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Danger Signs in Danger Signs in Newborn Newborn

Dr Varsha Atul Dr Varsha Atul ShahShah

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Sick newbornSick newborn

Early detection, Early detection, prompt treatment and prompt treatment and

referral (if required) referral (if required) are necessary to prevent high mortalityare necessary to prevent high mortality

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Problems in early Problems in early diagnosis of sick diagnosis of sick

newbornnewborn

Non-specific signsNon-specific signs Difficulties in preterm and LBW Difficulties in preterm and LBW

babiesbabies

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Lethargy and poor Lethargy and poor suckingsucking

In a term baby who was feeding In a term baby who was feeding earlier earlier indicates neonatal illness indicates neonatal illness (as perceived by mother) (as perceived by mother)

In a preterm baby In a preterm baby needs careful needs careful assessment because it may be due assessment because it may be due to cold stress or immaturityto cold stress or immaturity

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Capillary refill time Capillary refill time (CRT)(CRT)

Indicates tissue perfusionIndicates tissue perfusion Normal CRT < 3 secondsNormal CRT < 3 seconds Prolonged CRT Prolonged CRT >> 3 seconds * 3 seconds * Use 10ml/kg normal saline bolusUse 10ml/kg normal saline bolus

* Hypotension, hypothermia, acidosis* Hypotension, hypothermia, acidosis

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Capillary refill time Capillary refill time (CRT)(CRT)

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Respiratory problemsRespiratory problems RR > 60 / min*RR > 60 / min* RetractionsRetractions GruntGrunt Central cyanosisCentral cyanosis ApneaApnea

*Rate should be counted in a quiet *Rate should be counted in a quiet state and not immediately after feedstate and not immediately after feed

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RREETTRRAACCTTIIOONNSS

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Body temperature in Body temperature in newborn infant (newborn infant (ooC)C)

Normal range

Cold stress

Moderate hypothermia

Severe hypothermia Outlook grave, skilled care urgently needed

Danger, warm baby

Cause for concern

37.5o

36.5o

36.0o

32.0o

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Failure to pass meconium Failure to pass meconium and urineand urine

Failure to pass meconiumFailure to pass meconiumMajority pass within 24 hrsMajority pass within 24 hrs Delayed passageDelayed passage May have passed in –uteroMay have passed in –utero Lubricated per-rectal thermometer may be Lubricated per-rectal thermometer may be

therapeutictherapeutic Suspect obstructionSuspect obstruction

Failure to pass urineFailure to pass urineMajority pass within 48 hrsMajority pass within 48 hrs Delayed passageDelayed passage Exclude obstructive uropathy or renal agenesisExclude obstructive uropathy or renal agenesis

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Causes of vomiting*Causes of vomiting* Ingestion of meconium stained amniotic Ingestion of meconium stained amniotic

fluid fluid Systemic illnessSystemic illness Congestive cardiac failureCongestive cardiac failure Raised ICP – IVH, asphyxiaRaised ICP – IVH, asphyxia Metabolic disorders (CAH, galactosemia)Metabolic disorders (CAH, galactosemia)

*Persistent, projectile or bile stained - r / o *Persistent, projectile or bile stained - r / o intestinal obstructionintestinal obstruction

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Causes of diarrheaCauses of diarrhea

Infective diarrhea* (often non breast fed baby) Infective diarrhea* (often non breast fed baby) Maternal ingestion of drugs Maternal ingestion of drugs (ampicillin, (ampicillin,

laxatives)laxatives) Metabolic disordersMetabolic disorders ThyrotoxicosisThyrotoxicosis Maternal drug addictionMaternal drug addiction

*Infective diarrhea needs treatment with *Infective diarrhea needs treatment with systemic antibioticssystemic antibiotics

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Cyanosis Cyanosis PeripheralPeripheralNormal at birthNormal at birthSeen in extremities due to coldSeen in extremities due to cold

CentralCentralAlways needs appropriate referralAlways needs appropriate referralSeen on lips and mucosaSeen on lips and mucosa Indicates cardiac or pulmonary Indicates cardiac or pulmonary

diseasedisease

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Peripheral Peripheral cyanosiscyanosis

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Central cyanosisCentral cyanosis

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Yellow Palms & SolesYellow Palms & Soles

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Yellow staining of solesYellow staining of soles

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Tracheo-esophageal Tracheo-esophageal fistulafistula

Excessive drooling; choking; cyanosis Excessive drooling; choking; cyanosis during feeds; respiratory distressduring feeds; respiratory distress

Failure to pass red rubber catheter Failure to pass red rubber catheter beyond 8 to 10 cm from mouthbeyond 8 to 10 cm from mouth

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Tracheo-esophageal Tracheo-esophageal fistulafistula

2020

Suspect cardiac diseaseSuspect cardiac disease

CyanosisCyanosis TachycardiaTachycardia MurmurMurmur HepatomegalyHepatomegaly ShockShock CardiomegalyCardiomegaly

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Abnormal weight loss Abnormal weight loss patternpattern

> 10 percent of birth weight in term> 10 percent of birth weight in term > 15 percent in preterm> 15 percent in preterm > 5 percent acute weight loss> 5 percent acute weight loss

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Danger signs : Danger signs : SummarySummary

LethargyLethargyHypothermiaHypothermiaRespiratory Respiratory

distressdistressCyanosisCyanosisConvulsionConvulsionAbd. distensionAbd. distension

BleedingBleedingYellow palms/ Yellow palms/

solessolesExcessive wt. Excessive wt.

losslossVomitingVomitingDiarrhea Diarrhea