Quality statement 3: Infant health – life‑threatening conditions

Quality statement

Women or main carers of babies are advised, within 24 hours of the birth, of the symptoms and signs of potentially life‑threatening conditions in the baby that require emergency treatment.

Rationale

Babies may experience serious health conditions in the immediate hours, days and weeks following the birth, which can lead to severe illness or in rare cases, death. Providing the mother or main carer with verbal and written information about the symptoms and signs that might indicate their baby has a serious health problem may result in emergency treatment being sought more promptly. This information should be provided within 24 hours of the birth.

Quality measures

Structure

Evidence of local arrangements to ensure that the women or main carers of babies are advised, within 24 hours of the birth, of the symptoms and signs of potentially life‑threatening conditions in the baby that require emergency treatment.

Data source: Local data collection.

Process

The proportion of women or main carers of the baby who are advised, within 24 hours of the birth, of the symptoms and signs of potentially life‑threatening conditions in the baby that require emergency treatment.

Numerator – the number of women or main carers of babies who are advised, within 24 hours of the birth, of the symptoms and signs of potentially life‑threatening conditions in the baby that require emergency treatment.

Denominator – the number of mothers or main carers of babies.

Data source: Local data collection.

Outcome

a) Incidence of potentially avoidable infant morbidity and mortality.

Data source: Local data collection. The Maternity Services Data Set collects data on neonatal deaths. The Perinatal mortality surveillance report (MBRRACE-UK) reports on rates of perinatal death.

b) Women and main carers feel informed about symptoms and signs of potentially life‑threatening conditions in the baby.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that systems are in place for women or main carers of babies to be advised, within 24 hours of the birth, of the symptoms and signs of potentially life‑threatening conditions in the baby that require emergency treatment.

Healthcare practitioners advise women or main carers of babies, within 24 hours of the birth, of the symptoms and signs of potentially life‑threatening conditions in the baby that require emergency treatment.

Commissioners ensure that they commission services that advise women or main carers of babies, within 24 hours of the birth, of the symptoms and signs of potentially life‑threatening conditions in the baby that require emergency treatment.

Women or the main carer of the baby are advised, within 24 hours of the birth, of the symptoms and signs of potentially life‑threatening conditions in the baby that require emergency treatment.

Source guidance

Postnatal care up to 8 weeks after birth (2015) NICE guideline CG37, recommendations 1.4.2 (key priority for implementation), 1.4.17 and 1.4.31 and expert group consensus

Definitions of terms used in this quality statement

First postnatal contact

The first postnatal contact should occur within 24 hours after the birth.

[Based on expert opinion]

Information provision

The woman or main carer of the baby should receive accurate, evidence‑based verbal and written information. If the baby is unwell and in hospital, the information should be provided to the mother or main carer prior to the baby's discharge.

The woman or main carer of the baby should also be provided with a contact number that can be used at any time of the day or night to seek urgent advice (for example, the labour ward triage number). The woman or main carer of the baby should be advised to contact the emergency services if they are very concerned about their baby's health.

Symptoms and signs of life‑threatening conditions in the baby (0–3 months)

The following symptoms and signs are suggestive of potentially life‑threatening physical conditions in the baby (0–3 months):

A major change in the baby's behaviour, for example:

  • less active than usual

  • less responsive than usual

  • more irritable than usual

  • breathing faster than usual or grunting when breathing

  • feeding less than usual

  • nappies much less wet than usual

  • has blue lips

  • is floppy

  • has a fit

  • has a rash that does not fade when pressed with a glass

  • vomits green fluid

  • has blood in their stools

  • has a bulging or very depressed fontanelle

  • has a temperature higher than 38°C

  • with the exception of hands and feet, feels cold when dressed appropriately for the environment temperature

  • within the first 24 hours after the birth:

    • has not passed urine

    • has not passed faeces (meconium)

    • develops a yellow skin colour (jaundice).

[Adapted with expert group consensus from information provided in the Department of Health's Birth to Five book, NICE's guideline on neonatal infection (early onset), table 2, and NICE's guideline on fever in under 5s]

Main carer

For the majority of babies the main carer will be the mother. For some babies the main carer could be a close relative, for example the baby's father or grandparent, or for looked‑after babies this could be a foster parent.

Equality and diversity considerations

Communication and information‑giving between women (and their families) and members of the maternity team is a key aspect of this statement. Relevant adjustments will need to be in place for anyone who has communication difficulties, and for those who do not speak or read English.