ANTIBIOTICS*

AMPICILLIN IM 50mg/kg

Preparation: Powder for injection 500mg and 1 g vials- add 1.7 mL of water for injection to the 500 mg vial for reconstitution to make 250 mg/mL solution OR add 3.3 mL of water for injection to the 1 g vial for reconstitution to make 250 mg/mL solution. Use table on page 35 to determine the dose to be injected according to the child's weight.

Injection: Administer by intramuscular injection into the upper outer thigh.

GENTAMICIN IM 3mg/kg if <2kg OR 5mg/kg if >2kg

Preparation: ampoule of 80mg/2mL, no dilution needed for IM administration. Use table on page 35 to determine the dose according to weight

Injection: Administer by intramuscular injection into the upper outer thigh.

* Infants with SEVERE JAUNDICE as ONLY danger sign and > 24hs of life DON'T need to receive antibiotics NOTE: for IM injections use appropriate antiseptic solution to disinfect the skin. Never inject into the deltoid (arm) or gluteal muscle; rotate sites if more than one injection.

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Malaria high-transmision areas:

If malaria RDT POSITIVE or NOT DONE (not available): treat for SEVERE MALARIA (OR POSSIBLE) ARTESUNATE IM 3mg/kg Preparation: Artesunate powder 60mg: dissolve the powder in 1 mL of sodium bicarbonate; then add 2mL of NaCl 0.9; this results in a solution of 3mL, containing 20mg of Artesunate per mL. Use table on page 35 to determine the dose to be injected according to the child's weight.

Injection: Administer by intramuscular injection into the upper outer thigh.

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Prevent or treat HYPOGLYCAEMIA (low blood sugar)Treat for hypoglycaemia* with: sublingual glucose 50% 1mL/kg OR NGT/OGT dextrose 10% or sugar water** 5mL/kg if child is unconscious/seizuring. To prevent hypoglycaemia, if the child is conscious tell the mother to continue breastfeeding every 2-3 hours; if breastfeeding is not possible give 10ml/kg of dextrose 10% or sugar water every 2-3hs PO or if unconscious via NGT/OGT.

* If glucometer is available test before treating; if blood glucose level is < 45mg/dL (2.5mmol/L) in the 1st day of life or <60mg/dL (3.3mmol/L) from day 2 onwards treat as indicated above

** To prepare sugar water: disolve 1 teaspoon of sugar in 50mL of water

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Low body temperature (<35.5ºC): explain the caretaker how to keep the infant warm by holding the baby in skin-to-skin contact and cover the head with a hat or, if skin-to-skin not possible or acceptable, cover the head with a hat and wrap the infant in warm dry clothes.

High body temperature (≥37.5ºC): remove blankets and covers. If temperature is still ≥ 37.5ºC and the infant looks in pain or diconfort give paracetamol PO 10mg/kg (oral suspension 120mg/5ml, see table on page 35 for dose according to weigh) if the child can swallow.

If the infant shows signs of VERY SEVERE DISEASE but can't be referred to hospital, explain to the caretaker that ambulatory antibiotic treatment can be provided. In the next page you'll find the suggested schemes according to the child's characteristics and clinical presentation.

Schedule daily (or twice a day) follow-up appointments for at least 7 days, and at each appointment: if referral becomes feasible refer urgently or if referral is not feasible continue giving the prescibed treatment for 7 days. At each contact with the patient reassess the young infant and treat if any new problem. Use a follow-up form to keep track of the treatment administered.

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Treat and prevent HYPOGLYCAEMIA (low blood sugar)Treat for hypoglycaemia* with: sublingual glucose 50% 1mL/kg OR NGT/OGT dextrose 10% or sugar water** 5mL/kg if child is unconscious/convulsing. To prevent hypoglycaemia, if the child is conscious tell the mother to continue breastfeeding every 2-3 hours; if unconscious give 10ml/kg of dextrose 10% or sugar water every 2-3hs via NGT/OGT at the health facility.

* If glucometer is available test before treating; if BGL is < 45mg/dL (2.5mmol/L) in the 1st day of life or <60mg/dL (3.3 mmol/L) from day 2 onwards treat as indicated above

** To prepare sugar water: disolve 1 teaspoon of sugar in 50mL of water6If

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Low body temperature (<35.5ºC): explain the caretaker how to keep the infant warm by holding the baby in skin-to-skin contact and cover the head with a hat or, if skin-to-skin not possible or acceptable, cover the head with a hat and wrap the infant in warm dry clothes. High body temperature (≥37.5ºC): remove blankets and covers. If temperature is still ≥ 37.5ºC and the infant looks in pain or diconfort give paracetamol PO 10mg/kg (oral suspension 120mg/5ml, see table on page 35 for dose according to weigh) if the child can swallow.

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Malaria high-transmision areas: if malaria RDT POSITIVE or NOT DONE (not available): treat for SEVERE MALARIA (OR POSSIBLE)ARTESUNATE IM 3mg/kg three doses, one every 12 hours (hours 0-12-24)Preparation: Artesunate powder 60mg: dissolve the powder in 1 mL of sodium bicarbonate; then add 2mL of NaCl 0.9; this results in a solution of 3mL, containing 20mg of Artesunate per mL. Use table on page 35 to determine the dose to be injected according to the child's weight.Injection: Administer by intramuscular injection into the upper outer thigh.

After the third IM dose, if referral is still not feasible and the patient can swallow, continue with PO Artemether 20mg/Lumefantrine 120mg or Artesunate/amodiaquine for 3 days (see dose and posology in page 35). Otherwise, continue with injectable Artesunate once a day for a total of 7 days.

Administration of IM antibiotics: intramuscular injection into the upper outer thigh. NOTE: for IM injections use appropriate antiseptic solution to disinfect the skin. Never inject into the deltoid (arm) or gluteal muscle; rotate sites if more than one injection.