Assessments of newborn babies

Each newborn baby is carefully checked at birth for signs of problems or complications. A complete physical assessment will be performed that includes every body system. Throughout the hospital stay, physicians, nurses and other healthcare providers continually assess a baby for changes in health and for signs of problems or illness. Assessment may include:

Apgar scoring:

The Apgar score is one of the first checks of your new baby's health. The Apgar score is assigned in the first few minutes after birth to help identify babies that have difficulty breathing or have a problem that needs further care. The baby is checked at one minute and five minutes after birth for heart and respiratory rates, muscle tone, reflexes, and color.

Each area can have a score of zero, one or two, with ten points as the maximum. A total score of ten means a baby is in the best possible condition. Nearly all babies score between eight and ten, with one or two points taken off for blue hands and feet because of immature circulation. If a baby has a difficult time during delivery, this can lower the oxygen levels in the blood, which can lower the Apgar score. Apgar scores of three or less often mean a baby needs immediate attention and care. However, only 1.4 percent of babies have Apgar scores less than seven at five minutes after birth.

 Sign Score=0 Score=1 Score=2
Heart Rate Absent Below 100 beats per minute Above 100 beats per minute
Respiratory Effort Absent Weak, irregular, or gasping Good, crying
Muscle Tone Flaccid Some flexing of arms and legs Well-flexed, or active movements of extremities
Reflex/Irritability No response Grimace or weak cry Good cry
Color Blue all over, or pale Body pink, hands and feet blue Pink all over

Birth weight and measurements:

A baby's birth weight is an important indicator of health. The average weight for term babies (born between 37 and 41 weeks gestation) is about 7 lbs. (3.2 kg). In general, small babies and very large babies are at greater risk for problems. Babies are weighed daily in the nursery to assess growth, fluid and nutrition needs. Newborn babies may lose as much as 10 percent of their birth weight. This means that a baby weighing 7 pounds 3 ounces at birth might lose as much as 10 ounces in the first few days. Premature and sick babies may not begin to gain weight right away.

Most hospitals use the metric system for weighing babies.

Converting grams to pounds and ounces:
1 lb. = 453.59237 grams; 1 oz. = 28.349523 grams; 1,000 grams = 1 Kg.

Measurements:

Other measurements are also taken of each baby. These include the following:

  • Head circumference (the distance around the baby's head), is normally about one-half the baby's body length plus 10 cm
  • Abdominal circumference - the distance around the abdomen
  • Length - the measurement from crown of head to the heel.

newbaby3Physical examination:

A complete physical examination is an important part of newborn care. Each body system is carefully examined for signs of health and normal function. The physician also looks for any signs of illness or birth defects. Physical examination of a newborn often includes assessment of:

  • Vital signs:
    • Temperature - able to maintain stable body temperature 98.6° F (37° C) in normal room environment
    • Pulse - normally 120 to 160 beats per minute
    • Breathing rate - normally 30 to 60 breaths per minute
  • General appearance - physical activity, tone, posture and level of consciousness
  • Skin - color, texture, nails, presence of rashes
  • Head and neck
    • Appearance, shape, presence of molding (shaping of the head from passage through the birth canal)
    • Fontanels (the open "soft spots" between the bones of the baby's skull)
    • Clavicles (bones across the upper chest)
  • Face - eyes, ears, nose, cheeks
  • Mouth - palate, tongue, throat
  • Lungs - breath sounds, breathing pattern
  • Heart sounds and femoral (in the groin) pulses
  • Abdomen - presence of masses or hernias
  • Genitals and anus - for open passage of urine and stool
  • Arms and legs - movement and development

Gestational assessment:

Assessing a baby's physical maturity is an important part of care. Maturity assessment is helpful in meeting a baby's needs if the dates of a pregnancy are uncertain. For example, a very small baby may actually be more mature than it appears by size, and may need different care than a premature baby.

An examination called The Dubowitz/Ballard Exam for Gestational Age is often used. A baby's gestational age often can be closely estimated using this exam. The Dubowitz/Ballard Exam evaluates a baby's appearance, skin texture, motor function and reflexes. The physical maturity part of the exam is done in the first two hours of birth. The neuromuscular maturity examination is completed within 24 hours after delivery. Information often used to help estimate babies physical and neuromuscular maturity are shown below.

Physical maturity:

The physical assessment part of the Dubowitz/Ballard Exam looks at physical characteristics that look different at different stages of a baby's gestational maturity. Babies who are physically mature usually have higher scores than premature babies.

Points are given for each area of assessment, with a low of -1 or -2 for extreme immaturity to as much as 4 or 5 for post-maturity.

  • Skin - ranges from sticky and red to smooth to cracking or peeling.
  • Lanugo (the soft downy hair on a baby's body) is absent in immature babies then appears with maturity and then disappears again with post-maturity.
  • Plantar creases - these creases on the sole of the feet range from absent to covering the entire foot depending on the maturity.
  • Breast - the thickness and size of breast tissue and areola (the darkened nipple area) are assessed.
  • Eyes and ears - eyes fused or open and amount of cartilage and stiffness of the ear tissue are assessed.
  • Genitals, male - presence of testes and appearance of scrotum, from smooth to wrinkled.
  • Genitals, female - appearance and size of the clitoris and the labia.

Neuromuscular maturity:

Six evaluations of the baby's neuromuscular system are performed. These include:

  • Posture - how does the baby hold his or her arms and legs.
  • Square window - how much the baby's hand can be flexed toward the wrist.
  • Arm recoil - how much the baby's arms "spring back" to a flexed position.
  • Popliteal angle - how much the baby's knee extends.
  • Scarf sign - how far the elbow can be moved across the baby's chest.
  • Heel to ear - how close the baby's foot can be moved to the ear.

A score is assigned to each assessment area. Typically, the more neurologically mature the baby, the higher the score.

When the physical assessment score and the neuromuscular score are added together, the gestational age can be estimated. Scores range from very low for immature babies (less than 26 to 28 weeks) to very high scores for mature and post-mature babies.

All of these examinations are important ways to learn about your baby's well-being at birth. By identifying any problems, your baby's physician can plan the best possible care.