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Warning symptoms in a newborn : What Parents must know ?
Birth of a baby is one among the most happy moments in Parent’s life. Every baby is a special gift for parents. But parenting can be stressful too.Over anxiety and stress can destroy the most beautiful period in any Parent’s life. It is also important to realize that newborn babies are more fragile and any illness if undetected can progress rapidly causing serious problems. Being aware of the warning signs and maintaining alertness will ensure safety.Few important warning symptoms in newborn are listed below.

1. Refusal of feeds: Breastfeeding is the most enjoyable process for any mother and baby. Usually a normal newborn baby demands feed every 2 to 3 hours ,or even more ,during the initial few days. Any baby who is less active, not demanding feeds for more than 4 hours at a stretch , for more than once a day, not sucking well or with weak intermittent sucks or not interested in feeds needs attention .

2. Less activity : Healthy newborns spend most of their time asleep, and during the initial 2 to 3 weeks this can be up to 12 to 16 hours per day . In between sleeps babies wake up every 2 to 3 hours , cry, and demand for feeds.When awake , new-borns display a large repertoire of spontaneous movements like stretching, straining, yawning etc. Less spontaneous activity , less cry, sleeping continuously for more than 4 hrs at a stretch ,can be of concern and needs medical attention.

3. Vomiting : Majority of healthy newborns are happy spitters, frequent small volume regurgitation or vomiting is normal in newborns, this gradually resolves and this does not affect babys health. But vomiting can be problematic in certain situations. Forceful vomiting associated with irritability or large volume vomitus and a hungry baby are not normal. Yellow coloured vomiting in a newborn is a surgical emergency and needs immediate attention

4. Blood in stools ; Blood in stools with or without vomiting or abdominal distension is not normal and needs medical attention. Simple causes like nipple cracks in mother and cracks around baby’s anus should be ruled out.

5. Fast breathing : Compared to adults breathing rate is more in newborns. A normal newborn takes about 30 to 60 breaths per minute. Breathing pattern is also different in a newborn.Babies may pause breathing for 5 to 10 seconds referred to as periodic breathing , then start a burst of fast breathing for 10 to 15 sec followed by regular breathing. This breathing pattern is more
frequent in the first 2 weeks after birth. Any baby who is consistently breathing at a rate of more than expected ,needs attention.If fast breathing is associated with indrawing of lower chest wall muscles or grunting, bluish discoluration of lips, tongue ,body or decreased activity needs urgent intensive care management.

6. Unresponsive events : Unresponsive events where baby pause breathing, turns limp , blue or pale even for a few seconds in the newborn period needs immediate medical attention. Most common reason is regurgitation of feeds causing airway muscle spasm. Keeping the baby sideways with head down position and rubbing on the back will mostly make the baby responsive.Do not shake the baby. Apnoeic events ( stopping breathing ) may also be due to infections, seizures, temperature disturbances, structural brain defects etc .Breath holding spells which are benign are unusual in newborn period

7. Abnormal movements: Normal newborns show a range of spontaneous movements like stretching, yawning, salivation, rhythmic movements of limbs, straining while passing urine and stools etc.Sudden jerky movements, persistent tremor like movements, stiffening of limbs and body, repeated chewing, sucking, blinking movements can be due to seizures and need urgent management.

8. Excessive crying: Crying is the most important way for babies to communicate .Babies cry for feeds, before getting a comfortable sleep, before passing urine, stools, due to wet napkins , for getting attention etc. Babies can be fussy during evening hours, going for inconsolable cry , mostly this is due to colic ,a major cause for parent concern, usually no specific treatment is required. Proper burping, keeping in upright position, going out for a car drive etc may console the baby.. After the cry episode baby will return to normal behaviour . This mostly settles by 3 to 4 months. Sudden onset of persistent inconsolable cry needs detailed examination and appropriate interventions.
9. Poor urine stream or urinary dribbling: It’s normal for babies to strain and cry before passing urine . If there is poor urine stream or urinary dribbling or fever with straining while passing urine needs medical attention. Phimosis ( can be normal in infancy )in boys and vaginal synechiae in girls should be ruled out.

10. Less frequent stools: A breast feeding healthy newborn is expected to pass meconium ( first sticky black stool) within first 24 hours after birth. Breast fed babies may pass stools several times a day, it’s quite normal for breastfed baby to pass stools after each feed. After the first month stool frequency decreases and a normal baby may not pass stools for 6 to 7 days. But,during the first month frequent stools in a breast fed baby is an indicator of adequate feeding and a normal breast fed baby should pass stools daily. Less frequent stools in the first month needs attention
11. Pale yellow / whitish stools and deep yellow urine: Stool colour in a normal newborn is deep yellow or greenish. Urine can be yellow in the initial few days and by the end of first week urine becomes clear or straw coloured. If stool colour is pale yellow or creamy white or white and urine is deep yellow beyond 2 weeks , investigations are needed to rule out serious illness.

12. Temperature disturbances: Temperature more than 37.5 or less than 36.5 in a newborn can be due to serious infections and needs immediate attention .Covid 19 infection can affect newborns . High fever, cough, poor activity, poor feeding, fast breathing / shallow breathing are the common symptoms

13. Dos and Don’ts : A normal newborn needs only breast milk for the first 6 months of life. Formula milk is prescribed only for medical indications.

Harmful practices like ‘Ora marunnu, herbal products , water ‘’should be avoided.
Before getting discharged from hospital after birth admission,make sure that lactation is established , baby has passed urine and stools and baby is active and is not having significant jaundice, Keep the umbilicus dry, avoid applying oil over umbilicus as this may predispose to infections and delayed cord shedding .
A normal newborn baby can be given a quick daily bath with lukewarm water at home after discharge.
It’s always good to review with a Neonatologist/Pediatrician within the first week to ensure normal health and weight gain of your baby.

Dr Jyothi Prabhakar
Senior Consultant
Department of Neonatology

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