Integrated Maternal and Newborn Care Basic Skills Course ...

Reference Manual
The following three adaptations may be necessary during an examination of a newborn:
• Count the respiratory rate whenever the baby is quiet.
• If the baby cries, take advantage to examine the mouth to look for cleft palate or thrush.
• If feeding is necessary to calm the baby, take advantage to observe attachment at the
breast and quality and adequacy of the sucking.
Check for danger signs
Check for the following newborn danger signs:
• Difficulty in sucking. The danger signs related to sucking/feeding can be assessed by
asking the mother and verified by direct observation.
• Lethargy, diminished activity, moving only when stimulated. Except in deep sleep,
babies move frequently, both spontaneously and on stimulation. The arms and legs are
flexed. If a limb is consistently kept straight, evaluate for paralysis. Note also if the limbs
seem very limp or flaccid.
• Fever or hypothermia. Assess the body temperature by at least touching the baby’s
abdomen, hands, and feet and ensuring that all are warm. Where possible, note the
axillary temperature with a thermometer leaving it in place for four minutes or as
recommended by the manufacturer for axillary temperature recording. The normal
temperature is 36.5-37.5 °C. The thermometer should be clean, preferably washed with
soap and clean water, and wiped with an alcohol swab to prevent cross infection. Storing
in liquid antiseptics should be done only if they are changed frequently. Otherwise there
is risk of infections with Pseudomonas sps which may be highly resistant organisms. It is
not recommended to take a rectal temperature as it is associated with a higher risk of
infection and trauma. In the newborn infant, both fever and low body temperature
outside the normal range of 36.5-37.5 °C are danger signs, especially if they are not
reversed rapidly with simple steps, such as warming through skin-to-skin contact, or
through removal of excess clothes, or covering in the hot weather.
• Rapid breathing/difficulty in breathing. Assess respiration: the normal respiratory rate
is 30-60 breaths/minute. There should be no flaring of the nostrils, grunting, or subcostal
retractions. Although breathing can be somewhat irregular with short pauses, there
should be no apnea, which is defined as cessation of breathing lasting for more than 20
seconds or of a shorter duration associated with cyanosis, pallor, or bradycardia with a
heart rate less than 110/minute. The normal heart rate ranges between 110-160
beats/minute, with the lower rates when the baby is asleep and the higher rates when
the baby is active or crying.
• Convulsions. Features of convulsions are often atypical in the newborn, such as a
“staring” look, blinking of eyelids, “chapping” movements of the lips, and clonic/tonic
movements of the limbs.
• Persistent vomiting and/or abdominal fullness . Vomiting is determined from the
history taken from the mother. Occasional vomiting is normal, but persistent vomiting or
green-colored vomitus are abnormal.
• Severe umbilical infection. Lift the cord to see the base; check for pus discharge,
redness, swelling, and foul smell. In the first day or two also check the cord for bleeding
or oozing of blood.
The danger signs are summarized in Table 10 below.
Integrated maternal and newborn care
Basic skills course
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