Integrated Maternal and Newborn Care Basic Skills Course ...

DANGER
SIGNS
Table 10. Guidelines for Identifying Danger Signs at Peripheral Centers
IDENTIFICATION
(Ask and look for)
Sucking less
or not
sucking at all
Lethargy/
inactivity
Fever/
low body
temperature
Fast
breathing/
respiratory
difficulty
Convulsions
Persistent
vomiting
and/or
abdominal
distension
Severe
umbilical
infection
Not sucking at all; sucking less than usual; not opening the mouth when offered
feeds; not demanding feeds.
Not as active as usual, sleeping excessively, difficult to arouse, not waking up
for feeds, lying limp, “loose-limbed,” excessively quiet or “too good.”
Fever: Body hot to touch, history of the mouth feeling excessively hot during
breastfeeding; temperature 38 °C or more. (While the temperature is usually
>38 °C, some feel that in the newborn it is better to be on more watchful when
the temperature is even 37.5 °C.)
Low body temperature/hypothermia: body feels colder than normal;
temperature less than 36.5 °C.
Respirations more than 60/minute (count a second to verify), flaring of the
nostrils, groaning or grunting, subcostal retraction.
Features of convulsions are often atypical in the newborn such as a “staring”
look, blinking of eyelids, “chapping” movements of the lips, clonic/tonic
movements of the limbs.
Occasional vomiting is common, but persistent vomiting or green-colored
vomitus are abnormal. Abdominal distension or fullness may be present.
Lift the cord to see the base. Look for spreading redness or swelling around the
umbilicus and/foul smell with or without pus discharge.
Earlier detection of problems such as major infections
Babies with danger signs have to be taken long distances to the appropriate centers. Hence,
ideally, infections need to be detected even earlier. Very early signs of infection are vague and
difficult to recognize. They include the baby “not looking well” or having a “sick look” or “facial
grimace.” They require careful daily observation.
Mothers, family members, and health care providers (depending on whether the baby is at
home or at a facility) should be encouraged to see the baby in adequate light at least once a
day, especially in the first week.
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Integrated maternal and newborn care
Basic skills course