1.5.2  Evaluating the newborn baby

You should evaluate the newborn for the following danger signs in the first six hours:

• Inadequate breastfeeding: Preterm, very low birth weight, asphyxiated or sick babies generally cannot suck breast milk well. Sucking increases milk production, so do not discourage the mother from breast feeding if she is not producing sufficient milk initially. Rehydrate her and encourage the baby to suckle.
• Neonatal jaundice: Yellowish discoloration of the newborn’s skin is an indication for immediate referral to the nearest health centre or hospital if it begins within the first 24 hours, or after the baby is two weeks old.
• Fever, repeated vomiting, swollen abdomen, or no stool after 24 hours: Fever (temperature equal to or above 37.5^oC), vomiting and the other danger signs indicate that there is a serious infection and/or an obstruction somewhere in the gastrointestinal tract.
• Hypothermia: If the baby feels cold to the touch, or has a temperature of less than 35^oC, this is known as hypothermia. Place the baby in skin-to-skin contact with the mother, wrap them both in warm blankets and put a warm cap or shawl on the baby’s head. Refer them quickly if the baby’s temperature does not rise soon towards normal.
• Respiratory distress: The baby is in respiratory distress if it is breathing at above 60 breaths per minute, its chest is ‘in-drawing’ (ribs sucking inwards as the baby gasps for breath), its lips are blue, and/or its heart rate is above 160 beats per minute.
• Bleeding from the umbilical stump or other site: If the umbilical stump was tied too loosely before it was cut, it may bleed, or the baby may bleed from the anus, indicating blood loss from the stomach or intestines.
• Red swollen eyelids or pus discharging from the eyes: If you have already treated the baby’s eyes with tetracycline ointment at birth, refer the mother and baby for specialised care.