How to assess the condition of a newborn

How to assess the condition of a newborn? 

In assessing the newly born infant, three basic questions should be asked:

  • 1. Is the newly born infant at term gestation?
  • 2. Is the newly born infant crying or breathing?
  • 3. Does the newly born infant have good muscle tone?

If the answers to all of these questions are “yes,” then the newly born can remain with the mother. The infant does not require routine suctioning of the nose and mouth. The baby should be dried and placed on the mother, skin-to-skin. Cover with dry linen and observe breathing, color, and activity. Delay cord clamping for at least 1 minute for newborns not requiring resuscitation. 

The newly born infant should be assessed and assigned an Apgar score at 1 minute and at 5 minutes of life. The Apgar score assesses heart rate, respirations, muscle tone, reflex irritability, and color. It indicates how the infant is doing or the responsiveness to the resuscitation but is not an indicator to initiate resuscitation. If the Apgar score is less than 7 at 5 minutes, then the scoring continues every 5 minutes for 20 minutes. Do not delay resuscitative efforts to obtain an Apgar score.

Apgar Score Chart

Score
Sign012
Heart rateAbsentSlow (< 100/min)> 100/min
RespirationsAbsentSlow, irregularGood, crying
Muscle toneLimpSome flexionActive motion
Reflex irritability (catheter in nares)No responseGrimaceCough, sneezes
ColorBlue or palePink body with blue extremitiesCompletely pink

If any answer to the three basic questions (term, breathing or crying, good tone) is “no,” then be prepared to initiate action in one of these four categories:

  • 1. Initial steps in stabilization (warm, clear airway, dry, stimulate)
  • 2. Ventilation
  • 3. Chest compressions
  • 4. Administration of epinephrine and volume expansion

Within the first 60 seconds, or the “golden minute,” the initial steps should be completed and ventilation (if warranted) begun. 

Sources

Aronson PL, Alessandrini EA: Neonatal resuscitation. In Fleisher GR, Ludwig S, Henretig FM (eds): Textbook of Pediatric Emergency Medicine, 6th ed. Philadelphia, Lippincott Williams & Wilkins, 2010. 

Kattwinkel J, Perlman JM, Aziz K, et al: Part 15: Neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122(18 Suppl 3):S909-S919.

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