DANGERDANGER

SIGNALS
IN NEWBORN
SIGNALS
IN
NEWBORNS

Rhishikesh Thakre
DM,MD,DCH,DNB,FCPS.

NEWBORN - Normal / abnormal ?

Subtle symptomatolgy
Single etiology - Multiple manifestation
Single manifestation - Multiple etiology
LOCALISATION IS DIFFICULT
RAPID PROGRESSION

NORMAL - appears ABNORMAL

Dehydration Fever
Transitional Stool
Setting sun sign
Sutural separation
Cortical thumb

NORMAL - appears - ABNORMAL

Acrocyanosis
Periodic Breathing
Erythema Toxicum
Phimosis
Umbilical granuloma / hernia
Red spot in eye
Sternomastoid tumor

NORMAL- appears - ABNORMAL

Vaginal discharge / bleeding
Breast engorgement / discharge
Sticky eyes - Blocked nasolacrimal duct
Murmur
Jitteriness
Palpable kidneys
Jaundice

ABNORMAL- appears- NORMAL

Excess weight gain
Quiet baby
Urine output
Drug administration
Edema of dorsum of hand & feet

DANGER SIGNALS
LABOR ROOM
IPPR causing cyanosis
Need for cardiac massage / drugs
Grunt
Frothing at mouth

DANGER SIGNALS
LABOR ROOM
Single umbilical artery
Increased AP diameter of chest
Anal patency
Palate integrity
Pre auricular tag
Urethral opening

DANGER SIGNALS
LABOR ROOM
-

Role of cord blood

VDRL
HIV
Rh ve mother : B group/ DCT/ Sbili / Hb
Thyroid screening

COLD STRESS

DANGER SIGNALS
Lethargy
Excessive crying
Poor feeding
Discolouration : yellow/blue/red/white
NOT PASSED STOOL (48 h) URINE (24 h)
Bleeding tendency
Abdominal distension

DANGER SIGNALS- Symptoms

Cough
Diarrhoea
Crying relieving cyanosis
Crying aggravating cyanosis

Delayed cord separation

JAUNDICE > 14 d

DANGER SIGNALS- Signs

Weight gain pattern
Eyes Cataract
Mouth Submucous Cleft palate
Lower limb pulses
Congenital dislocation of hip
Single second heart sound
Posterior fontanel
Lymphadenopathy

Hemangiomas

Portwine stain

Unique Presentations
PRETERMS
ABO incompatibility
Meconium aspiration
Erythema toxicum
Hirchsprungs disease
TTNB
HIE

TERM
Resp distress sy
Intraventricular
haemorrhage
NEC
PDA

Danger Signal : TOOL

RR

RESPIRATORY DISTRESS
0
1
< 60
60-80

Grunt

Absent

Auscult

Air Entry

Equal

Decreased

Retraction

None

Mild-Mod

Color

Pink

Dusky

2
> 80
Audible
Absent
Severe
Cyanosis

DANGER SIGNALS
ASPHYXIA
Cardiac Massage
Drug Administration
IPPR worsening cyanosis
Seizures in < 6 hours
Barrel chest in MSAF baby
Grunt in MSAF baby

DANGER SIGNALS
JAUNDICE
Preterm
Anemia
Hepato splenomegaly
High coloured urine
Clay coloured stool
Jaundice > 14 days
Jaundice < 36 hours

Danger Signal : TOOL

KRAMERS CRITERION
Jaundice
S. Bilirubin (mg%)
Face
4 - 8
Upper Trunk
5 - 12
Upto Thighs
8 - 16
Arms & Legs
11 16
Palms & Soles
> 18

DANGER SIGNALS
SURGICAL
Not passed stool ( 48 h )
Not passed urine ( 24 h )
Frothing at mouth
Single umbilical artery
Inability to pass feeding tube
Dextrocardia

To Conclude Be judicious
Assess objectively
High index of suspicion
Rest assured :
- exclusively breast fed
- gaining weight
- good tone, cry, & activity