Danger signs in newborns
- 1. Danger Signs in Newborn Dr Varsha Atul Shah 1
- 2. Sick newborn Early detection, prompt treatment and referral (if required) are necessary to prevent high mortality 2
- 3. Problems in early diagnosis of sick newborn Non-specific signs Difficulties in preterm and LBW babies 3
- 4. Lethargy and poor sucking In a term baby who was feeding earlier → indicates neonatal illness (as perceived by mother) In a preterm baby → needs careful assessment because it may be due to cold stress or immaturity 4
- 5. Capillary refill time (CRT) Indicates tissue perfusion Normal CRT < 3 seconds Prolonged CRT > 3 seconds * Use 10ml/kg normal saline bolus * Hypotension, hypothermia, acidosis 5
- 6. Capillary refill time (CRT) 6
- 7. Respiratory problems RR > 60 / min* Retractions Grunt Central cyanosis Apnea *Rate should be counted in a quiet state and not immediately after feed 7
- 9. Body temperature in newborn infant ( C) o 37.5o Normal range 36.5o Cold stress Cause for concern 36.0o Moderate hypothermia Danger, warm baby 32.0o Severe hypothermia Outlook grave, skilled care urgently needed 9
- 10. Failure to pass meconium and urine Failure to pass meconium Majority pass within 24 hrs Delayed passage May have passed in –utero Lubricated per-rectal thermometer may be therapeutic Suspect obstruction Failure to pass urine Majority pass within 48 hrs Delayed passage Exclude obstructive uropathy or renal agenesis 10
- 11. Causes of vomiting* Ingestion of meconium stained amniotic fluid Systemic illness Congestive cardiac failure Raised ICP – IVH, asphyxia Metabolic disorders (CAH, galactosemia) *Persistent, projectile or bile stained - r / o intestinal obstruction 11
- 12. Causes of diarrhea Infective diarrhea* (often non breast fed baby) Maternal ingestion of drugs (ampicillin, laxatives) Metabolic disorders Thyrotoxicosis Maternal drug addiction *Infective diarrhea needs treatment with systemic antibiotics 12
- 13. Cyanosis Peripheral Normal at birth Seen in extremities due to cold Central Always needs appropriate referral Seen on lips and mucosa Indicates cardiac or pulmonary disease 13
- 14. Peripheral cyanosis 14
- 15. Central cyanosis 15
- 16. Yellow Palms & Soles 16
- 17. Yellow staining of soles 17
- 18. Tracheo-esophageal fistula Excessive drooling; choking; cyanosis during feeds; respiratory distress Failure to pass red rubber catheter beyond 8 to 10 cm from mouth 18
- 19. Tracheo-esophageal fistula 19
- 20. Suspect cardiac disease Cyanosis Tachycardia Murmur Hepatomegaly Shock Cardiomegaly 20
- 21. Abnormal weight loss pattern > 10 percent of birth weight in term > 15 percent in preterm > 5 percent acute weight loss 21
- 22. Danger signs : Summary Lethargy Bleeding Hypothermia Yellow palms/ Respiratory distress soles Cyanosis Excessive wt. loss Convulsion Vomiting Abd. distension Diarrhea 22