A Monitor of 7 Signs for your Newborn Infant’s Urgent Treatment
Medical experts have compiled a checklist of seven signs that mothers and healthcare workers can use to identify severe illnesses in newborn infants requiring urgent treatment in hospital.
Around 4 million babies around the world die each year before they are a month old, and three-quarters of them die in the first week of life -- mainly from bacterial infections, birth complications and prematurity.
In an article published in the Lancet, the researchers said the list can help identify serious illnesses in infants under two months and bridge a gap in a previous checklist that did not cover infants in their first week of life.
"Anyone looking after children, mothers, should know that if children are not feeding well, it is a sign of serious illness, they should take it to care," said Martin Weber of the world Health Organization in Jakarta.
"It seems very simple, but these are messages we need to promote more widely. If the baby is not moving spontaneously and only doing so when you touch it, that should alert you that the baby has problems," Weber told Reuters in a phone interview.
The seven clinical signs are:
1. History of difficult feeding (the baby feeds little or not at all):
Newborns should be feeding every two to four hours. Feeding problems are not solely associated with breastfeeding. If you encounter any problems with breastfeeding, such as problems with the baby latching on, pain when breastfeeding, or if you are unsure that the baby is feeding well, speak with your physician.
About half of the cases of group B strep disease among newborns happen in the first week of life ("early-onset disease"), and most of these cases start a few hours after birth. Sepsis, pneumonia (infection in the lungs), and meningitis (infection of the fluid and lining around the brain) are the most common problems.
The symptoms for early-onset group B strep can seem like other problems in newborns. Some symptoms are fever, difficulty feeding, irritability, or lethargy (limpness or hard to wake up the baby). If you think your newborn is sick, get medical help right away.
The more prematurely newborns are born, the more they are prone to a number of serious and even life-threatening complications. The parts of the newborn babies brain which control the mouth and throat are immature so the newborn cannot suck and swallow normally and will have difficulty coordinating feeding with breathing.
2. History of convulsions:
Families have more time to act if there are signs of infection. Infection (including acute respiratory infection — or pneumonia) remains a danger throughout the neonatal period which may lead to sepsis. Signs of Sepsis (infection in an infant with serious systemic illness) are Pallor, Central cyanosis lethargy, Irritability, Hyperactivity, Fever, Jaundice in 1st 24 hours, Vomiting, Poor feeding, and Convulsions. Intracranial bleeding after a traumatic delivery may cause refusal to suck; lethargy and signs were poor reflex and convulsion.
It is well recognized that there is poor concordance between clinically evident convulsions and electroconvulsive seizures present on EEG monitoring. It may prove useful in infants who are showing equivocally abnormal movements but there is uncertainty as to whether they represent seizure activity. The trace may reduce or increase the threshold for anticonvulsant treatment.
3. Movement only when stimulated (baby is inactive or lethargic):
LONG CHAIN HYDROXY Acyl-CoA DEHYDROGENASE DEFICIENCY (LCHADD) or TRIFUNCTIONAL PROTEIN DEFICIENCY (TFP) due to genetic defects is caused by a defect in the intramitochondrial ß-oxidation of long chain fatty acids. It can cause severe hypoketotic hypoglycemia, lethargy, and liver dysfunction with hepatomegaly, clotting defect, metabolic acidosis, hyperammonemia cardiomyopathy, and sudden death.
Congenital hypothyroidism is a condition in which there is an inadequate production of the thyroid hormone; seen in one in 6,000 to 7,000 live births. Clinical signs that can develop include jaundice, constipation, poor muscle tone, feeding problems, lethargy, a puffy face, large tongue, umbilical hernia, and hypothermia. If untreated, severe mental retardation, growth delays, deafness, and other neurological abnormalities can occur.
Type 2 virus (genital herpes) is most often transmitted through sexual contact. In newborns, symptoms such as lethargy, irritability, tremors, seizures, and poor feeding generally develop between 4 and 11 days after delivery.
4. Breathing rate of 60 breaths per minute or more (Breathing is rapid, accompanied by chest in-drawing or gasping/grunting):
Intussusception occurs when one portion of the bowel slides into the next and creates an obstruction in the bowel, with the walls of the intestines pressing against one another. This, in turn, leads to swelling, inflammation, and decreased blood flow to the intestines involved. As the illness progresses, a child will become progressively weaker and may develop a fever and appear to go into shock. Symptoms of shock include lethargy, rapid heartbeat, weak pulse, low blood pressure, and rapid breathing.
For many respiratory tract infection in infants and children signs and symptoms may be included fever, cough, runny nose, rapid breathing, abnormal breath sounds, and hypoxia.
Patent ductus arteriosus (PDA) is one of the most common congenital heart defects. Increased levels of carbon dioxide (CO2) in the blood are detected in individuals with several lung diseases, including chronic obstructive pulmonary disease (COPD) and asthma thereby impair the ability of these cells to remove fluid from the lungs and resulting in difficulty breathing.
5. Severe chest indrawing:
A child is considered to be at high risk if your infants respiratory rate > 60/minute, apnea or grunting, moderate or severe chest indrawing, tachypnoea, cyanosis, or apnea with oxygen saturations < 90% on air, even no response to social cues, they are unable to be roused, or if rousable they do not stay awake with reduced skin turgor.
Acute respiratory infections (ARI) are one of the major causes of death of infants and children under the age of five years. In a child with cough or difficulty in breathing, pneumonia is indicated by fast breathing. Fast breathing and chest in-drawing or chest in-drawing alone are the signs of severe pneumonia.
6. Hyperthermia i.e. over 37.5 degrees Celsius (the body is especially hot):
When the newborn is in an environment that is too hot the baby's temperature rises above 37.5°C (99.5°F) and it develops hyperthermia. Hyperthermia should not be confused with fever, which is a raised body temperature in response to infection with microorganisms or other sources of inflammation. Such as in more severe cases of encephalitis, a person is more likely to experience high fever and any of a number of symptoms that relate to the central nervous system.
However, it is not possible to distinguish between fever and hyperthermia by measuring the body temperature or by clinical signs, and when the newborn has a raised temperature it is important to consider both causes. Infection should always be suspected first, unless there are very obvious external reasons for the baby becoming overheated.
7. Hypothermia i.e. under 35.5 Celsius (The body is especially cold):
Warning symptoms for hypothermia are; lethargy, weakness and loss of coordination, confusion, uncontrollable shivering, reduced respiratory or heart rate. Among infants, warning signs also include bright red skin and low energy. In cases of severe hypothermia (core body temperature is less than 82.5? F), the victim loses consciousness and their pulse may not be apparent.
In severely hypothermic babies the face and extremities may develop a bright red color, even in non-white neonates. Sclerema — a hardening of the skin associated with reddening and edema — may occur on the back and limbs or over the whole body. The baby becomes lethargic and develops slow, shallow and irregular breathing and a slow heart beat. Low blood sugar and metabolic acidosis, generalized internal bleeding (especially in the lungs) and respiratory distress may occur. Such a level of hypothermia is very dangerous and unless urgent measures are taken, the baby will die.
Moreover the mother/family brings the baby to the health facility as soon as one of these Common danger signs in the newborn appears:
- The base of the umbilical cord is red, inflamed, is leaking pus or has a bad odor
- Persistent vomiting/abdominal distention
Weber and colleagues started off with a checklist of 31 signs that first-line health workers used to identify severe illnesses in 8,889 infants brought to clinics in Bangladesh, Bolivia, Ghana, India, Pakistan and South Africa.
These assessments were compared against decisions made by pediatricians. Weber's team later found the assessments were reliable even after the list was narrowed down to seven points.
Weber stressed that mortality figures can only be reduced if proper healthcare is available to these children.
According to Chief Medical Officer UK; in babies, parents should look out for one or more the following symptoms signs and symptoms of meningitis and septicaemia as this is the time of year when cases rise:
- A high-pitched, moaning cry
- A bulging fonatenelle
- Being difficult to wake
- Floppy and listless or stiff with jerky movements
- Refusing feeds
- Rapid/ unusual/ difficult breathing (septicaemia)
- Pale or blotchy skin
- Red or purple spots that do not fade under pressure (septicaemia)
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