1. Quality Education for a Healthier Scotland Multidisciplinary The Unwell Infant? Promoting multiprofessional education and development in Scottish maternity care

2. Quality Education for a Healthier Scotland Multidisciplinary The Unwell Infant? Weel? Nae Affy Weel? Affy Nae Weel?

3. Quality Education for a Healthier Scotland Multidisciplinary 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. 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.

5. 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

6. Quality Education for a Healthier Scotland Multidisciplinary 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. Quality Education for a Healthier Scotland Multidisciplinary A - Airway Obstruction: Tongue Feed ? abnormality

8. 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.

9. 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

10. Quality Education for a Healthier Scotland Multidisciplinary 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. 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.

12. Quality Education for a Healthier Scotland Multidisciplinary D – Disability Hypotonia/floppy Hypertonia Agitation Inactive/lethargy Jittery Weak, moaning cry Seizures.

13. Quality Education for a Healthier Scotland Multidisciplinary E - Exposure Always examine the baby fully looking for: signs of infection trauma or bruising abdominal distension

14. 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)

15. Quality Education for a Healthier Scotland Multidisciplinary Any questions?

16. Quality Education for a Healthier Scotland Multidisciplinary Summary If you (or the mother) feel the baby looks ill then investigate and observe closely?