1 | who_corpus.pdf | 393 |
Therapeutic
end-points for ceasing infusion may be a clinically stable patient and serum
iron < 60 µmol/litre.(?<=[.!?])\s+(?=[A-Z0-9])Morphine and other opiates
Check for reduced consciousness, vomiting or nausea, respiratory depression
(slowing or absence of breathing), slow response time and pin-point pupils.(?<=... | 56 | 105 | 2 | WHO-0001 | 1 | who_corpus.pdf | 266 |
33
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
Carbon monoxide
Give 100% oxygen to accelerate removal of carbon monoxide (Note: patient
can look pink but still be hypoxaemic) until signs of hypoxia disappear.
Monitor with a pulse oximeter, but be aware that it can give falsely high
readings.(?<=[.!?])\s+(?=[A-Z0-9])I... | 57 | 106 | 0 | WHO-0001 | 1 | who_corpus.pdf | 374 |
1.7
Drowning
Initial assessment should include ensuring adequate airway patency, breath-
ing, circulation and consciousness (the ‘ABCs’).(?<=[.!?])\s+(?=[A-Z0-9])Check if there are any injuries,
especially after diving or an accidental fall.(?<=[.!?])\s+(?=[A-Z0-9])Facial, head and cervical spine
injuries are common... | 57 | 107 | 1 | WHO-0001 | 1 | who_corpus.pdf | 299 |
34
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
1.8
Electrocution
Provide emergency care by ensuring airway patency, breathing and circula-
tory support.(?<=[.!?])\s+(?=[A-Z0-9])Provide oxygen, especially for children with severe hypoxia,
facial or oral burns, loss of consciousness or inability to protect the airway,
or r... | 58 | 108 | 0 | WHO-0001 | 1 | who_corpus.pdf | 395 |
It is important to have some knowledge of
the common poisonous animals, early recognition of clinically relevant enven-
oming or poisoning, and symptomatic and specifi c forms of treatment available.(?<=[.!?])\s+(?=[A-Z0-9])1.9.1
Snake bite
Snake bite should be considered in any case of severe pain or swelling of
a l... | 58 | 109 | 1 | WHO-0001 | 1 | who_corpus.pdf | 300 |
35
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
– signs of neurotoxicity: respiratory diffi culty or paralysis, ptosis, bulbar
palsy (diffi culty in swallowing and talking), limb weakness
– signs of muscle breakdown: muscle pains and black urine
■Check Hb (when possible, blood clotting should be assessed).(?<=[.!?])\s+(?=[A-Z0... | 59 | 110 | 0 | WHO-0001 | 1 | who_corpus.pdf | 397 |
Attention to carefully securing the endotracheal tube
is important.(?<=[.!?])\s+(?=[A-Z0-9])An alternative is to perform an elective tracheostomy.(?<=[.!?])\s+(?=[A-Z0-9])Antivenom
■If there are systemic or severe local signs (swelling of more than half the
limb or severe necrosis), give antivenom, if available.
... | 59 | 111 | 1 | WHO-0001 | 1 | who_corpus.pdf | 363 |
36
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
If itching or an urticarial rash, restlessness, fever, cough or diffi cult breathing
develop, then stop antivenom and give adrenaline at 0.15 ml of 1:1000 IM
(see anaphylaxis treatment, p.(?<=[.!?])\s+(?=[A-Z0-9])109.(?<=[.!?])\s+(?=[A-Z0-9])Possible additional treatment includ... | 60 | 112 | 0 | WHO-0001 | 1 | who_corpus.pdf | 388 |
Other treatment
Surgical opinion: Seek a surgical opinion if there is severe swelling in a limb,
it is pulseless or painful or there is local necrosis.(?<=[.!?])\s+(?=[A-Z0-9])Surgical care will include:
– excision of dead tissue from wound
– incision of fascial membranes (fasciotomy) to relieve pressure in limb... | 60 | 113 | 1 | WHO-0001 | 1 | who_corpus.pdf | 261 |
37
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
Monitor the patient very closely immediately after admission, then hourly
for at least 24 h, as envenoming can develop rapidly.(?<=[.!?])\s+(?=[A-Z0-9])1.9.2
Scorpion sting
Scorpion stings can be very painful for days.(?<=[.!?])\s+(?=[A-Z0-9])Systemic effects of venom are
muc... | 61 | 114 | 0 | WHO-0001 | 1 | who_corpus.pdf | 347 |
120).(?<=[.!?])\s+(?=[A-Z0-9])Treatment
First aid
Transport to hospital as soon as possible.(?<=[.!?])\s+(?=[A-Z0-9])Hospital care
If there are signs of severe envenoming, give scorpion antivenom, if available
(as above for snake antivenom infusion).(?<=[.!?])\s+(?=[A-Z0-9])Other treatment
Treat heart fail... | 61 | 115 | 1 | WHO-0001 | 1 | who_corpus.pdf | 295 |
38
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
1.9.3
Other sources of envenoming
Follow the same principles of treatment as above.(?<=[.!?])\s+(?=[A-Z0-9])Give antivenom, when
available, if there are severe local or any systemic effects.(?<=[.!?])\s+(?=[A-Z0-9])In general, venomous spider bites can be painful but rarely re... | 62 | 116 | 0 | WHO-0001 | 1 | who_corpus.pdf | 378 |
Rubbing the sting may
cause further discharge of venom.(?<=[.!?])\s+(?=[A-Z0-9])Antivenom may be available.(?<=[.!?])\s+(?=[A-Z0-9])The dose of
antivenom to jellyfi sh and spider venoms should be determined by the amount of
venom injected.(?<=[.!?])\s+(?=[A-Z0-9])Higher doses are required for multiple bites, severe s... | 62 | 117 | 1 | WHO-0001 | 1 | who_corpus.pdf | 373 |
When there is more than one life-
threatening state, simultaneous treatment of injuries is essential and requires
effective teamwork.(?<=[.!?])\s+(?=[A-Z0-9])1.10.1 Primary survey or initial assessment
The initial rapid assessment, also commonly referred to as ‘the primary survey’,
should identify life-threatening in... | 62 | 118 | 2 | WHO-0001 | 1 | who_corpus.pdf | 292 |
39
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
ously undiagnosed injury may become apparent.(?<=[.!?])\s+(?=[A-Z0-9])Expose the child’s whole body
to look for injuries.(?<=[.!?])\s+(?=[A-Z0-9])Start with assessment and stabilization of the airway, assess
breathing, circulation and level of consciousness, and stop any haemorrha... | 63 | 119 | 0 | WHO-0001 | 1 | who_corpus.pdf | 309 |
Draw blood for
Hb and group and cross-matching as you set up IV access.
Document all procedures undertaken.(?<=[.!?])\s+(?=[A-Z0-9])1.10.2 Secondary survey
Conduct a secondary survey only when the patient’s airway patency, breathing,
circulation and consciousness are stable.
Undertake a head-to-toe examinati... | 63 | 120 | 1 | WHO-0001 | 1 | who_corpus.pdf | 293 |
40
1.(?<=[.!?])\s+(?=[A-Z0-9])TRIAGE
•
X-rays: depending on the suspected injury (may include chest, lateral neck,
pelvis, cervical spine, with all seven vertebrae, long bones and skull).
•
Ultrasound scan: a scan of the abdomen may be useful in diagnosing internal
haemorrhage or organ injury.(?<=[.!?])\s+(?=[A-Z0... | 64 | 121 | 0 | WHO-0001 | 1 | who_corpus.pdf | 390 |
269.(?<=[.!?])\s+(?=[A-Z0-9])Notes
TRAUMA AND INJURIES | 64 | 122 | 1 | WHO-0001 | 1 | who_corpus.pdf | 31 |
41
2.(?<=[.!?])\s+(?=[A-Z0-9])DIAGNOSIS
CHAPTER 2
Diagnostic approaches
to the sick child
2.1
Relationship to the IMCI approach and stages
of hospital care
The Pocket book is symptom-based in its approach, the symptoms following
the sequence in the IMCI guidelines: cough, diarrhoea, fever.(?<=[.!?])\s+(?=[A-Z0-9])T... | 65 | 123 | 0 | WHO-0001 | 1 | who_corpus.pdf | 313 |
Severely malnourished
children are also considered separately (see Chapter 7), because they require
special attention and treatment if their high mortality risk is to be reduced.(?<=[.!?])\s+(?=[A-Z0-9])In hospital, the stages of management for any child are:
••
emergency triage
••
emergency treatment (if required)
•... | 65 | 124 | 1 | WHO-0001 | 1 | who_corpus.pdf | 157 |
42
2.(?<=[.!?])\s+(?=[A-Z0-9])DIAGNOSIS
••
supportive care
••
monitoring
••
planning discharge
••
follow-up
This chapter summarizes taking a history, examining the child, laboratory
investigations and making a differential diagnosis.(?<=[.!?])\s+(?=[A-Z0-9])2.2
Taking history
Taking a history generally starts with u... | 66 | 125 | 0 | WHO-0001 | 1 | who_corpus.pdf | 370 |
The feed
ing history of infants and younger children is essential, as this is often when
malnutrition begins.(?<=[.!?])\s+(?=[A-Z0-9])For older children, information on development milestones
is important.(?<=[.!?])\s+(?=[A-Z0-9])Whereas the history is obtained from a parent or caretaker for
younger children, older... | 66 | 126 | 1 | WHO-0001 | 1 | who_corpus.pdf | 330 |
The approach
to examining children should be flexible.(?<=[.!?])\s+(?=[A-Z0-9])Ideally, you will perform the most
‘invasive’ part of the examination (e.g. the head and neck examination) last.
••
Do not upset the child unnecessarily.
••
Leave the child in the arms of the mother or carer.
••
Observe as many signs as p... | 66 | 127 | 2 | WHO-0001 | 1 | who_corpus.pdf | 162 |
43
2.(?<=[.!?])\s+(?=[A-Z0-9])DIAGNOSIS
–– Is the child irritable?
–– Is the child vomiting?
–– Is the child able to suck or breastfeed?
–– Is the child cyanosed or pale?
–– Does the child show signs of respiratory distress?
–– Does the child use auxiliary muscles of breathing?
–– Is there lower chest wall indrawing?
–... | 67 | 128 | 0 | WHO-0001 | 1 | who_corpus.pdf | 385 |
You obtain little
useful information if you listen to the chest of a crying child.(?<=[.!?])\s+(?=[A-Z0-9])Signs that involve
interfering with the child, such as recording the temperature, testing for skin
turgor, capillary refill time, blood pressure or looking at the child’s throat or
ears should be done last.(?<... | 67 | 129 | 1 | WHO-0001 | 1 | who_corpus.pdf | 309 |
44
2.(?<=[.!?])\s+(?=[A-Z0-9])DIAGNOSIS
••
microscopy of CSF
••
urinalysis (including microscopy)
••
blood grouping and cross-matching
••
HIV testing
In the care of sick newborns (< 1 week), blood bilirubin is also an essential
investigation.(?<=[.!?])\s+(?=[A-Z0-9])Other common investigations are valuable:
••
pulse o... | 68 | 130 | 0 | WHO-0001 | 1 | who_corpus.pdf | 368 |
Remember that a sick child
might have more than one clinical problem requiring treatment.(?<=[.!?])\s+(?=[A-Z0-9])Section 1.5, Tables 1–4 (pp.(?<=[.!?])\s+(?=[A-Z0-9])21–26) present the differential diagnoses for
emergency conditions encountered during triage.(?<=[.!?])\s+(?=[A-Z0-9])Further tables of symptom-
specif... | 68 | 131 | 1 | WHO-0001 | 1 | who_corpus.pdf | 375 |
45
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
CHAPTER 3
P roblems of the neonate
and young infant
3.1 Essential newborn care at delivery
46
3.2 Neonatal resuscitation
46
3.2.1 Post-resuscitation care
50
3.2.2 Cessation of resuscitation
50
3.3 Routine care for all newborns after delivery
50
3.4 Prevention of neo... | 69 | 132 | 0 | WHO-0001 | 1 | who_corpus.pdf | 365 |
46
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
This chapter provides guidance on essential newborn care and the management
of problems in neonates and young infants, from birth to 2 months of age.(?<=[.!?])\s+(?=[A-Z0-9])It
includes neonatal resuscitation, the recognition and management of neonatal
sepsis and other bac... | 70 | 133 | 0 | WHO-0001 | 1 | who_corpus.pdf | 335 |
Skin-to-skin contact and early breastfeeding are the best ways to keep an infant
warm and prevent hypoglycaemia.(?<=[.!?])\s+(?=[A-Z0-9])Term and low-birth-weight neonates weigh-
ing > 1200 g who do not have complications and are clinically stable should
be put in skin-to-skin contact with the mother soon after birth... | 70 | 134 | 1 | WHO-0001 | 1 | who_corpus.pdf | 311 |
47
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
CHART 12.(?<=[.!?])\s+(?=[A-Z0-9])NEONATAL RESUSCITATION
A
B
C
a Positive pressure ventilation should be initiated with air for infants with gestation > 32
weeks.(?<=[.!?])\s+(?=[A-Z0-9])For very preterm infants, it is preferable to start with 30% oxygen if possible.(?<=[.!?... | 71 | 135 | 0 | WHO-0001 | 1 | who_corpus.pdf | 352 |
Check the heart rate (HR) with a stethoscope.
■ HR > 100/min:
Continue to ventilate
at 40 breaths per
min.
Every 1–2 min stop
to see if breathing
spontaneously.
Stop ventilating
when respiratory
rate is > 30 breaths
per min.
Give post
resuscitation care.
(see section 3.2.1,
p.(?<=[.!?])\s+(?=[A-Z0-9])... | 71 | 136 | 1 | WHO-0001 | 1 | who_corpus.pdf | 357 |
48
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
CHART 12.(?<=[.!?])\s+(?=[A-Z0-9])NEONATAL RESUSCITATION
Chart 12.(?<=[.!?])\s+(?=[A-Z0-9])Neonatal resuscitation: Steps and process
There is no need to slap the infant; rubbing the back two or three times in
addition to thorough drying is enough for stimulation.(?<=[.!?])\s... | 72 | 137 | 0 | WHO-0001 | 1 | who_corpus.pdf | 348 |
B.(?<=[.!?])\s+(?=[A-Z0-9])Breathing
Choose a mask size that fi ts over the nose and mouth (see below): size 1
for normal-weight infant, size 0 for small (< 2.5 kg) infants
Ventilate with bag and mask at 40–60 breaths/min.
■ Make sure the chest moves up with each press on the bag; in a very small
infant, make sure... | 72 | 138 | 1 | WHO-0001 | 1 | who_corpus.pdf | 391 |
49
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
CHART 12.(?<=[.!?])\s+(?=[A-Z0-9])NEONATAL RESUSCITATION
Chart 12.(?<=[.!?])\s+(?=[A-Z0-9])Neonatal resuscitation
Inadequate seal
If you hear air escaping from
the mask, form a better seal.(?<=[.!?])\s+(?=[A-Z0-9])The commonest leak is between
the nose and the cheeks.(?<=[.... | 73 | 139 | 0 | WHO-0001 | 1 | who_corpus.pdf | 269 |
50
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
3.2.1
Post resuscitation care
Infants who require resuscitation are at risk for deterioration after their vital
signs have returned to normal.(?<=[.!?])\s+(?=[A-Z0-9])Once adequate ventilation and circulation has
been established:
Stop ventilation.
Return to mother... | 74 | 140 | 0 | WHO-0001 | 1 | who_corpus.pdf | 294 |
Give them the infant to hold if they so wish.(?<=[.!?])\s+(?=[A-Z0-9])3.3
Routine care for all newborns after delivery
The routine care described below applies to all newborns, either born in hospital
or born outside and brought to the hospital.
Keep the baby in skin-to-skin contact on the mother’s chest or at he... | 74 | 141 | 1 | WHO-0001 | 1 | who_corpus.pdf | 295 |
51
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
3.4
Prevention of neonatal infections
Many early neonatal infections can be prevented by:
•
avoiding unnecessary separation of the newborn from the mother e.g.
baby unit
•
hand-washing before delivering and handling the infant
•
good basic hygiene and cleanliness during... | 75 | 142 | 0 | WHO-0001 | 1 | who_corpus.pdf | 334 |
59) and avoiding use of incubators for
preterm infants.(?<=[.!?])\s+(?=[A-Z0-9])If an incubator is used, do not use water for humidifi cation
(where Pseudomonas will easily colonize) and ensure that it was thoroughly
cleaned with an antiseptic.
•
strict sterility for all procedures
•
clean injection practices
•
r... | 75 | 143 | 1 | WHO-0001 | 1 | who_corpus.pdf | 185 |
52
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
Problems during the days after birth:
Convulsions: Treat with phenobarbital (see p.(?<=[.!?])\s+(?=[A-Z0-9])53); ensure hypoglycaemia is
not present (check blood glucose).
Apnoea: common after severe birth asphyxia; sometimes associated with
convulsions.(?<=[.!?])\s... | 76 | 144 | 0 | WHO-0001 | 1 | who_corpus.pdf | 366 |
The prognosis is less grim for infants
who have recovered some motor function and are beginning to suck.(?<=[.!?])\s+(?=[A-Z0-9])The
situation should be sensitively discussed with parents throughout the time
the infant is in hospital.(?<=[.!?])\s+(?=[A-Z0-9])3.6
Danger signs in newborns and young infants
Neonates a... | 76 | 145 | 1 | WHO-0001 | 1 | who_corpus.pdf | 315 |
53
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
Emergency management of danger signs:
Open and maintain airway.(?<=[.!?])\s+(?=[A-Z0-9])Give oxygen by nasal prongs if the young in-
fant is cyanosed or in severe respiratory distress or hypoxaemic (oxygen
saturation ≤ 90%).
Give bag and mask ventilation (p.(?<=[.!?]... | 77 | 146 | 0 | WHO-0001 | 1 | who_corpus.pdf | 400 |
If you cannot insert an IV drip, give expressed breast milk or
glucose through a nasogastric tube.
Give phenobarbital if convulsing (see p.(?<=[.!?])\s+(?=[A-Z0-9])53).
Admit.
Give vitamin K (if not given before).
Monitor the infant frequently (see below).(?<=[.!?])\s+(?=[A-Z0-9])3.7
Convulsions or fi ... | 77 | 147 | 1 | WHO-0001 | 1 | who_corpus.pdf | 261 |
54
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
Treat convulsions with phenobarbital (loading dose 20 mg/kg IV).(?<=[.!?])\s+(?=[A-Z0-9])If convul-
sions persist, give further doses of phenobarbital 10 mg/kg up to a maximum
of 40 mg/kg.(?<=[.!?])\s+(?=[A-Z0-9])Watch for apnoea.(?<=[.!?])\s+(?=[A-Z0-9])Always have a ba... | 78 | 148 | 0 | WHO-0001 | 1 | who_corpus.pdf | 355 |
51) are more likely to develop
serious bacterial infection.(?<=[.!?])\s+(?=[A-Z0-9])All of the danger signs listed in section 3.6 are
signs of serious bacterial infection, but there are others:
■severe jaundice
■severe abdominal distension
Localizing signs of infection are:
■signs of pneumonia (see section 4.2)... | 78 | 149 | 1 | WHO-0001 | 1 | who_corpus.pdf | 264 |
55
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
For newborns with any signs of serious bacterial infection or sepsis, give
ampicillin (or penicillin) and gentamicin as fi rst-line antibiotic treatment (for
dosages see pp.(?<=[.!?])\s+(?=[A-Z0-9])69–72)
If at greater risk of staphylococcus infection (extensive skin... | 79 | 150 | 0 | WHO-0001 | 1 | who_corpus.pdf | 391 |
Neonatal malaria is very rare.(?<=[.!?])\s+(?=[A-Z0-9])If confi rmed, treat with artesunate
or quinine (see p.(?<=[.!?])\s+(?=[A-Z0-9])158).
For supportive care, see p.(?<=[.!?])\s+(?=[A-Z0-9])56.(?<=[.!?])\s+(?=[A-Z0-9])3.9
Meningitis
Clinical signs
Suspect meningitis if signs of serious bacterial infection (see... | 79 | 151 | 1 | WHO-0001 | 1 | who_corpus.pdf | 296 |
56
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
Treatment
The fi rst-line antibiotics are ampicillin and gentamicin for 3 weeks (see
pp.(?<=[.!?])\s+(?=[A-Z0-9])69–72).
Alternatively, give a third-generation cephalosporin, such as ceftriaxone
(50 mg/kg every 12 h if < 7 days of age and 75 mg/kg after 1 week) or
... | 80 | 152 | 0 | WHO-0001 | 1 | who_corpus.pdf | 367 |
3.10
Supportive care for sick neonates
3.10.1 Thermal environment
Keep the young infant dry and well wrapped.
A hat can reduce heat loss.(?<=[.!?])\s+(?=[A-Z0-9])Keep the room warm (at least 25 °C).(?<=[.!?])\s+(?=[A-Z0-9])Keeping a
young infant in close skin-to-skin contact with the mother (Kangaroo mother ... | 80 | 153 | 1 | WHO-0001 | 1 | who_corpus.pdf | 274 |
57
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
Check regularly that the infant’s temperature is maintained in the range
36.5–37.5 °C (97.7–99.5 °F) rectal or 36.0–37.0 °C (96.8–98.6 °F) axillary.(?<=[.!?])\s+(?=[A-Z0-9])Use a low-reading thermometer to ensure detection of hypothermia.(?<=[.!?])\s+(?=[A-Z0-9])3.10.2 F... | 81 | 154 | 0 | WHO-0001 | 1 | who_corpus.pdf | 373 |
IV fl uids should ideally be given with an in-line burette to ensure the
exact doses of fl uids prescribed.(?<=[.!?])\s+(?=[A-Z0-9])Increase the amount of fl uid given over the fi rst 3–5 days (total amount, oral
plus IV).(?<=[.!?])\s+(?=[A-Z0-9])Day 1
60 ml/kg per day
Day 2
90 ml/kg per day
Day 3
120 ml/kg per day
Th... | 81 | 155 | 1 | WHO-0001 | 1 | who_corpus.pdf | 361 |
Do not use
IV glucose without sodium after the fi rst 2 days of life.(?<=[.!?])\s+(?=[A-Z0-9])Suitable alterna-
tive IV fl uids after the fi rst 2 days are half normal saline and 5% dextrose.(?<=[.!?])\s+(?=[A-Z0-9])Monitor the IV infusion very carefully (ideally through an in-line burette).
•
Use a monitoring sheet.
•... | 81 | 156 | 2 | WHO-0001 | 1 | who_corpus.pdf | 163 |
58
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
•
Weigh the infant daily.
•
Watch for facial swelling: if this occurs, reduce the IV fl uid to a minimum or
take out the IV line.(?<=[.!?])\s+(?=[A-Z0-9])Introduce breastfeeding or milk feeding by orogastric
or nasogastric tube as soon as it is safe to do so.(?<=[.!?])\s+(... | 82 | 157 | 0 | WHO-0001 | 1 | who_corpus.pdf | 325 |
Oxygen can be discontinued once the infant can maintain
saturation > 90% in room air.(?<=[.!?])\s+(?=[A-Z0-9])Nasal prongs are the preferred method for delivering oxygen to this age group,
with a fl ow rate of 0.5–1 litre/min, increased to 2 litres/min in severe respira-
tory distress to achieve oxygen saturation > 90... | 82 | 158 | 1 | WHO-0001 | 1 | who_corpus.pdf | 395 |
Start feeds within 1 h of delivery.(?<=[.!?])\s+(?=[A-Z0-9])Their mothers usually need ad-
ditional support for exclusive breastfeeding.(?<=[.!?])\s+(?=[A-Z0-9])They should be kept warm at all
times.(?<=[.!?])\s+(?=[A-Z0-9])All low-birth-weight infants are at risk of infection and should be closely
observed for infec... | 82 | 159 | 2 | WHO-0001 | 1 | who_corpus.pdf | 159 |
59
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
3.11.2 Infants with a birth weight < 2.0 kg (< 35 weeks’ gestation)
All infants with a gestation < 35 weeks or a birth weight < 2.0 kg should be
admitted to a special care unit.(?<=[.!?])\s+(?=[A-Z0-9])These infants are at risk of hypothermia, feeding
problems, apnoea, resp... | 83 | 160 | 0 | WHO-0001 | 1 | who_corpus.pdf | 376 |
If any of these signs is present, it should be closely monitored.(?<=[.!?])\s+(?=[A-Z0-9])Management
of common problems is discussed below.(?<=[.!?])\s+(?=[A-Z0-9])Preventing hypothermia
Low-birth-weight neonates (weighing < 2000 g) who are clinically stable
should be given Kangaroo mother care
starting soon after b... | 83 | 161 | 1 | WHO-0001 | 1 | who_corpus.pdf | 370 |
Incubators should be washed
with disinfectant between infants and
should be of a basic design that can be
used appropriately by the staff available.(?<=[.!?])\s+(?=[A-Z0-9])Position for Kangaroo mother care
of young infant.(?<=[.!?])\s+(?=[A-Z0-9])Note: After wrapping
the child, cover the head with a cap to
preve... | 83 | 162 | 2 | WHO-0001 | 1 | who_corpus.pdf | 141 |
60
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
Feeding
Many low-birth-weight infants will be able to suckle at the breast.(?<=[.!?])\s+(?=[A-Z0-9])Infants who
can suckle should be breastfed.(?<=[.!?])\s+(?=[A-Z0-9])Those who cannot breastfeed should be given
expressed breast milk with a cup and spoon.(?<=[.!?])\s+(?=[A... | 84 | 163 | 0 | WHO-0001 | 1 | who_corpus.pdf | 395 |
Special feeding considerations for infants weighing < 1.5 kg at birth
These infants are at the highest risk of feeding problems and necrotizing
enterocolitis.(?<=[.!?])\s+(?=[A-Z0-9])The smaller the infant, the higher the risk.
•
Starting on the fi rst day, give 10 ml/kg per day of enteral feeds, preferably
expressed... | 84 | 164 | 1 | WHO-0001 | 1 | who_corpus.pdf | 366 |
Very low-birth-weight infants
may need a 10% glucose solution.(?<=[.!?])\s+(?=[A-Z0-9])Add 10 ml of 50% glucose to every 90 ml
of 4.3% glucose + 0.18% normal saline, or use 10% glucose in water solution.
•
Start enteral feeding when the condition of the infant is stable and there is no
abdominal distension or tend... | 84 | 165 | 2 | WHO-0001 | 1 | who_corpus.pdf | 325 |
61
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
each day.(?<=[.!?])\s+(?=[A-Z0-9])Reduce or withhold feeds if there are signs of poor tolerance.(?<=[.!?])\s+(?=[A-Z0-9])Aim to establish feeding within the fi rst 5–7 days so that the IV drip can be
removed, to avoid infection.
•
The feeds may be increased during the fi rst ... | 85 | 166 | 0 | WHO-0001 | 1 | who_corpus.pdf | 384 |
Caffeine is preferred if it is available.
The loading dose of caffeine citrate is 20 mg/kg orally or IV (given slowly
over 30 min).(?<=[.!?])\s+(?=[A-Z0-9])A maintenance dose of 5 mg/kg per day should be prescribed
24 h later and can be increased by 5 mg/kg every 24 h to a maximum of
20 mg/kg per day, unless si... | 85 | 167 | 1 | WHO-0001 | 1 | who_corpus.pdf | 348 |
3.11.3 Common problems of low-birth-weight infants
Respiratory distress syndrome
Preterm infants are at risk for respiratory distress syndrome due to surfactant
defi ciency.(?<=[.!?])\s+(?=[A-Z0-9])This can be reduced if pregnant mothers at risk for premature de-
livery (e.g. premature contractions or premature rupture... | 85 | 168 | 2 | WHO-0001 | 1 | who_corpus.pdf | 182 |
62
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
limiting condition, because birth triggers an increase in surfactant production.(?<=[.!?])\s+(?=[A-Z0-9])The challenge is to support the infant for the fi rst few days of life until such
time as the defi ciency resolves.(?<=[.!?])\s+(?=[A-Z0-9])The key clinical features usuall... | 86 | 169 | 0 | WHO-0001 | 1 | who_corpus.pdf | 383 |
If there is persistent respiratory distress or hypoxaemia, do chest X-ray to
check for pneumothorax.(?<=[.!?])\s+(?=[A-Z0-9])Necrotizing enterocolitis
Necrotizing enterocolitis (a bowel infection) may occur in low-birth-weight
infants, especially after enteral feeds are started.(?<=[.!?])\s+(?=[A-Z0-9])The condition ... | 86 | 170 | 1 | WHO-0001 | 1 | who_corpus.pdf | 183 |
63
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
■bile-stained vomit or bile-stained fl uid up the nasogastric tube
■blood in the stools
General signs of systemic illness include
■apnoea
■drowsiness or unconsciousness
■fever or hypothermia
Treatment
Stop enteral feeding.
Pass a nasogastric tube and leave it... | 87 | 171 | 0 | WHO-0001 | 1 | who_corpus.pdf | 398 |
If there is gas in the
abdominal cavity outside the bowel, there may be bowel perforation.(?<=[.!?])\s+(?=[A-Z0-9])Ask a
surgeon to see the infant urgently.(?<=[.!?])\s+(?=[A-Z0-9])Examine the infant carefully each day.(?<=[.!?])\s+(?=[A-Z0-9])Reintroduce expressed breast milk feeds
by nasogastric tube when the abdo... | 87 | 172 | 1 | WHO-0001 | 1 | who_corpus.pdf | 388 |
64
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
Counselling on discharge
Counsel parents before discharge on
•
exclusive breastfeeding
•
keeping the infant warm
•
danger signs for seeking care
Low-birth-weight infants should be followed up weekly for weighing and as-
sessment of feeding and general health, until they ha... | 88 | 173 | 0 | WHO-0001 | 1 | who_corpus.pdf | 389 |
65
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
■infants if palms and soles are yellow at any age.(?<=[.!?])\s+(?=[A-Z0-9])The investigations depend on the probable diagnosis and what tests are avail-
able but may include:
•
Hb or packed cell volume
•
full blood count to identify signs of serious bacterial infection (h... | 89 | 174 | 0 | WHO-0001 | 1 | who_corpus.pdf | 361 |
The serum bilirubin levels are
included in case exchange transfusion is possible or if the infant can be transferred quickly
and safely to another facility where exchange transfusion can be performed.
b Risk factors include small size (< 2.5 kg at birth or born before 37 weeks’ gestation), haemolysis
and sepsis.
c ... | 89 | 175 | 1 | WHO-0001 | 1 | who_corpus.pdf | 101 |
66
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
Continue phototherapy until the serum bilirubin level is lower than the threshold
range or until the infant is well and there is no jaundice of palms and soles.(?<=[.!?])\s+(?=[A-Z0-9])If the bilirubin level is very high (see table) and you can safely do exchange
transfusio... | 90 | 176 | 0 | WHO-0001 | 1 | who_corpus.pdf | 395 |
Review 48 h after starting treatment
if the child is not improving.(?<=[.!?])\s+(?=[A-Z0-9])Severe
conjunctivitis (a lot of pus and/or
swelling of the eyelids) is often due to
gonococcal infection.(?<=[.!?])\s+(?=[A-Z0-9])Treat as inpa-
tient, as there is a risk for blindness,
and twice-daily review is needed.
... | 90 | 177 | 1 | WHO-0001 | 1 | who_corpus.pdf | 179 |
67
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
IM once) or kanamycin (25 mg/kg up to a maximum total dose of 75 mg IM
once), according to national guidelines.(?<=[.!?])\s+(?=[A-Z0-9])Also use as described above:
tetracycline eye ointment or
chloramphenicol eye ointment
Also treat the mother and her partner for s... | 91 | 178 | 0 | WHO-0001 | 1 | who_corpus.pdf | 387 |
If you suspect syphilis, do a VDRL test if possible.(?<=[.!?])\s+(?=[A-Z0-9])INFANTS OF MOTHERS WITH INFECTIOUS DISEASES | 91 | 179 | 1 | WHO-0001 | 1 | who_corpus.pdf | 44 |
68
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
Treatment
Asymptomatic neonates born to women with a positive VDRL or rapid
plasma reagin test should receive 37.5 mg/kg (50 000 U/kg) of benzathine
benzylpenicillin in a single IM dose.
Symptomatic infants should be treated with:
– procaine benzylpenicillin at 50... | 92 | 180 | 0 | WHO-0001 | 1 | who_corpus.pdf | 386 |
115).
•
If the infant is doing well and tests are negative, continue prophylactic
isoniazid to complete 6 months of treatment.
•
Delay BCG vaccination until 2 weeks after treatment is completed.(?<=[.!?])\s+(?=[A-Z0-9])If BCG
has already been given, repeat 2 weeks after the end of isoniazid treatment.(?<=[.!?])\s+(... | 92 | 181 | 1 | WHO-0001 | 1 | who_corpus.pdf | 151 |
69
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
DOSES OF COMMON DRUGS FOR NEONATES AND LOW-BIRTH-WEIGHT INFANTS
3.14
Doses of common drugs for neonates and low-birth-weight infants
Drug
Dosage
Form
Weight of infant in kg
1–< 1.5
1.5–< 2
2–2.5
2.5–< 3
3–3.5
3.5–< 4
4–< 4.5
Aminophylline
to prevent
apnoea
Calculate the e... | 93 | 182 | 0 | WHO-0001 | 1 | who_corpus.pdf | 292 |
Ampicillin
IM/IV: 50 mg/
kg First week of
life: every 12 h
Weeks 2–4 of life:
every 8 h
Vial of 250 mg
mixed with
1.3 ml sterile
water to 250
mg/1.5 ml
0.3–
0.6 ml
0.6–
0.9 ml
0.9–
1.2 ml
1.2–
1.5 ml
1.5–
2.0 ml
2.0–
2.5 ml
2.5–
3.0 ml
Caffeine citrate
Calculate the exact oral maintenance dose
Loading dose:
Oral... | 93 | 183 | 1 | WHO-0001 | 1 | who_corpus.pdf | 213 |
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
70
3. YOUNG INFANTS\nDrug\nDosage\nForm\nWeight of infant in kg\n1–< 1.5\n1.5–< 2\n2–2.5\n2.5–< 3\n3–3.5\n3.5–< 4\n4–< 4.5\nCefotaxime\nIV: 50 mg/kg\nPremature infants: \nevery 12 h \nFirst week of life: \nevery 8 h \nWeeks 2–4 of life: \nevery 6 h\nVial of 500 mg \nmixed with 2... | 94 | 184 | 0 | WHO-0001 | 1 | who_corpus.pdf | 398 |
1.75 ml\n3–3.5 ml\n1.75–\n2 ml\n3.5–4 ml\n2–2.5 ml\n4–4.5 ml\nCloxacillin\n25–50 mg/kg per \ndose \nFirst week of life: \nevery 12 h \nWeeks 2–4 of life: \nevery 8 h\n25-mg vial \nmixed with \n1.3 ml sterile \nwater to 250 \nmg/1.5 ml\n25 mg/kg: \n0.15–\n0.3 ml \n50 mg/kg: \n0.3–\n0.6 ml \n0.3–\n0.5 ml\n0.6–\n0.9 ml\n0... | 94 | 185 | 1 | WHO-0001 | 1 | who_corpus.pdf | 280 |
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
71
Drug
Dosage
Form
Weight of infant in kg
1–< 1.5
1.5–< 2
2–2.5
2.5–< 3
3–3.5
3.5–< 4
4–< 4.5
Gentamicin
Preferably calculate exact dose based on the infant’s weight
First week of life:
Low-birth-weight
infants: IM/IV: 3
mg/kg once a day
Normal birth
weight: IM/IV: 5
mg/k... | 95 | 186 | 0 | WHO-0001 | 1 | who_corpus.pdf | 320 |
Kanamycin
IM/IV: 20 mg/
kg (one dose for
pus draining from
eyes)
2-ml vial to
make 125
mg/ml
0.2–
0.3 ml
0.3–
0.4 ml
0.4–
0.5 ml
0.5–
0.6 ml
0.6–
0.7 ml
0.7–
0.8 ml
0.8–
1.0 ml
Naloxone
0.1 mg/kg
Vial 0.4 mg/ml
0.25 ml
0.25 ml
0.5 ml
0.5 ml
0.75 ml
0.75 ml
1 ml
PENICILLIN
Benzylpenicillin
50 000 U/kg per
dose
Fi... | 95 | 187 | 1 | WHO-0001 | 1 | who_corpus.pdf | 218 |
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
72
Drug
Dosage
Form
Weight of infant in kg
1–< 1.5
1.5–< 2
2–2.5
2.5–< 3
3–3.5
3.5–< 4
4–< 4.5
Benzathine
benzylpenicillin
50 000 U/kg once
a day
IM: vial of
1 200 000 U
mixed with 4 ml
sterile water
0.2 ml
0.3 ml
0.4 ml
0.5 ml
0.6 m... | 96 | 188 | 0 | WHO-0001 | 1 | who_corpus.pdf | 288 |
73
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
Notes | 97 | 189 | 0 | WHO-0001 | 1 | who_corpus.pdf | 31 |
74
3.(?<=[.!?])\s+(?=[A-Z0-9])YOUNG INFANTS
Notes | 98 | 190 | 0 | WHO-0001 | 1 | who_corpus.pdf | 31 |
75
4.(?<=[.!?])\s+(?=[A-Z0-9])COUGH
CHAPTER 4
Cough or diffi culty in breathing
Cough and diffi culty in breathing are common problems in young children.(?<=[.!?])\s+(?=[A-Z0-9])The
causes range from a mild, self-limited illness to severe, life-threatening disease.(?<=[.!?])\s+(?=[A-Z0-9])This chapter provides guideline... | 99 | 191 | 0 | WHO-0001 | 1 | who_corpus.pdf | 244 |
Management of these problems in infants < 2 months of age is described
in Chapter 3 and management in severely malnourished children in Chapter 7.(?<=[.!?])\s+(?=[A-Z0-9])4.1 Child presenting with cough
76
4.2 Pneumonia
80
4.2.1 Severe pneumonia
80
4.2.2 Pneumonia
86
4.3 Complications of pneumonia
88
4.3.1 ... | 99 | 192 | 1 | WHO-0001 | 1 | who_corpus.pdf | 246 |
76
4.(?<=[.!?])\s+(?=[A-Z0-9])COUGH
Most episodes of cough are due to the common cold, each child having several
episodes a year.(?<=[.!?])\s+(?=[A-Z0-9])The commonest severe illness and cause of death that presents
with cough or diffi cult breathing is pneumonia, which should be considered
fi rst in any differential ... | 100 | 193 | 0 | WHO-0001 | 1 | who_corpus.pdf | 343 |
Not all children will show every symptom or sign.(?<=[.!?])\s+(?=[A-Z0-9])General
■central cyanosis
■apnoea, gasping, grunting, nasal fl aring, audible wheeze, stridor
■head nodding (a movement of the head synchronous with inspiration indicat-
ing severe respiratory distress)
■tachycardia
■severe palmar pall... | 100 | 194 | 1 | WHO-0001 | 1 | who_corpus.pdf | 146 |
77
4.(?<=[.!?])\s+(?=[A-Z0-9])COUGH
■lower chest wall indrawing
■hyperinfl ated chest
■apex beat displaced or trachea shifted from midline
■raised jugular venous pressure
■on auscultation, coarse crackles, no air entry or bronchial breath sounds
or wheeze
■abnormal heart rhythm on auscultation
■percussio... | 101 | 195 | 0 | WHO-0001 | 1 | who_corpus.pdf | 379 |
78
4.(?<=[.!?])\s+(?=[A-Z0-9])COUGH
Table 6.(?<=[.!?])\s+(?=[A-Z0-9])Continued
Diagnosis
In favour
Effusion or
empyema
– Reduced movement on affected side of chest
– Stony dullness to percussion (over the effusion)
– Air entry absent (over the effusion)
Asthma or
wheeze
– Recurrent episodes of shortness of breath... | 102 | 196 | 0 | WHO-0001 | 1 | who_corpus.pdf | 366 |
79
4.(?<=[.!?])\s+(?=[A-Z0-9])COUGH
Table 6.(?<=[.!?])\s+(?=[A-Z0-9])Continued
Diagnosis
In favour
Tuberculosis
– Chronic cough (> 14 days)
– History of contact with TB patient
– Poor growth, wasting or weight loss
– Positive Mantoux test
– Diagnostic chest X-ray may show primary complex or
miliary TB
– Sputum p... | 103 | 197 | 0 | WHO-0001 | 1 | who_corpus.pdf | 308 |
80
4.(?<=[.!?])\s+(?=[A-Z0-9])COUGH
4.2
Pneumonia
Pneumonia is caused by viruses or bacteria.(?<=[.!?])\s+(?=[A-Z0-9])It is usually not possible to
determine the specifi c cause of pneumonia by clinical features or chest X-ray
appearance.(?<=[.!?])\s+(?=[A-Z0-9])Pneumonia is classifi ed as severe or non-severe on the... | 104 | 198 | 0 | WHO-0001 | 1 | who_corpus.pdf | 228 |
Severe pneumonia may require additional supportive care, such as oxygen,
to be given in hospital.(?<=[.!?])\s+(?=[A-Z0-9])4.2.1
Severe pneumonia
Diagnosis
Cough or diffi culty in breathing, plus at least one of the following:
■central cyanosis or oxygen saturation < 90% on pulse oximetry
■severe respiratory distr... | 104 | 199 | 1 | WHO-0001 | 1 | who_corpus.pdf | 257 |
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