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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
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4.6 Head or whole body cooling in management of hypoxic ischaemic
encephalopathy
Head or whole body cooling should not be done outside well-resourced, tertiary neonatal intensive care units, because there is potential for harm from this therapy
in low-resource settings.
Strong recommendation, moderate quality evidence
4.7 Antibiotics for treatment of necrotizing enterocolitis
Young neonates with suspected necrotizing enterocolitis NEC should be treated with IV or IM ampicillin or penicillin and gentamicin as irst line antibiotic
treatment for 10 days.
Strong recommendation, low quality evidence
4.8 Kangaroo Mother Care
Low birth weight LBW neonates weighing 2000 g who are clinically stable should be provided Kangaroo Mother Care KMC early in the irst week of life.
Strong recommendation, moderate quality evidence
4.9 Prevention of hypothermia immediately after birth in LBW infants
LBW neonates weighing 1200g who do not have complications and are clinically stable should be put in skin-to-skin contact with the mother soon ater birth and
ater drying them thoroughly to prevent neonatal hypothermia.
Weak recommendation, low quality evidence
Recommendations for treatment of cough and difficulty in breathing 4.10
Treatment of non-severe pneumonia with wheeze
Antibiotics are not routinely recommended for children aged 2–59 months with non- severe pneumonia i.e. fast breathing with no chest indrawing or danger sign with
a wheeze but no fever temperature 38 °C, as the cause is most likely to be viral.
Strong recommendation, low quality evidence
4.11 Antibiotic treatment for non-severe pneumonia with no wheeze
a Children with non-severe pneumonia i.e. fast breathing with no chest indrawing or danger sign should be treated with oral amoxicillin. he exception is in patients
with HIV: — With low HIV prevalence, give amoxicillin at least 40mgkgdose twice daily
for 3 days.
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