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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?