CHAPTER 36

INFECTION PREVENTION, IMMUNIZATION AND MINOR DISORDERS OF NEWBORN

KEY TERMS

• Immunization is a process of developing the immunity against a particular infection by injecting the antigen (infectious agent) actively.
• Immunity is defined as the ability of the body to fight against the infectious agents resulting in life the threatening diseases.
• Antigen is the infectious agent that has the ability to affect or deteriorate the immunity of the individual’s body once present in the body.
• Antibody is the blood protein produced in response to and counteracting a specific antigen.
• Vaccine is a substance used to stimulate the immunity to a particular infectious agent of a pathogen, typically prepared from an inactivated or weakened form of the causative agent or from its constituents or products.

INFECTION PREVENTION IN NEWBORN

Newborns are the ones with low immunity to fight against the infectious agents surrounding them. They have a higher chance of getting infected just after delivery because of the physiological changes to adapt to the extrauterine life.

Prevention of Infection

Steps of handwashing

Categories of biomedical waste management

IMMUNIZATION

Immunization is the process of getting the vaccine and becoming immune to the disease after vaccination.

Immunity

Immunity is the resistance offered by the host to the harmful effects of pathogenic microbial infection.

Types of immunity

Types of immunity

Acquired Immunity

Vaccines

Vaccine are the active immunizing agents, immun-obiological substance designed to produce specific protection against a given disease. It stimulates the production of protective antibodies.

Cold Chain

It is the system of storage and transport of vaccines at optimum temperature = (2-8°C) from manufacturers to the site of vaccinations. This cold chain is needed because vaccines are sensitive to heat and they may also lose their potency if not stored and transported at optimum temperature.

Storage of vaccines

MINOR DISORDERS OF NEWBORN AND ITS MANAGEMENT

Ophthalmia Neonatorum

Ophthalmia neonatorum is defined as any purulent discharge from an eye of an infant within 30 days of birth. Numerous etiologies have been implicated including chemical conjunctivitis as well as viral and bacterial infections.

Causative Agents

Treatment

Chloramphenicol is commonly used but erythromycin or gentamicin should be used for chlamydial infection and polymyxin for P. aeroginosa.

Oral Thrush and Perianal Thrush

Candidiasis in the mouth and throat is also called thrush or oropharyngeal candidiasis. Candidiasis in the esophagus (the tube that connects the throat to the stomach) is called esophageal candidiasis or Candida esophagitis.

Symptoms

Treatment

Topical application of nystatin or amphotericin cream, clotrimoxazole or miconazole suspension is done as prescribed by the physician. The suspension is swabbed inside the infant’s mouth three times a day for 5 days.

Paronychia

Paronychia is an infection of the proximal and lateral toenail and fingernail folds which may occur spontaneously or following trauma or manipulation. It is one of the most common infections of the hand, and it is essential to know how to treat it appropriately.

Classification

Treatment

In the early stages, dabbing with chlorhexidine 0.5% in spirit may be sufficient to dry up the whitlow. The baby’s hand should be enclosed in a mitten in order to prevent him from touching his eyes with it.

Omphalitis

Omphalitis is an infection of the umbilicus and/ or surrounding tissues, occurring primarily in the neonatal period.

Etiology

Treatment

Neonatal Mastitis

This condition occurs due to the squeezing of the newborn’s breasts, which are enlarged due to the effect of maternal hormones.

Causes

• Hypertrophy of the breast in female infants.
• Bacterial infection: Staphylococcus aureus, Escherichia coli, Salmonella Group B Streptococcus.

Sign and Symptoms

Treatment

Antibiotic therapy:

• Parenteral betalactamase–resistant penicillin and adding an aminoglycoside.
• If an abscess forms, incision and drainage are done.

Rhinitis

It is an inflammation of the mucous membrane of the nose.

Causes

• It happens when hormones from the mother are passed to the baby at birth.
• Bacterial infection: Staphylococcus.

Signs and Symptoms

• Baby may have noisy breathing, may snort or have nasal congestion.
• If the congestion is severe it may be hard for your baby to feed.

Diagnostic Tests

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• History and physical examination

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• Culture report of any nasal sample

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Treatment

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• Oxymetazalone (Afrin®) or Decadron® drops will be prescribed. These drops will help in reducing congestion and swelling inside the nose.

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• Ephedrine nasal drops 0.25% are administered as babies are compulsive nose breathers.

Nursing Management

Vomiting

Vomiting is a forcible ejection of gastric content.

Causes

• Gastric irritation
• Toxic effect on vomiting center
• Reflex vomiting
• Obstruction of the digestive tract
• Increased intracranial tension
• Metabolic disorders
• Emotional disturbances

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Management

Abdominal Distension

Children with periodic abdominal distension should be referred to a paediatrician.

Causes

Clinical Features

Diagnostic Test

• The history of passing stools and urine should be found out.
• X-ray of the abdomen may be taken.

Management

Constipation

Prolonged straining and forceful effort of defection with the passage of hard stool is called constipation. Many symptoms accompany constipation such as irritability, lack of sleep, nausea, refusal of feeds, abdominal distensions, and abdominal pain.

Classification of Constipation

Causes

Warning Signs of Constipation in Neonates

Passage of meconium more than 48 hours after delivery, small-caliber stools, failure to thrive, fever, bloody diarrhea, bilious vomiting, tight anal sphincter, and empty rectum with palpable abdominal fecal mass.

Management

• Laxatives, suppositories or enema will be given as per prescription.

Pain in Infants

Pain is subjective, personal and causes the sensation of discomfort. It can be classified into three types:

Management