3.8 Follow-up visits and care for the sick young infant
Follow-up visits are recommended for young infants who are classified as having local bacterial infection and jaundice. You assess a sick young infant differently at a follow-up visit from how you do at an initial visit. Once you know that the young infant has been brought to the clinic for a follow-up visit, you should ask the mother whether there are any new problems. If the infant has a new problem then you should carry out a full assessment as if it were an initial visit.
If the young infant does not have a new problem and was previously assessed as having a local bacterial infection then you should follow the steps outlined in Box 3.4 below.
The instructions for follow-up care of local bacterial infection and jaundice can be found in the ‘young infant’ chart.
Box 3.4 Follow-up care for a young infant with local bacterial infection
Two days after initial assessment:
- Look at the umbilicus. Is it red or draining pus? Does the redness extend to the skin?
- Look at the skin pustules. Are there many or severe pustules?
Treatment:
- If the pus or redness remains the same or is worse, refer the infant to hospital.
- If the pus and redness have improved, tell the mother to continue giving the five days of antibiotic and treating the local infection at home.
If the young infant was previously assessed for jaundice, follow the steps in Box 3.5 below.
Box 3.5 Follow-up care for a young infant with jaundice
If the young infant was previously assessed as having jaundice then you should follow the steps outlined below.
Two days after initial assessment:
- Check for danger signs in the newborn
- Counsel and support optimal breastfeeding
- Follow-up of kangaroo mother care
- Follow-up of counselling given during previous visits
- Counsel mother/family to protect baby from infection
- Give one capsule of 200,000 IU vitamin A to the mother if not given before
- Immunize the baby with OPV and BCG if not given before.
Ask about new problems.
Look for jaundice — are the palms and soles yellow?
- If the palms and soles are yellow, or the infant is aged 14 days or more, refer the infant to hospital.
- If the palms and soles are not yellow and the infant is less than 14 days old, and jaundice has not decreased, advise the mother on home care, when to return immediately and ask her to return for a follow-up visit in two days.
- If the jaundice has started decreasing, reassure the mother and ask her to continue home care. Ask her to return for a follow-up visit when the infant is two weeks old. If the jaundice continues beyond two weeks of age, refer the infant to the hospital.
In this section you have looked at how to provide follow-up care for the sick young infant. During the follow-up visit you should see if the mother is following your advice from the previous visits and ask her if there any new problems. If there are, then you will need to do another full assessment of the young infant.
3.7.2 Treatment for a young infant who does not need urgent referral