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Referral and warning signs
When to refer
Any danger sign identified (See PED002). Very low birth weight (<1500g) or very preterm (<32 weeks). Significant malformation. Need for specialized care.
Red flags
- See Danger Signs list in PED002.
- Significant difficulty breathing (grunting, severe indrawing).
- Floppy or stiff baby.
- Convulsions.
- Hypothermia (<35.5°C) despite warming efforts.
- Severe jaundice <24h or involving palms/soles.
Signs and symptoms
- Assessment Points:
- - Age, place of birth, delivery attendant.
- - Birth weight, gestation (LBW/Preterm/Twin status).
- - Birth problems (difficult birth, resuscitation).
- - Feeding assessment (frequency, effectiveness, problems, other feeds).
- - Mother's concerns.
- Examination Findings:
- - Breathing: Rate (Normal 30-60/min), Grunting, Chest indrawing, Cyanosis, SpO2.
- - Activity/Movements: Normal, symmetrical, floppy, stiff, spontaneous.
- - Tone.
- - Temperature: Warmth (Normal 36.5-37.5°C).
- - Head/Presenting Part: Swelling, bruising.
- - Abdomen: Distension, pallor.
- - Umbilicus: Clean, signs of infection (redness, pus).
- - Skin: Pustules, bullae, swelling, hardness, jaundice, pallor.
- - Mouth: Thrush (ulcers, white patches).
- - Malformations.
- - Weight.
- Danger Signs (See PED002 - Newborn Danger Signs).
Risk factors
- Low Birth Weight (LBW)
- Preterm birth
- Twin/Multiple gestation
- Difficult birth / Birth asphyxia / Need for resuscitation
- Maternal infection / fever near delivery
- Prolonged rupture of membranes (>18 hours)
- Maternal conditions (HIV, Syphilis, TB)
Diagnosis
Clinical assessment
Systematic examination including history taking (maternal/birth factors), observation (breathing, activity, colour), listening (heart rate, breath sounds), and feeling (temperature, tone, fontanelle, abdomen). Assess feeding by observing a breastfeed.
Investigations
- Temperature check.
- Weight measurement.
- Pulse oximetry (SpO2) if available and indicated.
Diagnostic criteria
Routine assessment for all newborns to establish baseline health and identify deviations or risk factors requiring further action.
Management
Non-pharmacological management
- Routine Care for Well Baby:
- - Ensure warmth (skin-to-skin, appropriate clothing/wrapping).
- - Initiate exclusive breastfeeding on demand as soon as possible.
- - Clean cord care (keep dry, clean, exposed; no application needed unless infected).
- - Routine hygiene.
- - Vitamin K 1mg IM (if not given at birth).
- - Tetracycline eye ointment application (prophylaxis).
- - Record details on home-based record.
- - Counsel mother on danger signs, routine care, follow-up visits (3-7 days), immunization schedule.
- Management of Identified Issues (Links to other entries):
- - Danger Signs -> PED002
- - Feeding Problems -> PED007
- - Low Birth Weight / Preterm -> PED003
- - Risk of Infection/Local Infections -> PED004
- - Jaundice -> PED005
- - Risk of HIV/Syphilis/TB -> PED006 / Specific disease entries
- - Birth Injury/Malformation -> PED011
Pharmacological treatment
- Vitamin K 1mg IM single dose.
- Tetracycline eye ointment 1% single application.
Monitoring
Routine follow-up visit at 3-7 days of age. Monitor feeding, weight gain, temperature, breathing, activity.
Complications
- Failure to identify danger signs leading to delayed treatment.
- Hypothermia.
- Hypoglycaemia.
- Feeding difficulties.
- Infection.
Prevention
- Skilled birth attendance.
- Essential newborn care practices (warmth, clean cord care, early breastfeeding).
- Antenatal screening and care.
Patient education
- Importance of warmth (KMC).
- Exclusive breastfeeding benefits and technique.
- Clean cord care.
- Recognizing newborn danger signs and when to seek care immediately.
- Importance of follow-up visits and immunization schedule.
Uganda-specific notes
Emphasis on Essential Newborn Care package. Vitamin K and Tetracycline eye ointment are standard practice. KMC is key for LBW/preterm infants. Assess for risks common in the setting (maternal infections, home births).
References
- Uganda Clinical Guidelines (UCG) 2023
Chapter 17, Section 17.1.1, 17.1.2 (Initial Assessment parts)