Quality standard

Quality statement 3: Symptoms and signs of illness in babies

Quality statement 3: Symptoms and signs of illness in babies

Quality statement

Parents are given information and advice, before transfer to community care or before the midwife leaves after a home birth, about symptoms and signs of serious illness in the baby that require them to contact emergency services. [2013, updated 2022]

Rationale

Babies may experience serious health conditions in the immediate hours, days and weeks after the birth, which can lead to severe illness or in rare cases, death. Providing parents with information and advice about the symptoms and signs of serious illness will enable them to seek help as soon as possible if their baby is seriously ill.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of women who had a live birth who received information and advice, before transfer to community care or before the midwife left after a home birth, about symptoms and signs of serious illness in the baby that require them to contact emergency services.

Numerator – the number in the denominator who received information and advice, before transfer to community care or before the midwife left after a home birth, about symptoms and signs of serious illness in the baby that require them to contact emergency services.

Denominator – the number of women who had a live birth.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

Outcome

a) Incidence of infant mortality within the first 8 weeks after birth.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. The NHS Digital Maternity Services Data Set collects data on neonatal deaths. The Healthcare Quality Improvement Partnership's MMBRACE-UK perinatal mortality surveillance report publishes rates of perinatal death.

b) Proportion of parents who feel informed about symptoms and signs of serious illness in the baby.

Numerator – the number in the denominator who feel informed about symptoms and signs of serious illness in the baby.

Denominator – the number of parents of babies.

Data source: Data could be collected from a local survey of parents of babies.

What the quality statement means for different audiences

Service providers (such as NHS hospital trusts and community providers) ensure there are local processes to inform and advise parents, before transfer to community care or before the midwife leaves after a home birth, about the symptoms and signs of serious illness in the baby that require them to contact emergency services. Providers ensure that accessible information about the symptoms and signs of serious illness in babies is available for parents, which could include information about the Baby Check scoring system.

Healthcare professionals (such as midwives) give information and advice to parents, before transfer to community care or before the midwife leaves after a home birth, about the symptoms and signs of serious illness in the baby that require them to contact emergency services. Healthcare professionals could include information about the Baby Check scoring system which may help parents decide whether to seek advice from a healthcare professional if they think their baby may be unwell. Healthcare professionals check that parents understand the information they have been given, and how it relates to them.

Commissioners (integrated care systems) commission services that provide information and advice to parents, before transfer to community care or before the midwife leaves after a home birth, about symptoms and signs of serious illness in the baby that require them to contact emergency services.

Parents of babies are given advice, before they are discharged from the hospital or birth team, about symptoms and signs of serious illness in the baby that mean they need to contact emergency services.

Source guidance

Definitions of terms used in this quality statement

Contact emergency services

Calling 999 or 112 in the UK. [Gov.uk webpage on 999 and 112: the UK's national emergency numbers]

Symptoms and signs of serious illness in the baby

Parents should be made aware:

  • of the possible significance of a change in the baby's behaviour or symptoms, such as refusing feeds or changes in their level of responsiveness

  • that fever may not be present in young babies with a serious infection

  • that the presence or absence of individual symptoms or signs may be of limited value in identifying or ruling out serious illness in a young baby.

The following symptoms and signs are, however, suggestive of serious illness in a baby:

  • appearing pale, ashen, mottled or blue (cyanotic)

  • unresponsive or unrousable

  • having a weak, abnormally high-pitched or continuous cry

  • abnormal breathing pattern, such as:

    • grunting respirations

    • increased respiratory rate (over 60 breaths per minute)

    • chest indrawing

  • temperature over 38°C or under 36°C

  • non-blanching rash

  • bulging fontanelle

  • neck stiffness

  • seizures

  • focal neurological signs

  • diarrhoea associated with dehydration

  • frequent forceful (projectile) vomiting

  • bilious vomiting (green or yellow-green vomit)

  • within the first 24 hours after the birth:

    • has not passed urine

    • has not passed faeces (meconium)

    • develops a yellow skin colour (jaundice)

  • is showing abnormal behaviour (for example, inconsolable crying or listlessness), or

  • is unusually floppy, or

  • has developed new difficulties with feeding.

[NICE's guideline on postnatal care, recommendations 1.3.2, 1.4.4 and 1.4.7 to 1.4.9, NICE's guideline on neonatal infection, recommendation 1.1.12 and NICE's guideline on jaundice in newborn babies under 28 days, recommendation 1.1.1]

Equality and diversity considerations

Parents should be given information they can easily access and understand themselves, or with support, so they can communicate effectively with healthcare services. Clear language should be used, and the content and delivery of information should be tailored to individual needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate. People should have access to an interpreter or advocate if needed. The interpreter or advocate should not be a member of the woman's family, her legal guardian or her partner, and they should communicate with the woman in her preferred language. For parents with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.

It may be difficult to recognise jaundice in some babies with darker skin tones. Information and advice about how to check the baby for jaundice should be useful across all skin tones: examination of the sclerae, gums and blanched skin in bright (preferably natural) light.