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Intregrated management of

neonatal illness IMNCI


(0-2 months)

SUBMITTED TO: MS. SABA MA’AM


SUBMITTED BY:MS. MEENA
MSc NURSING 1ST YEAR
DEFINITION:
IMNCI is an integrated approach to child health that
focuses on the well being of the whole child. It
focussed primarily on the most common causes of child
mortality-diarrhoea, pneumonia, measles, malaria, and
malnutrition, illness affecting children aged 0 – 2
months, 2 months -5 year including both preventive
and curative elements to be implemented by families.
. OBJECTIVES
*To determine baseline mortality among children
under 5yrs of age(NMR,IMR,USMR)
*To determine prevalence of fever, loose stools,
cough and any other illness(morbidity density)in
two weeks prior to day of field survey among
children under 5yrs of age.
*To assess effective programme coverage for
specified disease condition(cough with fast
breathing) occuring in two weeks prior to day of
field survey
Beneficiaries of IMNCI
*Care of young infants for new born
(under 2months)
*Young children(2months-5yrs
COMPONENTS
*HEALTH WORKER Case
management skills
*HEALTH SERVICE Improvement in
overall health
*COMMUNITY Improvements in
family and community health
carepractices
PRINCIPLES
*All sick young infants upto two months must be
assessed for bacterial infection/jaundice and major
symptoms of diarrohea
*all sick children 2months to 5yrs must examine
for general danger signs which indicate the need
for referral or admission to a hospital
*all young infants and child 2months-5yrs of age
must be routinely assessed for nutritional and
immunisation status, feeding problems and other
potential problems
CLASSIFICATION ACCORDING
TO COLOR CODE COLOR
*Pink: Hospital referral
*Yellow: Admission of Initiation of
special treatment
*Green: Home management
CARE OF CHILDREN ACCORDINGTO
IMNCI0-2 MONTHS:
*Keeping the child warm
*Intiation of breast feeding.
*Counselling for exclusive breast feeding.
*Cord, skin and eye care.
*Recognition of illness in newborn and
management and/referral.
*Immunisation
*Home visit in the post natal period.
Assessment of sick young infant
upto 2 months
1.Possible bacterial infection /
jaundice
2.Does the infant have diarrhoea
3.Feeding problems
4.Immunization status
CLASSIFY CHECK FOR POSSIBLE
BACTERIAL INFECTION
•Has the infant had convulsions?
•Count the breaths in one minute. _______ breaths
per minute Repeat if elevated ________ Fast
breathing?
•Look for severe chest indrawing.
•Look for nasal flaring.
•Look and listen for grunting.
•Look and feel for bulging fontanelle
. •Look for pus draining from the ear.
•Look at umbilicus.
Is it red or draining pus?
Does the redness extend to the skin?

•Fever (temperature 37.5 C or feels hot) or low


body temperature (below 35.5° C or feels cool).
•Look for skin pustules.

Are there many or severe pustules?

•See if young infant is lethargic or unconscious.


•Look at young infant's movements.
Less than normal?
THEN CHECK FOR FEEDING PROBLEM OR
LOW WEIGHT
•Is there any difficulty feeding? Yes_____
No______
•Is the infant breastfed? Yes_____ No_____
•IfYes, how many times in 24 hours?_____ times
•Does the infant usually receive any other foods or
drinks? Yes_____ No_____ If Yes, how often?
•What do you use to feed the child?
ASSESS BREASTFEEDING:
•Has the infant breastfed in the previous hour?
•Determine weight for age. Low _____ Not Low _____ If
infant has not fed in the previous hour, ask the mother to
put her infant to the breast. Observe the breastfeed for 4
minutes.
•Is the infant able to attach? To check attachment, look
for: — Chin touching breast Yes _____ No _____ —
Mouth wide open Yes _____ No _____ — Lower lip
turned outward Yes _____ No _____ — More areola
above than below the mouth Yes _____ No _____ no
attachment at all not well attached good attachment
•Is the infant suckling effectively (that is,
slow deep sucks, sometimes pausing)?
not suckling at all not suckling effectively
suckling effectively
•Look for ulcers or white patches in the
mouth
ASK:-
•Does the child have diarrohea?
• IF YES THEN , FOR HOW LONG?
LOOK AND FEEL:-
•Look at the general conditions. Is he/she
-lethargic or unconscious?
-restless and irritable?
•Look for sunken eyes
•Pinch the skin of abdomen , and notice how
it goes back: -very slowly
( longer than two seconds)?
It is a sign commonly used by health care workers
to assess the degree of fluid loss or dehydration.
I. Locate the area on the child's abdomen halfway
between the umbilicus and the side of the
abdomen; then pinch the skin using the your
thumb and finger.
II. Place your hand in such a way that when the
skin is pinched, the fold of skin will be in a line up
and down the child's body and not across the
child's body.
III. It is important to firmly pick up all of the
layers of skin and the tissue under them for fifteen
to thirty seconds and then release it.
TURGOR SIGN:
When released, the skin pinch goes back either
• very slowly (longer than 2 seconds),
• slowly (skin stays up even for a brief instant),
• Immediately.
SIGNS OF DIARRHOEA
Classification:
Signs Classify treatment Two of the following signs: Lethargic or
unconscious Sunken eyes Skin goes back very slowly SEVERE
DEHYDRATION
If infant has low weight or another severe classification: Give first
dose of intramuscular ampicilline and gentamicine
- Refer URGENTLY to hospital with mother giving frequent sips
of ORS on the way
- Advise mother to continue breast feeding
- Advise mother to keep the young infant warm on the way to the
hospital OR
If infant does not have low weight or any other severe
classification: - Give fluid for severe dehydration (Plan C) and then
refer to hospital after rehydration
Two of the following signs:
• Restless, irritable
• Sunken eyes
• Skin pinch goes back slowly.
SOME DEHYDRATIO N If infant has low weight or
another severe classification: - Give first dose of
intramuscular ampicilline and gentamicine
- Refer URGENTLY to hospital with mother giving
frequent sips of ORS on the way
- Advise mother to continue breast feeding
-Advise mother to keep the young infant warm on the
way to the hospital If infant does not have low weight or
another severe classification:
- Give fluids for some dehydration (Plan B)
- Advise mother when to return immediately
•Not enough signs to classify as some or
severe dehydration NO
DEHYDRATION
Give fluids to treat diarrhea at home
Advise mother when to return
immediately
Follow up in 5 days if not improving
<PLAN A>
Diarrhea lasting 14 days or more SEVERE
PERSISTENT DIARRHOEA
 Give first dose of intramuscular
ampilicin and gentamicin if infant has low
weight if the young infant has low weight,
dehydration or another severe classification.
Refer to hospital
Advise to keep the baby warm
Treat to prevent low blood sugar
Blood in the stools SEVERE
DYSENTERY
Give first dose of intramuscular
ampilicin and gentamicin if infant has
low weight if the young infant has low
weight, dehydration or another severe
classification.
Refer to hospital
Advise to keep the baby warm
Treat to prevent low blood sugar
COUNSEL THE MOTHER ON THE 4 RULES
OF HOME TREATMENT
1. GIVE EXTRA FLUID( AS MUCH AS THE
CHILD WILL TAKE )
Breastfeed frequently and for longer at each feed.
Give ORS and clean water in addition to breast
milk
2. GIVE ZINC SUPPLEMENTS (Not for infant
below 2 months)
3. CONTINUE BREAST FEEDING
4. TELL HER WHEN TO RETURN
Give in clinic recommended amount of ORS over 4-hr
period (which is 200-400 ml for a child whose age is < 4
months or whose weight is <6 kgs.)
 If the child wants more, give more.
 After 4 hrs, reassess the child and classify for
dehydration & select the appropriate plan to continue
treatment.
 Begin feeding the child at the clinic. If mother has to
leave before 4 hrs, show her how to prepare ORS, tell &
ask how much to give in 4 hrs, explain the above
mentioned 4 rules of home treatment.
CHECK THE YOUNG INFANT'S
IMMUNIZATION STATUS BCG DPT1
DPT2 OPV 0 OPV 1 OPV 2

Circle immunizations needed today.


Return for next immunization on:
(Date)
CHECK IMMUNIZATION STATUS:
IMMUNIZATION SCHEDULE

• Birth - BCG,OPV(0) HepB1

• 6 weeks - DPT1, OPV1, HepB2


MANAGEMENT OF THE SICK YOUNG
INFANT AGE 1 WEEK UP TO 2 MONTHS
Name:___________ Age:___________
Weight:____________________kg____________
____________Temperature:_______________C
ASK: What are the infant's problems?
__________________________________ Initial
visit?_________________ Follow-up Visit?

CONCLUSION:
IMNCI strategy has emerged as a promising approachto deal with issues related to child survival.
-Major strength is it use evidence based management decisions
-This approach could help country to achieve millenium goal.
BIBLIOGRAPHY:

Wong's & Whaley, “Nursing Care Of Infants and Children” , Fifth edition, Nancy L. Coin Publisher, Page no. 105-154,520-523.
Gupta Piyush, “Essential Paediatric Nursing” , 7th edition, page no. 93, 96-98.
Ghai OP, “Essentials Of Paediatric” , Eighth Edition, CBS publisher’s and distributers, Page no. 9-11.
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