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challenging as they require updating national essential medicine lists and building consensus at national level.
Establishing national standards for hospital care for children is critical in improving quality of care and is a major component of the quality improvement
process. Countries will be encouraged to set up national technical working groups to support the national adaptation process with the involvement of all stakeholders.
he standards will then be adapted and endorsed by stakeholders, locally translated as required, and disseminated to all hospitals in the country. In most cases, it may
require orientation of the health workers on the new case management protocols as part of the quality of care improvement process.
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4. Recommendations
Recommendations for management of newborn conditions 4.1
Vitamin K prophylaxis in newborns
a All newborns should be given 1 mg of vitamin K intramuscularly IM ater birth i.e. ater the irst hour by which the infant should be in skin-to-skin contact with
the mother and breastfeeding should be initiated.
Strong recommendation, moderate quality evidence
b Neonates requiring surgical procedures, those with birth trauma, preterm newborns, and those exposed in utero to maternal medication known to interfere
with vitamin K are at especially high risk of bleeding and must be given vitamin K 1 mg IM.
Strong recommendation, moderate quality evidence
4.2 Prophylactic antibiotics in newborns with risk factors for infection
A neonate with risk factors for infection i.e. membranes ruptured 18 hours before delivery, mother had fever 38 °C before delivery or during labour, or amniotic luid
was foul smelling or purulent should be treated with the prophylactic antibiotics ampicillin IM or intravenously, IV and gentamicin for at least 2 days. Ater 2 days,
the neonate should be reassessed and treatment continued only if there are signs of sepsis or a positive blood culture.
Weak recommendation, very low quality evidence
4.3 Skin-to-skin contact in the first hour of life
Newborns without complications should be kept in skin-to-skin contact with their mothers during the irst hour ater birth to prevent hypothermia and promote
breastfeeding.
Strong recommendation, low quality evidence
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4.4 Management of neonatal jaundice
a Term and preterm newbors with hyperbilirubinaemia should be treated with phototherapy or exchange transfusion guided by the following cut-of levels of
serum hyperbilirubinaemia:
AGE PHOTOTHERAPY
EXCHANGE TRANSFUSION HEALTHY NEWBORNS
≥35 WEEKS GESTATION NEWBORNS
35 WEEKS GESTATION OR ANY RISK FACTORS
HEALTHY NEWBORNS ≥35 WEEKS GESTATION
NEWBORNS 35 WEEKS GESTATION
OR ANY RISK FACTORS
Day 1 Any visible jaundice
260 mmoll 15 mgdL
220 mmoll 10 mgdL
Day 2 260 mmoll
15 mgdL 170 mmoll
10 mgdL 425 mmoll
25 mgdL 260 mmoll
15 mgdL Day
≥3 310 mmoll
18 mgdL 250 mmoll
15 mgdL 425 mmoll
25 mgdL 340 mmoll
20 mgdL
Weak recommendation, very low quality evidence
b Clinicians should ensure that all newborns are routinely monitored for the development of jaundice and that serum bilirubin should be measured in those at
risk: — in all babies if jaundice appears on day 1
— in preterm babies 35 weeks if jaundice appears on day 2 — in all babies if palms and soles are yellow at any age
Strong recommendation, very quality evidence
c Phototherapy should be stopped once serum bilirubin is 50 mmoll 3 mgdl or below the phototherapy threshold.
Weak recommendation, expert opinion
4.5 Empirical antibiotics for suspected neonatal sepsis
a Neonates with signs of sepsis should be treated with ampicillin or penicillin and gentamicin as the irst line antibiotic treatment for at least 10 days.
Strong recommendation, low quality of evidence
b If a neonate with sepsis is at greater risk of staphylococcus infection e.g. extensive skin pustules, abscess, or omphalitis in addition to signs of sepsis, they should be
given cloxacillin and gentamicin instead of penicillin and gentamicin.
Strong recommendation, expert opinion
c Where possible, blood cultures should be obtained before starting antibiotics. If an infant does not improve in 2–3 days, antibiotic treatment should be changed,
or the infant should be referred for further management.
Strong recommendation, expert opinion
