DANGER SIGNS AND THEIR MANAGEMENT

Place the baby in a warm environment, weigh the baby, establish IV access and manage accordingly:

RESPIRATION

  • Not breathing (apnoea) or gasping (respiratory rate <20/minute): Start resuscitation immediately.
  • Respiratory distress – rate >60/minute, chest retraction, grunting, central cyanosis: Give oxygen by nasal prong or nasal catheter.

SHOCK

Shock can be due to severe blood loss at birth, or dehydration through failure to feed, vomiting or diarrhoea.
For the baby who has lost a lot of blood there will be severe pallor in addition to signs of shock.

Signs of shock

  • Cold hands and feet
  • Capillary refill >3 seconds (this may be difficult to elicit in a baby with severe blood loss because of severe
    pallor)
  • Altered consciousness.

For both causes restore circulating blood volume by giving normal saline or Ringer’s lactate at 20ml/kg intravenously as rapidly as possible. Reassess and if still in shock repeat the dose. For the baby that has bled, get blood as quickly as possible and transfuse.

UNCONSCIOUS/CONVULSING/SPASMS

These could be due to serious bacterial infection, birth asphyxia, neonatal tetanus or bilirubin toxicity.

Establish the cause through history and treat accordingly. Control convulsions using phenobarbital preferably IV 10–20mg/kg;
give slowly while watching breathing.

UNABLE TO BREASTFEED

Causes include

  • Serious bacterial infection
  • Birth asphyxia
  • Low birth weight
    (preterm baby).

Give dextrose 10ml/kg IV or nasogastric tube to prevent or treat hypoglycaemia immediately. This can be followed by giving breast milk as soon as possible according to the condition of the baby.

VERY OR EXTREMELY LOW BIRTH WEIGHT

Refer or admit urgently for specialized care. If referring, Kangaroo Mother position can be used to keep baby warm during the journey; pass a nasogastric tube and give expressed breast milk to prevent hypoglycaemia. All babies with danger signs will need admission to a unit that can treat them. Transfer by the quickest means available preferably by ambulance so that you can administer
oxygen if the baby has breathing problems.