Doctor's Write Up

Common Infections in Infancy
Dr. Yong Sin Chuen
Consultant Paediatrician & Neonatologist
Pantai Medical Centre

Infections are common in the newborn and infants. Some of these infections can be very serious and the infant can deteriorate very rapidly. It is therefore vital for parents to recognise the common features that an infant may present with. Parents should seek medical advice when they are unsure even if it is in the middle of the night as there will be doctors on call in most hospitals.

The common symptoms which may suggest infection in infancy include :

- refusal of feeds
- lethargy
- floppy
- apnoea ( cessation of breathing )
- fever ( usually taken to be more than 37.5 degrees celsius )

Omphalitis

This is infection of the umbilicus. This may manifest as redness around the umbilicus or green, yellow discharge from the umbilicus. Initial cleaning with alcohol swabs three times daily may be sufficient to control the infection. However if this is not better after 2 days, medical advice should be sought.

Conjunctivitis

The eye(s) may be red, swollen with green discharge. This usually requires prompt treatment following an eye swab. Common eye drops used are chloramphenicol or gentamicin drops. If left untreated, scarring of the cornea and rupture of the eyeball may occur in some cases.

Common cold ( upper respiratory tract infection )

This is probably the commonest infection in the first year of life, especially for those with siblings at home or those sent to daycare centres. The infants typically present with blocked nose and poor feeding. Symptomatic relief may be obtained from nose drops and mild antihistamine.

Otitis media

This is infection in the middle ear and may present with fever, irritability or even ear discharge. Symptomatic treatment with paracetamol and antibiotics may be required.

Bronchiolitis

This is an infection of the smaller branches of the airway of the lungs and tends to occur in the rainy months in Malaysia. Typically, the infant presents with wheezing and difficulty in breathing. In the moderately severe cases, refusal of feeds may occur. Admission to hospital is indicated for those who are unable to finish feeds, those having blue episodes and drowsiness.

Pneumonia

This is inflammation of the lung alveoli. Usually one segment of the lung is affected. Cough, fever and breathing difficulty are common features. A chest X-ray is needed to confirm the diagnosis. This should be treated in hospital with antibiotics and some infants may require oxygen.

Meningitis

This is infection of the lining of the brain. Fever, irritability, drowsiness and vomiting are common. The baby needs to be admitted to hospital for a lumbar puncture to confirm the diagnosis. Treatment is by intravenous antibiotics. There are now vaccines to prevent the 2 commonest organisms which cause meningitis in Malaysia.

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