Management of Malaria in Neonates

Neonatal malaria is defined as symptoms attributable to malaria with evidence of ring forms of malaria parasites in the blood of an infant within the first twenty-eight days (4 weeks) of life.

Congenital malaria is defined as symptoms attributable to malaria with evidence of ring forms of malaria parasites in the blood of an infant within the first seven days (1 week) of life. The signs and symptoms often resemble those of neonatal septicemia.

Clinical presentation

• Fever

• Lethargy

• Unable to breastfeed

• Vomiting

• Irritability

• Respiratory distress

• Seizures

• Jaundice

• Pallor

• Hepatosplenomegaly

• Laboratory findings may include presence of malaria parasites

Investigations

• Full blood picture

• Blood sugar

• Blood culture and sensitivity

• Blood smear for malaria parasites

• Serum electrolytes

• Cerebrospinal fluid (CSF) analysis

Management of neonatal malaria

• Neonatal malaria should always be considered as severe malaria, so manage as per severe malaria guideline

• Neonates with suspected malaria should be admitted immediately, as they can deteriorate rapidly and die at home

• Parenteral artesunate is the recommended treatment of choice for neonates

• Injectable artemether may be used as an alternative if artesunate is not available

• Broad-spectrum antibiotics should be given, as severe malaria is often accompanied by septicemia (refer to septicemia treatment guidelines)

Nursing care and monitoring

• Monitor vital signs (pulse rate, respiratory rate, temperature)

• Monitor input and output

• Check blood smear for malaria parasites daily

• Ensure adequate feeding

• Advise caregivers on the use of long-lasting insecticidal nets (LLINs)