Technical Training on HBNC

Session-IVaIdentification of signs and actions

– Sepsis in new bornSigns of generalized sepsis in newborn and action to

be taken

Skin infection care

Hypothermia care

Fever and or chest indrawing

Hyperthermia and pneumonia

Hyperthermia care

Umbilical sepsis

Eye infection-Swollen or with pus

Cracks or redness on the skin fold

(Thigh/Axilla/Buttock)

SepsisGeneralized sepsis in newborn

All limbs limp

Feeding less or has

stopped feeding

Weak cry or the baby has

stopped crying

Action – Refer the baby to the nearest health facility to consult a medical doctor

Skin infection

Mild

Treat skin pustules and

blisters or local skin

infection by 0.25%

Gentian Violet (GV) in

children under 2 months

(eg newborns)

Treat skin pustules and

blisters or local skin

infection by 0.5% Gentian

Violet (GV) in children

over 2 months

Skin infectionModerate to severe

Skin infection-Severe

rash with Pus filled

Pustule and blisters.

There multiple pus points

on the body of the baby.

Action - Referral of the baby to

the nearest health facility to

consult a medical doctor for

treatmentSevere

Moderate

Hypothermia care

The baby is having

low body temperature

below 35.5oC (95.5oF.

The baby is suffering

from infection and is

having sepsis.

Action - Wrap the baby in the cloth with head covered and keep closer to the

mother. The baby needs to be referred to the nearest health facility keeping the

baby warm.

Fever and or chest indrawing

The baby has a

temperature above

37.2oC (98.96≈99oF).

The baby is suffering

from infection and is

having sepsis.

Action – Referral of the baby to the nearest health facility for consultation with a

medical doctor.

Pneumonia in newborn

The baby has a

temperature above

37.2oC (98.96≈99oF)

with breath rate of

above 60/minute and

there is indrawing of

chest. The baby is

suffering from

pneumonia.

Action – Referral of the baby to the nearest health facility for consultation with a

medical doctor.

Temperature above 37.2oC (98.96≈99oF)

Unwrap the baby and take

off its cap.

Ventilate the room too to cool

the baby.

Ask the mother to start

breastfeeding.

If there is a source of extra

heat (like a fire) in the room,

put it out.

Wait for 30 minutes and take

the temperature once again.

Counselling on Management of Hyperthermia

Persistent Hyperthermia

If the baby’s temperature returns to

normal, explain to the mother that in very

warm weather, the baby does not have to

kept covered with additional cloth or kept

wrapped.

Action - If the temperature is still above normal after the above measures have

been taken, refer the baby for treatment. Temperature persists above 37.2oC

(98.96≈100oF)

Umbilical sepsis

• There pus filled

umbilicus with or

without fever.

Umbilical sepsis

Treat Umbilical cord infection by 0.25%

Gentian Violet (GV) paint in children under

2 months (eg newborns)

Treat Umbilical cord infection by 0.5%

Gentian Violet (GV) paint in children over

2 months

Action - Referral of the baby to the nearest health facility for consultation with a

medical doctor

Eye infection-Swollen or with pus

Apply antibiotic

ointment in the baby’s

eyes or a capsule

which is available

Action - Consult a medical

doctor of the nearest facility

Cracks or redness on the skin fold

(Thigh/Axilla/Buttock)Treat Cracks or

redness on the skin

fold by 0.25% Gentian

Violet (GV) in children

under 2 months (eg

newborns)

Treat Cracks or

redness on the skin

fold by 0.5% Gentian

Violet (GV) in children

over 2 months

Referral of the baby to the nearest health

facility for consultation with a medical

doctor.

Session-IVb

Others complains in newborn and action

– Baby crying incessantly or passing urine less

than 6 times a day

– Jaundice-Skin and palm deep yellow

colouration

– Distended abdomen or mother says ‘Baby

vomits’

– Congenital Anomaly (Oesophageal

Artesia/Imperforate Anus)

Baby crying incessantly Is the baby crying

incessantly or passing

urine less than 6

times a day

Advise mother to feed

the baby after every 2

hours. Correct

attachment of the

baby with nipple and

areola.Do not give other liquids as honey water, glucose water, Gripe water, Naunehal…

Jaundice in newborn

Clinical assessment of severity of jaundice in

newborn

Jaundice limited to eyes and

face

Jaundice extended to trunk

Jaundice extended to abdomen

Physiological Jaundice - Normal

Jaundice appearing

within 24 hours of

birth

Jaundice extended to

legs

There is deep yellow

colouration of palm

and sole of baby

Alert signs in a newborn with jaundice

Action – Referral of the baby to the nearest

health facility

Distended abdomen or mother says

‘Baby vomits’

Action – Burping of the child

BurpingPlace the abdomen of

the baby on the left

shoulder of the mother

Gently tap the back of

the baby 3-4 times

The baby has a burping

sound and burps

The baby is normal

Burping in sitting positionPlace baby in sitting position.

Lean them forward, supporting

their chin and chest with your

hand.

Pat their back in an upward

motion.

You may want to squeeze the

cheeks of their face to open the

mouth.

Continue until you hear the

burp of air.

Distended abdomen or mother says ‘Baby

vomits often’ –

Congenital Anomaly (Oesophageal

Artesia/Imperforate Anus)

Session-IVc

Identification of other signs and actions

– In Mother

Post partum haemorrhage

Post partum depression/mood changes

Post partum haemorrhage

Action - Refer the mother to the nearest health facility

for ruling out cervical/vaginal tear, retained placenta and

floppy (atonic) uterus.

Is the bleeding heavy. (Normally changes pad

after 4-6 hours)

Often this is quite obvious, but sometimes it

may be difficult to judge.

Using more than 5 pads a day or more than one

thick cloth in a day, she is having heavy

bleeding.

Some women may suffer from mood

changes after delivery.

They need family support.

The changes usually disappear after a

week or so.

The changes become severe.

Post partum depression/mood

changes

Action – Observe for one week and if it persists then referral is required

Session-IVd

Identification of signs and actions

– Sepsis in mother

Signs of puperal sepsis

Cracked Nipples/painful and/ breast engorgement

and infection

Gentian Violet and its use in baby and

mother

Puerperal sepsis (Infections)

Puerperal sepsis is infection of the genital

tract at any time between the onset of

rupture of membranes or labour and till 42

days after delivery or abortion.

Action – Referral for mother is required to the

nearest facility since she needs antibiotics

treatment. Immediate referral on the same day is

advisable.

Signs of Puerperal sepsis

(Infections)Abnormal and foul-smelling lochia

(discharge), may be blood-stained

Fever (temperature >38°C or > 100.5ºF)

Lower abdominal pain and tenderness

Burning micturition (urine)

Uterus not well contracted

Feeling of weakness

Vaginal bleedingAny two or more of the following signs and symptoms are present.

Painful

Cracked/fissured Nipples

Breast engorgement and

infection

Sore nipples, or a breast

infection

Breast problem

Action – Advise on breast Hygiene and use of emollients such as milk

cream and then refer the mother to the nearest facility to consult a doctor

Gentian Violet

Properties of GV

Gentian violet is an antiseptic dye used to

treat fungal infections of the skin

It also has weak antibacterial effects and

may be used on minor cuts and scrapes to

prevent infection.

It has antibacterial, anti fungal, and

pantheistic properties and is an important

as a topical antiseptic.

Use in baby

Apply Gentian Violet paint twice daily after

gently washing off pus and crusts with

soap and water dry the area and paint with

0.5% G V.

Umbilical cord infection & skin pustules

Use in baby

Treat skin pustules or Umbilical cord or

local skin infection or Cracks or redness

on the skin by 0.5% Gentian Violet (GV) in

children over 2 months

• Treat skin pustules or Umbilical cord or

local skin infection or Cracks or redness

on the skin by 0.25% Gentian Violet (GV)

in children under 2 months (eg newborns)

Oral Thrush

To treat oral thrush by

0.25 % Gentian violet

paint in children under 2

months (eg newborns)

and by 0.5% GV paint in

children over 2 months.

Use in mother

Treatment of nipple soreness with 0.5 %

GV Paint