Clarify before acting: Safety check: is the fever with convulsions, neck stiffness, or none of these?
Results for "Fever" (Age: 0 - 2 months)
Possible Serious Bacterial Infection or Very Severe Disease 0 - 2 months
Refer URGENTLY
High match
Cha kumwambia mlezi
- Explain that the baby is very sick and needs urgent hospital care.
- Explain treatments given (antibiotics, sugar/milk).
- Teach the mother how to keep the infant warm on the way to the hospital (skin-to-skin contact or warm wrapping).
- Advise mother to continue trying to breastfeed if possible.
- Write a detailed referral note including all signs, classification, and treatments given (drug, dose, time).
Classification for a young infant (birth to 2 months) presenting with specific signs indicating a high risk of severe bacterial infection (like sepsis, meningitis, pneumonia) or other very severe conditions. Requires immediate pre-referral treatment and urgent referral to hospital.
Key Features
- ANY ONE of the specified signs indicates PSBI or Very Severe Disease.
- Signs include severe feeding problems, convulsions, respiratory distress (severe chest indrawing or fast breathing <7d), temperature instability (high or low), or significantly reduced movement.
- This is a life-threatening emergency in young infants.
Red Flags (Warning Signs)
- Stopped feeding completely
- Convulsions
- Severe chest indrawing
- Apnea (periods of stopped breathing - implied by severe illness)
- Temperature instability (high or low)
- No movement at all / deep lethargy
- Cyanosis
Tathmini
Uliza
- Is the infant having difficulty in feeding?
- Has the infant had convulsions?
Tazama, sikiliza, hisi
- Count the breaths in one minute. Repeat if >= 60.
- Look for SEVERE chest indrawing.
- Measure axillary temperature. Is it ≥38°C or <35.5°C?
- Look at the young infant's movements. Does the infant move on his/her own? Stimulate if not moving. Does the infant move only when stimulated? Does the infant not move at all?
- Check specific signs listed in classification criteria.
Classification
- Any ONE of the following signs:
- Not able to feed since birth, stopped feeding well, or not feeding at all
- Convulsions
- Severe chest indrawing
- Fast breathing (>= 60 breaths/minute) in infants LESS THAN 7 DAYS OLD
- Fever (>= 38°C axillary)
- Low body temperature (< 35.5°C axillary)
- Movement only when stimulated or no movement at all
- -> POSSIBLE SERIOUS BACTERIAL INFECTION OR VERY SEVERE DISEASE
Urgency / Refer urgently
Refer URGENTLY
Tiba kabla ya rufaa
- Give first dose of intramuscular antibiotic: Gentamicin (5 mg/kg, or 4 mg/kg if low birth weight concentration becomes 20mg/ml. Dose based on weight (refer to local dosing charts or calculate carefully). Ampicillin (prepare 500mg vial): Dose based on weight. (Refer to Page 40 for general statement, precise dosing usually requires local protocol/weight chart).
- Treat to prevent low blood sugar (Hypoglycemia): If infant can breastfeed, ask mother. If cannot feed but can swallow, give 20-50ml (approx 10ml/kg) EBM. If cannot swallow, give EBM via NG tube. (Sugar water is not the first option for neonates, EBM preferred, page 40 focuses on EBM).
- If referral is refused or not possible: Continue antibiotic treatment (e.g., Gentamicin OD + Ampicillin BD/QDS based on protocol) for 7 days. Continue warmth, feeding support (NG if needed), oxygen if available/indicated. This is high-risk care outside referral center.
Usimamizi
Non-Pharmacological Management
- Quickly complete assessment for all necessary pre-referral treatments.
- Keep the infant warm: Initiate skin-to-skin contact (Kangaroo Mother Care) if possible OR wrap infant in warm, dry clothes, including hat/socks, cover with blanket. Ensure no draughts.
- Handle gently.
Monitoring & Follow-Up
- To be managed at referral hospital facility.
Counselling Points
- Explain that the baby is very sick and needs urgent hospital care.
- Explain treatments given (antibiotics, sugar/milk).
- Teach the mother how to keep the infant warm on the way to the hospital (skin-to-skin contact or warm wrapping).
- Advise mother to continue trying to breastfeed if possible.
- Write a detailed referral note including all signs, classification, and treatments given (drug, dose, time).
Differential Diagnosis
- Neonatal Sepsis
- Bacterial Meningitis
- Severe Pneumonia
- Birth Asphyxia complications
- Congenital Heart Disease
- Metabolic disorders
- Hypoglycemia
- Severe Jaundice complications (kernicterus)
Potential Complications
- Septic shock
- Meningitis with neurological sequelae
- Respiratory failure
- Apnea
- Hypoglycemia complications (brain damage)
- Hypothermia complications
- Death
Prevention
- Clean delivery practices.
- Maternal health (screening/treatment of infections like GBS).
- Early and exclusive breastfeeding.
- Thermal care at birth.
- Handwashing.
- Prompt recognition and care seeking for newborn illness.
- Cord care (clean and dry, or chlorhexidine where recommended).
Reference: IMCI Chart Booklet - Page 33, Page 40 (Pre-referral)
Presumptive TB (Young Infant) 0 - 2 months
Refer for Assessment
High match
Cha kumwambia mlezi
- Explain that the baby has signs that might indicate TB and needs further tests at the hospital.
- Explain any pre-referral treatments given.
- Advise on keeping infant warm and continuing feeding during transport.
- Ask about caregiver's health (possible TB source) and advise testing if needed.
- Write a detailed referral note listing signs, symptoms, weight, and reason for TB suspicion.
Classification for a young infant (<2 months) with symptoms suggestive of Tuberculosis OR weight <1.5kg OR WFA <-3 Z-score. Requires referral for further assessment and management.
Key Features
- Presence of ANY symptom suggestive of TB (persistent cough/fever, non-responsive pneumonia, contact history) OR Very low weight (<1.5kg or WFA<-3Z) triggers suspicion.
- Diagnosis is challenging in this age group; high index of suspicion needed.
- Requires referral for specialized investigation (e.g., gastric aspirates, X-ray, GeneXpert) and management.
- Young infants with danger signs also warrant TB consideration and referral.
Red Flags (Warning Signs)
- Any danger sign (PSBI/VSD signs).
- Signs of meningitis.
- Respiratory distress.
- Failure to thrive.
Tathmini
Uliza
- History of contact with a person with PTB or chronic cough?
- Persistent fever (>14 days)?
- Persistent cough (>14 days)?
- Check: Does infant have pneumonia not responding to standard therapy?
- Check: Weight for age. Is it <1.5kg? Is WFA Z-score < -3?
- Check: Presence of ANY danger sign (implies severe illness, increasing TB suspicion if other symptoms present).
Classification
- Presence of ANY of the symptoms and signs suggestive of TB (contact Hx, cough>14d, fever>14d, non-responsive pneumonia) OR Weight less than 1.5kg OR WFA PRESUMPTIVE TB
Urgency / Refer urgently
Refer for Assessment
Tiba kabla ya rufaa
- Manage any danger signs (PSBI/VSD treatment - Page 40).
- Keep warm.
- Support feeding.
Usimamizi
Non-Pharmacological Management
- Keep infant warm.
- Support feeding.
- Refer to hospital for further assessment and management.
Pharmacological Treatment
- If danger signs also present, provide pre-referral treatment for PSBI/VSD (Antibiotics, prevent hypoglycemia - Page 40) before referral.
- TB treatment is typically initiated at referral center after investigation.
Monitoring & Follow-Up
- To be managed at referral hospital / TB clinic.
Counselling Points
- Explain that the baby has signs that might indicate TB and needs further tests at the hospital.
- Explain any pre-referral treatments given.
- Advise on keeping infant warm and continuing feeding during transport.
- Ask about caregiver's health (possible TB source) and advise testing if needed.
- Write a detailed referral note listing signs, symptoms, weight, and reason for TB suspicion.
Differential Diagnosis
- PSBI / Sepsis
- Severe Pneumonia (bacterial/viral)
- Congenital infection
- Malnutrition / Failure to thrive (non-TB causes)
- Congenital lung/airway anomalies
Potential Complications
- Disseminated TB (miliary, meningitis)
- Severe pneumonia
- Death
Prevention
- BCG vaccination at birth.
- Early identification and treatment of infectious TB cases in household.
- IPT for eligible exposed infants (though usually started >2 months).
Reference: IMCI Chart Booklet - Page 37
Features
IMCI Guidelines
Quickly access assessment, classification, and treatment guidance from the IMCI handbook.
Symptom Search
Search by condition name, keyword, or common symptoms such as fever, cough, or diarrhoea.
Age Groups
Separate guidance for young infants 0-2 months and children 2 months-5 years.
Red Flags
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Common Conditions Quick Access
Cough / Pneumonia
Guidance for assessing cough, difficult breathing, and classifying pneumonia severity.
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Protocols for diarrhoea assessment, dehydration levels, and fluid management.
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Steps for managing fever, malaria testing, and treating febrile illness.
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Identify general danger signs that need urgent referral and immediate action.
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