4th. Week

Mycobacterium tuberculosis, the etiological agent of tuberculosis (TB), is a leading cause of human disease and death, particularly in developing countries.
Worldwide, TB is intimately linked to poverty, making the control of TB a matter of justice and human rights.
In some areas with a high burden of TB, existing strategies for TB control cannot keep pace with the rising number of cases of TB occurring in parallel with the HIV/AIDS pandemic.
Emerging mycobacterial drug resistance further complicates the situation.

Maternal and neonatal immunization refers to immunization prior to pregnancy, during pregnancy, and during the post-partum period that is intended to provide protection to both the mother and her child.
This is a critical concept, as neonates and premature infants are particularly vulnerable to infections with vaccine-preventable diseases. Additionally, their immature immune systems cannot mount protective immune responses to specific vaccine antigens until several weeks or months after birth. This creates a gap during which newborns are extremely vulnerable.

The following signs should be assessed during each postnatal care contact and the newborn should be referred for further evaluation if any of the signs is present:
- stopped feeding well
- history of convulsions
- fast breathing
- severe chest in-drawing
- no spontaneous movement
- temperature >37.5 or <35.5 °C
- jaundice in the first 24 hours of life, or yellow palms and soles at any age.
The family should be encouraged to seek health care early if they identify any of the above danger signs in-between postnatal care visits.
 

The following are recommendations to consider when hospital discharge after neonatal admission, and even if the baby was born healthy and at term:
· avoid exposing the patient to crowds of people;
· avoid passive exposure to smoke from parents and other family members;
· limit contact between newborns and infected people as much as possible.
If parents and close caregivers present signs of flu or a cold:
· increase personal hygiene precautions, including hand hygiene;
· put a mask or a handkerchief over the mouth and nose while caring for newborns;

It is very important to control the temperature of the newborn baby. Cold hands and feets are characteristic of healthy babies; it does not mean that they feel cold.
The permanent proximity of the mother facilitates skin-to-skin contact, a situation favoring the maintenance of the baby's temperature.
It is recommended that bathing be delayed, if possible over 24 hours after birth, and that the environment where the newborn baby is placed be free of air currents.

When there is a medical indication to administer a human milk substitute for a specific situation, it must be prepared under safe conditions.
• Wash hands.
• Boil filtered water (after it begins to boil, wait 15 minutes), and then allow to cool to room temperature.
• Use the quantity of water corresponding to the quantity of feed desired; for every 30 ml of water add one level measure of milk powder.
• Shake the feeding bottle until the powder is totally dissolved.
• Milk should be prepared at the time of each feeding.

Skin irritations can be caused by prolonged contact with urine and feces. To avoid them, the diaper should be changed as often as needed. It is important to clean the baby with water and neutral soap after bowel movements, and to keep the diaper region dry.
• Change diaper frequently.
• Wash the region with neutral soap.
• Keep the skin clean and dry, especially in folds and grooves.
• After washing, dry the area well and powder with dry cornstarch in the affected region.

• Choose a location for the bath without drafts, during the warmest part of the day.
• Have all necessary items ready in advance and close at hand: towel, soap, clothes, diaper, blanket.
• Bathe daily or more than once a day, if necessary (if the newborn is restless, crying, hot, feverish...).
• Do not use alcohol in bath water; it dries the skin and irritates the mucous membranes. and it is dangerous.
• Do not use lotions, perfumes, talcum powder, or ointments.
• Dry skinfolds thoroughly.

• Remove excess feces with the disposable diaper.
• Take the baby to water for a cleaning, removing all feces, or use a cloth diaper moistened with lukewarm water to clean, avoiding friction. When cleaning infant girls, it is important to wipe from the vagina toward the anus rather than the reverse (to prevent urinary infection).
• Dry thoroughly and put on a clean diaper. Use cornstarch but avoid talcum powders, which can cause allergies
• Avoid the use of premoistened wipes, which can cause allergic reactions in the child.

To reduce transmission of respiratory viruses during rooming-in and after hospital discharge, provide guidance to health professionals and family members on the following precautions:
• health professionals: disinfect hands before and after contact with patients.
• isolate patients hospitalized with suspicion of respiratory infection, with precautions that include:
· hand washing before and after contact with patients and their personal items;
· use of gloves and apron for contact with patients;