Maternal knowledge of neonatal warning signs: a cross-sectional study

ORIGINAL ARTICLE

Maternal Knowledge of Neonatal Warning Signs: A Cross-Sectional Study

Beatriz Martins¹, Beatriz Andrade¹, Mónica Marçal², Anabela Salazar², Madalena Tuna².

¹Pediatrics Department, Hospital Santa Maria, Unidade Local de Saúde de Santa Maria, Lisbon, Portugal,
²Neonatology Service, Hospital de São Francisco Xavier, Unidade Local de Saúde Lisboa Ocidental, Lisbon, Portugal.

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Abstract
Background: The neonatal period is a vulnerable stage of infancy. Early recognition of warning signs is essential to prevent potentially fatal outcomes. Maternal knowledge of these signs is an important marker of health literacy and can guide interventions to improve neonatal care.
Objective: To evaluate maternal knowledge of neonatal warning signs and to identify sociodemographic factors associated with knowledge levels.
Methods: Observational, cross-sectional, descriptive-analytical study at a level II hospital. Mothers of newborns hospitalized in the nursery completed an electronic questionnaire assessing sociodemographic characteristics and knowledge of neonatal warning signs. Descriptive and comparative statistics were performed.
Results: A total of 150 mothers participated. Maternal age ranged 18 - 42 years, with 57.3% Portuguese and 42.7% of other nationalities. Most mothers were employed (78%) and 38.7% had prior experience with children or healthcare. Knowledge scores ranged from 1 to 17 (mean ± SD: 9.89 ± 3.24), with 66% correctly identifying more than half of the warning signs. Commonly recognized signs included fever (>38ºC), bloody stools, central cyanosis, and periumbilical infection signs (>75%). Less recognized signs included moaning and reduced urine output (<25%). No statistically significant associations were found between knowledge scores and maternal age, education, employment status, parity, nationality, or prior experience with children/healthcare.
Conclusion: Maternal knowledge of neonatal warning signs is variable, with a good recognition of obvious signs but limited awareness of subtle indicators of serious illness. Health literacy interventions are essential to improve parental recognition of warning signs, promote timely healthcare seeking, and prevent neonatal morbidity and mortality.

Why this article important?

This study addresses an important gap in the literature: to our knowledge, it is the first to assess maternal knowledge of neonatal warning signs in Portugal, and one of the few conducted in a developed European setting, where most prior research on this topic originates from low- and middle-income countries. Despite a relatively favourable sociodemographic profile, our findings reveal that a substantial proportion of mothers fail to recognize subtle but clinically significant warning signs, while frequently misidentifying benign findings as requiring urgent care. These results highlight that health literacy gaps are not confined to specific risk groups and may contribute both to delayed recognition of serious neonatal illness and to unnecessary healthcare utilization. Given the central role of primary care in neonatal follow-up within the Portuguese National Health Service, these findings provide a timely and practical basis for designing targeted parental education strategies during the prenatal period, maternity ward stay, and early follow-up visits.

Summary of article

This manuscript presents the first study assessing maternal knowledge of neonatal warning signs in Portugal, and one of the few conducted in a developed European setting. Based on 150 mothers surveyed at a level II hospital in the Lisbon region, it shows that mothers frequently failed to recognize subtle but clinically significant warning signs, while often misclassifying benign findings as urgent, with no significant sociodemographic predictors of knowledge level. These findings highlight that health literacy gaps are not confined to specific risk groups and support the need for structured, universal parental education strategies in primary and maternity care.

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