Table 2

Round 1 heat chart to show which items met consensus and their outcomes

SubjectItemsAgree, %Outcome
SepsisMaternal fever >38°C in labour91Include
DiagnosisPROM >18 hours74Include (WHO RF)
Major RFOffensive smelling liquor74Include (WHO RF); MCTW
Very/extremely premature (<32/40 weeks)74Second round
Prolonged second stage (>3 hours)53Exclude
Minor RFPrematurity (32–37 weeks gestation)81Second round
Born before arrival70Second round
Major signsBoil/abscess93Include
symptomsGrunting or severe respiratory distress or moderate-severe work of breathing97Include
Red skin all around umbilicus81Include, MCTW
Jaundice <24 hours old83Include, MCTW
Tachypnoea >60 bpm (>2 hours old)83Include, MCTW
Convulsions89Include, MCTW
Pustules all over body80Include, MCTW
Bulging fontanelle77Include (WHO danger sign)
Temperature >37.5°C73Include for Malawi version
Admitted with or history of fever68Second round
History of apnoea67Exclude
Bilious vomiting61Second round
Minor signsTachypnoea 60–80 bpm and <2 hours old85Include
Weak or absent suck (and >34/40 weeks)73Exclude
Poor feeding73Include (WHO danger sign), MCTW
Irritability70Second round
Distended abdomen67Second round
Heart rate >160 that cannot be explained by fever/crying64Exclude
Mild work of breathing55Exclude
Additional RF?Cut-off at 72 hours for early vs late neonatal sepsis?100Include
Definition of maternal fever >38°C?93Include
Should PROM be >18 hours or >24 hours in LICs?93Include>18 hours
Hypothermia <35.5°C83Second round
Fever in a newborn should be classified as >37.5°C in this setting?83Include
Please comment on our weighting system of major=100 % / Minor=50%77Exclude
Cut-off at >34/40 weeks for absent suck as a sign of sepsis?60Exclude
Reduced movement of limbs43Exclude
Joint swelling42Exclude
Criteria for ‘consider meningitis’42Second round
ManagementDo you agree with the antibiotic doses?93Include
Do you agree with the specified sepsis investigations if possible?83Include
Antibiotic duration for symptomatic sepsis=7–10 days?83Include (change to stop at day seven if clinically well)
Do you agree with the antibiotic choices if no local recommendation?80Include (add WHO choices)
Antibiotic duration for asymptomatic sepsis=5 days?66Include for Malawi, exclude for international
BirthResuscitation: BVM >5 mins / CPR>10 mins94Include
AsphyxiaFoetal distress86Include, MCTW
DiagnosisApgar at 5 mins<778Include as per COIN
Vaginal breech76Exclude
Prolonged second stage >3 hours duration73Exclude
Vacuum delivery69Exclude
Emergency caesarean section61Exclude
Birth injury44Second round
Hypotonia and gestation >34/40 weeks80Include
Absent suck and gestation >34/40 weeks64Second round
Should birth asphyxia be classified as mild, moderate or severe?54Exclude
Additional RF?Exclude the Moro reflex in LICs due to the difficulties of training HCW in checking safely?80Include as part of Thompson score
Poor feeding49Exclude
Respiratory distress43Include as part of Thompson score
Weight>4 kg43Exclude
ManagementGive intravenous fluids if not tolerating oral or nasogastric feeds?97Include
No passive cooling for infants in LICs?94Include
RDN DiagnosisDo you agree with tachypnoea of >60 bpm for the other categories of RDN?100Include
Tachypnoea of 60–80 bpm <2 hours old without signs or symptoms of sepsis should be treated as TTN and no antibiotics given?76Exclude
History of fast/laboured/noisy breathing is relevant as a sign or symptomatic of RDN when not present on admission?44Exclude
RDNMeconium aspiration syndrome82Include
diagnosticTransient tachypnoea of the newborn66Exclude
criteriaRespiratory distress syndrome63Second round
Congenital pneumonia63Second round
ManagementCut-off of 90% O2 saturations before giving oxygen?91Include
Give antibiotics in all cases except TTN?77Exclude
Time cut-off of 2 hours for TTN? Would you have a higher or lower threshold?54Exclude
HypothermiaDiagnostic criteria for hypothermia?100Include
  • BPM, breaths per minute; BVM, bag valve mask; COIN, Care of the Infant and Newborn; CPR, cardiopulmonary resuscitation; HCW, heathcare worker; LICs, low-income countries; MCTW, minor changes to wording; PROM, prolonged rupture of membranes; RDN, respiratory distress of the newborn; RF, risk factor; TTN, transient tachypnoea of the newborn.