Unusual cry in newborn

Recently, I attended a caesarean section and resuscitated the baby. It was a boy with full term pregnancy. The mother had no significant problem during pregnancy. She got admitted in the hospital 18 hours after the rupture of membrane (leaking membrane). There was dribbling of amniotic fluid whole day. After the caesarean section, the baby cried spontaneously. He weighted 3.5 Kg. There was no respiratory distress. The colour of the baby was pink. There was no obvious congenital anomaly and the activities were normal. The baby was put to breast within an hour. He passed urine but not  stool (meconium) even after 24 hours.

Everything was  apparently fine, parents as well as relatives were happy. But we noticed that the baby cried out often and on; and the cry was very unusual — high pitched and almost every 20-30 minutes. The temperature of the baby was normal and sucking was quite okay. After rectal wash, the baby passed meconium (stool), but screaming was still there.

Sepsis screening confirmed that the baby had got neonatal sepsis. This infection might be an ascending infection through genital tract and probably due to prolonged rupture of membrane.

Cry in newborn is common and it is related to hunger, any discomfort, trauma, wetting of diapers etc. But unusual cry is always suspicious. Neonatal sepsis is one of the leading cause of newborn death and which accounts about 20% in Bangladesh.

There are many causes of neonatal sepsis — prolonged rupture of membrane (PROM) is one of them. Other notable causes are prematurity, low birth weight, prolonged labour, febrile illness of mother, frequent per vaginal examination during labour, instrumentation, poor hygiene etc. 

Poor sucking, fever, lethargy, respiratory distress, unusual cry, poor cry, less movement, vomiting, convulsion all are features of neonatal sepsis; but sometimes symptoms are not so obvious as it happened to our patient. So any newborn not doing well should be considered as sepsis until otherwise proven. In rupture of membrane, delay in intervention mostly invites neonatal sepsis and thus increases morbidity and neonatal mortality.

Simple awareness can prevent this unwanted suffering. Wishing happy ending of all pregnancy.

The author is a Professor of Paediatrics at Community Based Medical College, Mymensingh.

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