Integrated Maternal and Newborn Care Basic Skills Course ...

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