Bringing a baby into the world is a joyful moment, but the first few weeks after birth, known as the neonatal period, can sometimes bring unexpected health scares that no new parent is ever truly ready for.
From sudden fevers and breathing troubles to that worrying yellow tinge in your baby’s skin, it can be hard to tell what’s normal and what needs urgent care.
While most newborns are healthy, emergencies can arise at any time – even within hours of birth.
The good news? Many of these conditions are manageable and treatable when recognised early.
To help you feel more prepared, informed and confident, we spoke to Dr Livia Chow Huey Ling, Consultant Paediatrician and Neonatologist at Pantai Hospital Ayer Keroh, who answers some of the most common questions parents have about neonatal emergencies, from respiratory distress and severe jaundice to sepsis, SIDS and choking.
Her expert advice could make all the difference in a critical moment.
What are the most common neonatal emergencies parents should be aware of?
Neonatal period starts from birth till the end of 28 days.
Most babies are delivered healthy but there are some babies that suffer from some neonatal emergency conditions.
Neonatal emergencies can happen anytime from immediately after birth, during hospital stay until the end of neonatal period at 28 days.
It is crucial for parents to know how to identify neonatal emergencies as early as possible as most of these need prompt medical attention and resuscitation.
Lack of such can be fatal.
Some of the common neonatal medical emergencies includes respiratory distress, severe jaundice, hypoglycaemia, heart emergencies, surgical emergencies and infection.
How can parents recognise respiratory distress in newborns, and what immediate action should they take?
Respiratory distress is a medical emergency.
It is a condition that tells us that the body needs more oxygen.
When babies have to work hard to breathe or are not getting enough oxygen, they show signs that indicate respiratory distress such as:
- Increase in breathing rate
- Increases in heart rate which is caused by low oxygen levels
- Making noises when breathing
- Bluish discolouration of the lips or fingernails indicating low oxygen level
- Skin looks pale or grey
- Flaring of the nostrils where the nostrils spreads open while breathing secondary to increase work of breathing
- Chest retractions where you notice sucking in of the muscles between the ribs or at the neck
If your baby has signs of respiratory distress, call emergency services or go to the nearest emergency department in the hospital as soon as possible.
Neonatal jaundice is common among Malaysian newborns, when should parents worry?
Neonatal jaundice is common among newborn babies.
It’s caused by the accumulation of bilirubin, which is a yellow substance byproduct of red blood cell breakdown.
It is more common in babies because babies have a high red blood cell turnover in their blood and baby’s liver are less efficient in removing the bilirubin.
Jaundice usually happens after 24 hours and would normally reduce to a minimal level by 2 weeks.
Parents should bring their baby to their health practitioner if they see the following in the baby:
- Very sleepy and difficulty to wake up for feeds
- Constantly irritable
- Arching of the back
- Not passing enough of wet diapers
- High pitch cry
- Fever
- Jaundice level that increases very rapidly
- Jaundice occurring within 24 hours of life or persisting after 2 weeks of life for term babies and 3 weeks for premature babies
What are signs of infection (sepsis) in newborns, and how urgent is this condition?
Sepsis in newborns can be a life-threatening condition that occurs in babies younger than 28 days of life.
The signs and symptoms of sepsis may not be so obvious in newborns.
We can classify sepsis in newborns into 2 categories, namely early onset and late onset sepsis.
Early onset sepsis means that the infection occurs within the first 72 hours of life and late onset sepsis occurs after 72 hours of life.
Premature babies can be sicker compared to term babies as premature babies have more immature immune system.
Signs of sepsis include:
- Fever or low body temperature
- Difficulty breathing
- Poor feeding
- Less active than usual
- Vomiting
- Cold and clammy hands and feet
- Faster or slower heart rate
- Distended tummy
- Seizures
Parents need to be vigilant and bring your baby to see the doctor immediately if parents notice any of the below in their babies:
- Less active than before or more irritable than before
- Not feeding much
- Diaper has not been changed for more than 12 hours
- Cold and clammy hands
- Trouble breathing
- Very high fever
What should parents do if their newborn experiences choking?
As your baby is slowly weaned to solid food, there is always the risk of choking on their food.
The airway can be partially blocked or completely blocked when your baby experiences choking.
If you suspect choking in your baby, first determine if your baby can still breathe, cough or cry.
If the baby can still do so, parents might be able to clear the foreign body from the mouth.
However if baby is not able to cry, breathe or cough do the following steps:
- Put the baby face down along your forearm and support the head and neck.
- Make sure the head is lower than the chest.
- Deliver five sharp back blows between the shoulder blades with the heel of your hand.
- After each blow, make sure to check if the obstruction has been relieved.
- If the obstruction is not cleared, perform 5 chest thrust with the baby facing upward and the head lower than the chest.
- Put 2 fingers in the middle of the chest and give 5 chest thrust.
- Call for an ambulance if the obstruction is not cleared.
- Continue performing the back blows and chest thrust till help arrives.
Hypoglycemia (low blood sugar) in newborns can be alarming. How can parents detect it?
Hypoglycaemia is an emergency as it can cause seizures, neurodevelopment impairment and if severe death.
Hypoglycaemia can occur secondary to prolonged fasting, intercurrent illness or secondary certain genetic or metabolic health disease.
Premature babies or babies born to mothers with diabetes as well as small or large for gestational age are at higher risk to develop hypoglycemia.
Signs and symptoms of hypoglycaemia includes:
- Jitteriness or irritability
- Sweating
- Poor sucking or not wanting to feed
- Weak or high pitch cry
- Not active
- Low body temperature
- Poor muscle tone
- Seizures
If your baby develops any one the signs of hypoglycaemia bring your baby to the nearest hospital for immediate management.
Sudden Infant Death Syndrome (SIDS) worries many parents. What preventive measures can parents take?
Sudden infant death syndrome (SIDS) affects babies 1 year old and below but usually occurs within the first 6 months of life.
It is unknown what causes SIDS but it’s believed to be caused by a combination of multiple factors.
There are measures that we can take to prevent SIDS although we are not sure of the exact cause:
- Place your baby to sleep on their back and not on their side or on their tummy
- Tuck in the blanket so that the blanket will not move and cover the face of the babies
- Keep toys and pillows away from the cot during sleeping
- Keep other children or pets away from the bed when baby is on the bed
- Mattress of the bed should be firm and not soft
- Do not share the bed with your baby if:
- your baby is premature or small with weight less than 2.5 kg
- parents are taking medications that can cause drowsiness
- parents are smoking or taking alcohol.
- Do not put baby to sleep on sofa. Transfer baby into to cot if baby has fallen asleep on the sofa.
- Keep room temperature between 16 – 20°C as you do not want the baby to be too warm or too cold
Are there practical tips for parents to prepare for neonatal emergencies?
Neonatal emergencies can happen anytime to any baby and thus parents need to be prepared for any emergencies.
Firstly, parents need to be aware of what are the common neonatal emergencies and how to identify them.
Parents need to provide a safe home environment such as keeping away any objects that are choking hazards for babies, making sure babies sleep on their back and never leave your baby unsupervised at any one time.
Parents can also learn some basic first aid such as CPR and how to handle a choking baby.
There are also support groups or online resources that can provide information on basic first aid.
It is also important for parents to bring their babies for their regular follow ups with healthcare professionals.
Emergency services numbers or the nearest hospital contact number have to be available at all times.
What’s the single most crucial piece of advice you’d give parents regarding neonatal emergencies?
As the saying goes, prevention is better than cure.
Parents need to be aware of how to prevent a medical emergency and it is also important for parents to equip themselves with the knowledge of detecting signs and symptoms of common neonatal medical emergencies.
When parents are prepared they are more calm when dealing with an emergency and can ensure their babies get immediate medical attention from hospital emergency services.
In the scenario of a baby choking, if parents are equipped with the knowledge of how to handle a choking baby, prompt measures to dislodge the obstructed object from the baby can be performed while waiting for help.
Source: Dr Livia Chow Huey Ling, Consultant Paediatrician and Neonatologist, Pantai Hospital Ayer Keroh
Disclaimer: The information provided in this article is for informational purposes only and should not be considered as medical advice from Motherhood. For any health-related concerns, it is advisable to consult with a qualified healthcare professional or medical practitioner.
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