Danger signs in newborns

1. 11
Danger Signs in Danger Signs in
Newborn Newborn
Dr Varsha Atul ShahDr Varsha Atul Shah

2. 22
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

3. 33
Problems in early diagnosis Problems in early diagnosis
of sick newbornof sick newborn
 Non-specific signsNon-specific signs
 Difficulties in preterm and LBW babiesDifficulties in preterm and LBW babies

4. 44
Lethargy and poor suckingLethargy and poor sucking
In a term baby who was feeding earlier In a term baby who was feeding earlier ®®
indicates neonatal illness (as perceived by indicates neonatal illness (as perceived by
mother) mother)
In a preterm baby In a preterm baby ®® needs careful needs careful
assessment because it may be due to cold assessment because it may be due to cold
stress or immaturitystress or immaturity

5. 55
Capillary refill time (CRT)Capillary refill time (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

6. 66







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

7. 77
Respiratory problemsRespiratory problems
 RR > 60 / min*RR > 60 / min*
 RetractionsRetractions
 GruntGrunt
 Central cyanosisCentral cyanosis
 ApneaApnea
*Rate should be counted in a quiet state *Rate should be counted in a quiet state
and not immediately after feedand not immediately after feed

8. 88
RR
EE
TT
RR
AA
CC
TT
II
OO
NN
SS

9. 99
Body temperature in Body temperature in
newborn infant (newborn infant (
oo
C)C)
Normal range
Cold stress
Moderate hypothermia
Severe hypothermia Outlook grave, skilled
care urgently needed
Danger, warm baby
Cause for concern
37.5
o
36.5
o
36.0
o
32.0
o

10. 1010
Failure to pass meconium and Failure to pass meconium and
urineurine
Failure to pass meconiumFailure to pass meconium
Majority 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 therapeuticLubricated per-rectal thermometer may be therapeutic
Suspect obstructionSuspect obstruction
Failure to pass urineFailure to pass urine
Majority pass within 48 hrsMajority pass within 48 hrs
Delayed passageDelayed passage
Exclude obstructive uropathy or renal agenesisExclude obstructive uropathy or renal agenesis

11. 1111
Causes of vomiting*Causes of vomiting*
Ingestion of meconium stained amniotic fluid Ingestion of meconium stained amniotic 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

12. 1212
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, laxatives)(ampicillin, laxatives)
 Metabolic disordersMetabolic disorders
 ThyrotoxicosisThyrotoxicosis
 Maternal drug addictionMaternal drug addiction
*Infective diarrhea needs treatment with systemic *Infective diarrhea needs treatment with systemic
antibioticsantibiotics

13. 1313
Cyanosis Cyanosis
PeripheralPeripheral
Normal at birthNormal at birth
Seen in extremities due to coldSeen in extremities due to cold
CentralCentral
Always needs appropriate referralAlways needs appropriate referral
Seen on lips and mucosaSeen on lips and mucosa
Indicates cardiac or pulmonary diseaseIndicates cardiac or pulmonary disease

14. 1414
Peripheral cyanosisPeripheral cyanosis

15. 1515
Central cyanosisCentral cyanosis

16. 1616
Yellow Palms & SolesYellow Palms & Soles

17. 1717
Yellow staining of solesYellow staining of soles

18. 1818
Tracheo-esophageal fistulaTracheo-esophageal fistula
Excessive drooling; choking; cyanosis Excessive drooling; choking; cyanosis
during feeds; respiratory distressduring feeds; respiratory distress
Failure to pass red rubber catheter beyond Failure to pass red rubber catheter beyond
8 to 10 cm from mouth8 to 10 cm from mouth

19. 1919
Tracheo-esophageal fistulaTracheo-esophageal fistula

20. 2020
Suspect cardiac diseaseSuspect cardiac disease
 CyanosisCyanosis
 TachycardiaTachycardia
 MurmurMurmur
 HepatomegalyHepatomegaly
 ShockShock
 CardiomegalyCardiomegaly

21. 2121
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

22. 2222
Danger signs : SummaryDanger signs : Summary
LethargyLethargy
HypothermiaHypothermia
Respiratory distressRespiratory distress
CyanosisCyanosis
ConvulsionConvulsion
Abd. distensionAbd. distension
BleedingBleeding
Yellow palms/ Yellow palms/
solessoles
Excessive wt. lossExcessive wt. loss
VomitingVomiting
Diarrhea Diarrhea