Integrated Maternal and Newborn Care Basic Skills Course ...
Integrated Maternal and Newborn Care Basic Skills Course ...
Integrated Maternal and Newborn Care Basic Skills Course ...
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Reference Manual<br />
Check for jaundice<br />
Unlike in older infants, it is not easy to see jaundice in the early phase in the eyes of the<br />
newborn. It is best assessed in the skin. Jaundice starts in the face <strong>and</strong> spreads down to the<br />
h<strong>and</strong>s <strong>and</strong> feet. Gently press the tip of the nose, release the pressure, <strong>and</strong> observe the<br />
blanched area for any yellow tinge/color. It can also be seen in the grooves of the skin when the<br />
baby frowns or cries.<br />
This is the only time in life that some jaundice is normal, <strong>and</strong> this used to be termed physiologic<br />
jaundice of the newborn. It starts after the first 24 hours on the face <strong>and</strong> does not spread to the<br />
palms <strong>and</strong> soles <strong>and</strong> disappears by two weeks. When the color reaches the palms or soles, it<br />
correlates with a serum bilirubin of about 15 mg/100mL (or 256.5µmols/L). Such babies require<br />
referral for assessment <strong>and</strong> treatment, such as phototherapy.<br />
These guidelines apply only to full-term normal weight babies. Preterm <strong>and</strong> low birth weight<br />
babies require treatment at far lower levels of bilirubin. Hence, such babies with any jaundice<br />
need to be referred to a competent person/center for assessment <strong>and</strong> treatment. They should<br />
not be considered to have “physiological jaundice.”<br />
Here is a summary of referral criteria for jaundice:<br />
• starting early, within 24 hours of birth<br />
• present on the palms <strong>and</strong> soles<br />
• associated with a danger sign<br />
• occurring in a low preterm/birth weight baby<br />
• persisting beyond the second week of life<br />
Check for minor infections<br />
Conjunctivitis: Subconjunctival hemorrhage can be a normal finding following the delivery.<br />
Check for conjunctivitis, seen as redness <strong>and</strong>/or discharge.<br />
Thrush: Examine the tongue <strong>and</strong> the inner side of the mouth for oral thrush, seen as irregular,<br />
dirty, white patches on the tongue <strong>and</strong> inner sides of the cheeks. Thrush is different from the<br />
normal smooth white coating which may be seen over the middle of the tongue in some babies.<br />
It is best to look into the mouth when the baby cries or yawns. Avoid introducing a spatula or<br />
spoon into the mouth to open it. If doing this is unavoidable, then it must be done very gently, as<br />
vagal stimulation may result in bradycardia or even cardiac arrest.<br />
Skin infection including pustules on the skin: The lesions may be seen as yellowish<br />
pustules or as areas of peeling with underlying redness. Examine the skin from head to toe.<br />
Look particularly in the neck folds <strong>and</strong> elbow, behind the ears, in the axilla <strong>and</strong> groin. Turn the<br />
baby over <strong>and</strong> examine the back.<br />
Minor infections of the umbilicus: Look for pus discharge from the umbilicus or base of the<br />
cord (lift the cord to see the base) without redness or swelling over the surrounding skin <strong>and</strong>/or<br />
a foul smell.<br />
<strong>Integrated</strong> maternal <strong>and</strong> newborn care<br />
<strong>Basic</strong> skills course<br />
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