SciDev.Net

The new guidelines can help identify babies requiring hospital admission

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A simple set of clinical signs can be used to identify babies with severe illness who require hospital admission, a study has found.

The research was published in The Lancet last week (11 January).

An estimated four million babies die every year during the first 28 days of life, three quarters of them in their first week. Most births, particularly in poor countries, take place at home — meaning that sick babies are often taken to local health centres first, where the decision about whether to send the child to hospital is made.

"We believe early severe illness detection will provide a huge benefit for the newborn babies," Martin Weber of the WHO in Indonesia, and lead author of the study, told SciDev.Net.

He explained that severe illness in newborns tends to kill the babies quickly. "If the baby carries pneumonia, he or she could die within 10 or 15 days after the birth."

Weber and colleagues from the WHO's Young Infants Clinical Signs Study Group studied 3,177 infants aged 0–6 days and 5,712 infants aged 7–59 days, brought to health facilities in Bangladesh, Bolivia, Ghana, India, Pakistan, and South Africa.

A trained health worker recorded the presence or absence of 31 clinical signs, such as difficulty in feeding and lethargy, and a paediatrician then assessed each case for severe illness.

The team eventually found seven clinical signs that predicted severe illness in 85 per cent of infants. These include a history of difficulty in feeding and movement only when stimulated.

The original Integrated Management of Childhood Illness guidelines, developed during the mid-1990s, did not take the first week of life into account and cause high referral rates, potentially overburdening weak health systems.

"Because the new checklist uses a smaller number of signs than before, its adoption would make training and implementation simpler and less costly. This can be use all over the globe," Weber says.

Harni Koesno, chair of the Indonesia Midwife Association agrees early detection of illness in newborn babies would effectively reduce the neonatal mortality level.

According to the Indonesia Demographic and Health Survey 2002/2003 newborn mortality accounts for 39 per cent of national infant deaths.

Only 26.7 per cent of the infants were brought to hospital. Most deaths occurred in the home (54.2 per cent), while others died in hospital (38.5 per cent) and first-level health facilities (1.1 per cent).

Link to full paper in The Lancet*

Reference: The Lancet 371, 135 (2008)

*Free registration is required to view this paper