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The Unwell Infant?

The Unwell Infant?. Promoting multiprofessional education and development in Scottish maternity care. The Unwell Infant?. Weel? Nae Affy Weel? Affy Nae Weel?. Increased Risk. Low birth weight (preterm and SGA) Pre-existing problem, e.g. congenital anomaly

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The Unwell Infant?

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  1. The Unwell Infant? Promoting multiprofessional education and development in Scottish maternity care

  2. The Unwell Infant? • Weel? • Nae Affy Weel? • Affy Nae Weel?

  3. Increased Risk • Low birth weight (preterm and SGA) • Pre-existing problem, e.g. congenital anomaly • Problem in pregnancy (Sick Mother = Sick Baby) • Difficult delivery • Social disadvantage (multiple issues and pathologies) • Infection risk - PROM, GBS, febrile mother.

  4. Major Early Signs • Apnoea • Respirations – abnormal >60bpm • Persistent grunting respirations • Persistent intercostal or subcostal recession • Cyanotic lips and tongue • Bile-stained vomit.

  5. Major Early Signs • Baby floppy when lifted or held • Difficult to rouse • Irritable/jittery/constantly distressed during first 4 hours following delivery • Blood glucose <2.6mmol/l • Jaundice within first 12 hours • Skin rash at birth

  6. Vital Signs ABCDE+ A - check airway B - respiration and effort C - heart rate ? murmur colour, temperature, perfusion intake/output D - posture, tone and activity, blood glucose E - rash, jaundice + - Mother’s intuition! + - Midwife’s intuition.

  7. A - Airway • Obstruction: • Tongue • Feed • ? abnormality

  8. B - Breathing • Tachypnoea (>60bpm) • Grunting: babies who grunt are usually sick • Apnoea or Irregular: apnoea never normal in > 35 weeks gestation • LOOK FOR INFECTION.

  9. C - Circulation • Tachycardia • Bradycardia ? heart block • Irregular – extrasystoles (benign) • Reduced or absent femoral or brachial pulses • BP in all 4 limbs

  10. C – Circulation and Temperature • Cyanosis: check with oximeter • Central cyanosis ALWAYS abnormal • Pallor and mottling: capillary return > 3 secs • Hypothermia • Persisting temp >37.5°C ?over swaddling • Problems maintaining body temperature • Early onset jaundice.

  11. C – Circulation Intake/Output • Feeding: a complex activity-sensitive indicator. Babies who feed well are unlikely to be unwell • Urine output - especially >24 hours old • Vomiting persisting, excessive or bile-stained • Diarrhoea frank blood (not streaks), mucus • Abdominal distension/tenderness.

  12. D – Disability • Hypotonia/floppy • Hypertonia • Agitation • Inactive/lethargy • Jittery • Weak, moaning cry • Seizures.

  13. E - Exposure • Always examine the baby fully looking for: • signs of infection • trauma or bruising • abdominal distension

  14. Urgent Referral • Does the baby have any of the following? • Periodic breathing or persistently struggling to breathe. • Has become persistently pale or grey • Taken less than half normal feeds in past 12 hours (refused last 3 feeds) • Bile stained vomit • Will not waken or cannot be roused • Weak moaning cry (different to normal)

  15. Any questions?

  16. Summary • If you (or the mother) feel the baby looks ill then investigate and observe closely?

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