How do you identify a sick (infected) newborn - what are the signs?

The signs of neonatal infection are non-specific, so a high index of suspicion is needed. They include:

• Temperature instability (fever OR hypothermia)
• Poor feeding, lethargy, irritability, and abnormal tone
• Respiratory distress, apnoea, grunting, or tachypnoea
• Poor perfusion, tachycardia, jaundice, vomiting/abdominal distension, and seizures

Clinical relevance. Recognising the non-specific signs of neonatal infection (temperature instability, poor feeding, respiratory distress, lethargy) with a high index of suspicion enables prompt treatment.

More Detail

Identifying a sick (infected) newborn

Neonatal infection presents non-specifically - recognising the subtle signs is vital.

General

• Temperature instability - fever or (often) hypothermia.
• Poor feeding, lethargy or irritability, and 'just not right' per the parents/staff.
• Abnormal tone (hypotonia).

Respiratory

• Respiratory distress - grunting, tachypnoea, recession, or apnoea (pneumonia is the commonest early invasive infection).

Cardiovascular/other

• Tachycardia/bradycardia, poor perfusion (mottling), pallor.
• Jaundice (especially early), vomiting, abdominal distension, and feed intolerance.
• Seizures, a bulging fontanelle (meningitis).
• Rash; bleeding (DIC) in severe sepsis.

Key principle

• Because signs are non-specific and infection can deteriorate rapidly, maintain a high index of suspicion and investigate/treat promptly.