• Neonates - recognition of serious illness

    Neonates at particular risk of serious illness include:

    • Low birth weight babies (preterm or small for gestational age)
    • Those with a previously recognised medical problem eg. congenital anomaly
    • Babies from socially disadvantaged families.

    All infants less than 4 weeks old must be seen by an Emergency Registrar or Consultant. Clinical acumen will not reliably distinguishing 'well' from 'sick' infants in this age group.


    The following presenting features are associated with a higher risk of serious illness in young infants:


    Full sepsis evaluation and admission should be considered for any neonate with T>38. Investigations should be performed in the neonatal unit unless there is undue delay or the infant is to be admitted to a general ward.


    If the volume taken in the previous 24 hours is less than 50% of normal.

    Urine output

    Less than 4 wet nappies in 24 hours indicates a significant decrease in fluid intake.

    Peripheral circulation

    Generalized pallor of recent onset, mottling, cold periphery or sluggish capillary return (capillary refill time > 2 seconds).


    Poor response to stimulation; a weak cry.


    Decreased activity/movement and increased sleeping.

    Breathing difficulty

    The signs of respiratory distress in the neonate are tachypnoea (RR > 60/min), recession, expiratory grunt, nasal flaring and cyanosis.


    Defined as a pause in respiration of > 20 seconds. May be central (eg. prems), obstructive (eg. URTI with pharyngeal mucous, GOR, blocked nose) or combined.


    Any vomiting in excess of normal post-feed possiting must be treated seriously in the neonate.

    Bile-staining indicates bowel obstruction (eg. malrotation with volvulus).



    Severe jaundice

    Risk of bilirubin encephalopathy, particularly if haemolytic.
    Neonatal Fluid Guidelines