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  1. 1. Introduction
    1. 1.0 Overview
    2. 1.1 What is the Purpose of the Field Guide
    3. 1.2 Who is the Field Guide intended for?
    4. 1.3 How is the Field Guide organized?
  2. 2. Background
    1. 2.0 Overview
    2. 2.1 Humanitarian Settings Across the Globe
      1. 2.1.1 Challenges to Newborn Health Service Delivery
    3. 2.2 Newborn Health: Epidemiology
      1. 2.2.1 Global burden of newborn mortality
      2. 2.2.2 Principal causes of neonatal deaths
  3. 3. Newborn Health Services
    1. 3.0 Overview
    2. 3.1 General Principles and Considerations
      1. 3.1.1 The Continuum of Care Across the Lifecourse
      2. 3.1.2 Levels of Care
    3. 3.2 Essential Newborn Care
    4. 3.3 Newborn Care at Household/Community Level
      1. 3.3.1 During the Antenatal Period
      2. 3.3.2 Intrapartum and essential newborn care
      3. 3.3.3 Postnatal care
    5. 3.4 Newborn Care at Primary Care Facilities
      1. 3.4.1 Antenatal care
      2. 3.4.2 Intrapartum and essential newborn care
      3. 3.4.3 Postnatal care
    6. 3.5 Newborn Care at Hospitals
      1. 3.5.1 Antenatal care
      2. 3.5.2 Intrapartum and essential newborn care
      3. 3.5.3 Postnatal care
    7. 3.6 Additional Considerations for Preventing and Managing Principal Causes of Neonatal Deaths
      1. 3.6.1 Prematurity/Low Birth Weight (LBW)
      2. 3.6.2 Newborn Infections
      3. 3.6.3 Intrapartum Complications
  4. 4. Strategic Considerations
    1. 4.0 Overview
    2. 4.1 Mainstreaming newborn health in humanitarian coordination
      1. 4.1.1 Incorporate questions about newborn health services within a rapid health assessment
      2. 4.1.2 Advocate for the inclusion and prioritisation of newborn health in humanitarian response plans
    3. 4.2 Conducting a situational analysis
      1. 4.2.1 Examine national policies and protocols relevant to newborn health
      2. 4.2.2 Examine existing clinical guidelines, key messages/ BCC materials, tools and training materials
      3. 4.2.3 Assess resource availability: facilities, supplies and staff
    4. 4.3 Developing an inclusive and unified response strategy
      1. 4.3.1 Prioritizing newborn interventions
      2. 4.3.2 Update and distribute clinical guidelines and protocols
      3. 4.3.3 Develop and collate needs based staff training materials
      4. 4.3.4 Procure and distribute essential medicines and supplies
      5. 4.3.5 Ensure quality improvement and respectful care
      6. 4.3.6 Develop proposals to secure additional funding
    5. 4.4 Developing and implementing a monitoring and evaluation (M&E) plan
      1. 4.4.1 Compromised data flow and routine information systems
  5. 5. Program Implementation Considerations
    1. 5.0 Overview
    2. 5.1 Developing and disseminating key messages/behavior change communication (BCC) materials
    3. 5.2 Developing a referral system
      1. 5.2.1 When referral is not feasible
    4. 5.3 Home visits for mothers and babies
    5. 5.4 Procuring newborn care supply kits
    6. 5.5 Managing newborn deaths in crisis settings
      1. 5.5.1 Support for neonatal loss
      2. 5.5.2 Documenting neonatal loss
  6. 6. Annexes
    1. 6.1 Annex 1: Newborn health services summary tables by levels of care
      1. 6.1.1 Annex 1A
      2. 6.1.2 Annex 1B
      3. 6.1.3 Annex 1C
    2. 6.2 Annex 2: Doses of Common Drugs for Neonates
    3. 6.3 Annex 3: Advanced Care for Very Sick Newborns
    4. 6.4 Annex 4: Tools to Support Neonatal Referrals
      1. 6.4.1 Annex 4A: When to Refer a Newborn to the Hospital
      2. 6.4.2 Annex 4B: Job Aid: Transporting the Sick Newborn
      3. 6.4.3 Annex 4C: Sample Referral Note
    5. 6.5 Annex 5: Newborn Kits for Humanitarian Settings
    6. 6.6 Annex 6: Indicators
      1. 6.6.1 Annex 6A: Newborn Health Indicators for Routine Data Systems
      2. 6.6.2 Annex 6B: List of Indicators and Questions to Measure Facility Capacity to Provide Key Newborn Health Services
    7. 6.7 Annex 7: READY: Maternal and Newborn Health During Infectious Disease Outbreaks: Operational Guidance for Humanitarian and Fragile Settings
  7. 7. In Practice
    1. 7.1 Uganda
      1. 7.1.1 Recommendations
    2. 7.2 Kenya
      1. 7.2.1 Recommendations
    3. 7.3 Ethiopia
      1. 7.3.1 Recommendations
    4. 7.4 South Sudan
Newborn Field Guide

6.2 Annex 2: Doses of Common Drugs for Neonates

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Drug Dosage Form Weight of Infant (kilograms)
1–<1.5 1.5–<2 2–<2.5 2.5–<3 3–<3.5 3.5–<4 4–<4.5
Aminophylline to prevent apnoea

Loading dose: Oral or IVabbreviation over 30 minutes 6 mg/kg, then

 250 mg/10 ml vial. Dilute loading dose to 5 ml with sterile water, give slowly over 15–30 min 0.6 ml 0.8 ml 1.0 ml Aminophylline is not usually used for term infants

Maintenance dose:info First week of life: Oral: 2.5 mg/ kg every 12 h

 0.1–0.15 ml 0.15–0.20 ml 0.20–0.25 ml

Maintenance dose:info First week of life: Oral: 2.5 mg/ kg every 12 h

 0.15–0.2 ml 0.25–0.3 ml 0.30–0.4 ml
Ampicillin

IM/IVabbreviation: 50 mg/kg

First week of life: every 12 h

Weeks 2–4 of life: every 8 h

Vial of 250 mg mixed with 1.3 ml sterile water to 250 mg/1.5 ml

 0.3–0.6 ml 0.6–0.9 ml 0.9–1.2 ml 1.2–1.5 ml 1.5–2.0 ml 2.0–2.5 ml 2.5–3.0 ml
Caffeine citrate

Loading dose:info Oral: 20 mg/kg (or IVabbreviation over 30 min)

 20–30 mg 30–40 mg 40–50 mg 50–60 mg 60–70 mg 70–80 mg 80–90 mg

Maintenance dose:info 5 mg/kg daily oral (or IVabbreviation over 30 min)

 5–7.5 mg 7.5–10 mg 10–12.5 mg 12.5–15 mg 15–17.5 mg 17.5–20 mg 20–22.5 mg
Cefotaxime

IVabbreviation: 50 mg/kg

Premature infants: every 12 h

First week of life: every 8 h

Weeks 2–4 of life: every 6 h

 Vial of 500 mg mixed with 2 ml sterile water to 250 mg/ml 0.3 ml 0.4 ml 0.5 ml 0.6 ml 0.7 ml 0.8 ml 0.9 ml
Ceftriaxone for meningitis

IVabbreviation: 50 mg/kg every 12 h

 1g vial mix with 9.6 ml sterile water to 1 g/10 ml 0.5–0.75 ml 0.75–1 ml 1–1.25 ml 1.25–1.5 ml 1.5–1.75 ml 1.75–2 ml 2–2.5 ml
Cloxacillin

First week of life: every 12 h (25 mg/kg per dose)

 25 mg vial mixed with 1.3 ml sterile water to 250 mg/1.5 ml 0.15–0.3 ml 0.3–0.5 ml 0.5–0.6 ml 0.6–0.75 ml 0.75–1.0 ml 1.0–1.25 ml 1.25–1.5 ml

Weeks 2–4 of life: every 8 h (50mg/kg per dose)

 0.3–0.6 ml 0.6–0.9 ml 0.9–1.2 ml 1.2–1.5 ml 1.5–2.0 ml 2–2.5 ml 2.5–3.0 ml
Gentamicin

First week of life: Low-birth-weight infants: IM /IVabbreviation: 3 mg/kg once a dayinfo

Vial 20 mg/2 ml

Vial 80 mg/2 ml

Dilute to 8 ml with sterile water to 10 mg/ml

 0.3–0.5 ml 0.5–0.6 ml 0.6–0.75 ml 1.25–1.5 ml 1.5–1.75 ml 1.75–2 ml 2–2.25 ml

First week of life: Normal birth weight: IM /IVabbreviation: 5 mg/kg per dose once a dayinfo

 0.75–1.1 ml 1.1–1.5 ml 1.5–1.8 ml 1.8–2.2 ml 2.2–2.6 ml 2.6–3.0 ml 3.0–3.3 ml

Weeks 2–4 of life: IM / IVabbreviation: 7.5 mg/kg once a dayinfo
Kanamycin

IM/IVabbreviation: 20 mg/kg (one dose for pus draining from eyes)

 2 ml vial to make 125 mg/ml 0.2–0.3 ml 0.3–0.4 ml 0.4–0.5 ml 0.5–0.6 ml 0.6–0.7 ml 0.7–0.8 ml 0.8–1.0 ml
Naloxone 0.1 mg/kg Vial 0.4 mg/ml 0.25 ml 0.25 ml 0.5 ml 0.5 ml 0.75 ml 0.75 ml 1 ml
Penicillin
Drug Dosage Form Weight of Infant (kilograms)
1–<1.5 1.5–<2 2–<2.5 2.5–<3 3–<3.5 3.5–<4 4–<4.5
Benzylpenicillin First week of life: every 12 h (50 000 U/kg per dose) Vial of 600 mg (1 000 000 U) dilute with 1.6 ml sterile water to 500 000 U/ml 0.2 ml 0.2 ml 0.3 ml 0.5 ml 0.5 ml 0.6 ml 0.6 ml
Weeks 2–4 and older: every 6 h (50 000 U/kg per dose)
Benzathine benzylpenicillin 50 000 U/kg once a day IM: vial of 1 200 000 U mixed with 4 ml sterile water 0.2 ml 0.3 ml 0.4 ml 0.5 ml 0.6 ml 0.7 ml 0.8 ml
Procaine benzylpenicillin IM: 50 000 U/kg once a day 3 g vial (3 000 000 U) mixed with 4 ml sterile water 0.1 ml 0.15 ml 0.2 ml 0.25 ml 0.3 ml 0.3 ml 0.35 ml
Phenobarbital

Loading dose: IM/IVabbreviation or oral: 20 mg/kginfo

 Vial 200 mg/ml diluted with 4 ml sterile water ½ ¾ 1 1¼ 1½ 1¾ 2

Maintenance dose: Oral: 5 mg/kg per dayinfo

 30 mg tablets ¼ ¼ ½ ½ ½ ¾ ¾

Notes

Abbreviations