Quality Education for a Healthier Scotland

Multidisciplinary

The Unwell Infant?

Promoting multiprofessional

education and development in Scottish

maternity care

Quality Education for a Healthier Scotland

Multidisciplinary

The Unwell Infant?

• Weel?

• Nae Affy Weel?

•Affy Nae Weel?

Quality Education for a Healthier Scotland

MultidisciplinaryIncreased 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.

Quality Education for a Healthier Scotland

Multidisciplinary

Major Early Signs

• Apnoea • Respirations – abnormal >60bpm• Persistent grunting respirations• Persistent intercostal or subcostal

recession• Cyanotic lips and tongue• Bile-stained vomit.

Quality Education for a Healthier Scotland

Multidisciplinary

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

Quality Education for a Healthier Scotland

MultidisciplinaryVital Signs ABCDE+

A - check airwayB - respiration and effortC - heart rate ? murmur

colour, temperature, perfusion intake/output

D - posture, tone and activity, blood glucose

E - rash, jaundice+ - Mother’s intuition!+ - Midwife’s intuition.

Quality Education for a Healthier Scotland

Multidisciplinary

A - Airway

Obstruction:• Tongue• Feed• ? abnormality

Quality Education for a Healthier Scotland

Multidisciplinary

B - Breathing

• Tachypnoea (>60bpm)

• Grunting: babies who grunt are usually sick

• Apnoea or Irregular: apnoea never normal in > 35 weeks gestation

• LOOK FOR INFECTION.

Quality Education for a Healthier Scotland

Multidisciplinary

C - Circulation

• Tachycardia• Bradycardia ? heart block• Irregular – extrasystoles (benign)• Reduced or absent femoral or brachial

pulses• BP in all 4 limbs

Quality Education for a Healthier Scotland

MultidisciplinaryC – 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.

Quality Education for a Healthier Scotland

Multidisciplinary

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.

Quality Education for a Healthier Scotland

Multidisciplinary

D – Disability

• Hypotonia/floppy• Hypertonia• Agitation• Inactive/lethargy• Jittery• Weak, moaning cry• Seizures.

Quality Education for a Healthier Scotland

Multidisciplinary

E - Exposure

Always examine the baby fully looking for:

• signs of infection• trauma or bruising• abdominal distension

Quality Education for a Healthier Scotland

Multidisciplinary

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)

Quality Education for a Healthier Scotland

Multidisciplinary

Any questions?

Quality Education for a Healthier Scotland

Multidisciplinary

Summary

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