Newborn babies are checked for signs of problem or complications. A complete assessment will be performed that includes every body system. Your baby will be continually assessed by doctors, nurses, and other health care providers throughout his hospital system.

Assessment of newborns

Assessment may include the following :

Apgar Scoring

The APGAR test is a quick test performed  on  babies  at 1 and 5 minutes in the delivery room right after birth. The 1 minute test tells the doctor how the baby tolerated the birthing process. The 5 minute scores tells  how the baby is doing outside the mother’s womb. This test can help the doctor determine if the baby needs any immediate or future treatment.

The APGAR test examines the baby’s

• Heart beat
• Breathing effort
• Muscle tone
• Reflexes
• Skin color

Each category is scored from 0 to 2 with 2 being the  highest score.

Heart rate

0 – no heart beat

1 – fewer than 100 beats per minute ( baby not very responsive)

2 – more than 100 beats per minute (vigorous baby )

Breathing effort

0 –  baby is not breathing

1 – weak cry that may sound like grunting or whimpering

2- strong cry

Muscle tone

0 – loose and floppy muscles

1 –  some flexing of arms and legs

2 – active motion

Reflexes (response to stimulation)

0 – no response when airways is stimulated

1 – grimace during stimulation

2 – grimace and coughing or  sneezing when the baby is stimulated

Skin color

0 –  the baby’s entire body is blue or pale

1 – the baby’s body is pink but extremities ( hands and feet ) are blue

2 – the baby’s entire body is pink

A total score of 10 means a baby is in the best possible condition. Nearly all babies score between 8  and 10, 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.

Birth weight

A birth weight is an indicator of health. The average weight of full term babies (born between 37 and 41 weeks gestation) is about 7 lbs. (3.2 kg). Small babies and very large babies are generally at risk for health problems. Newborns lose about 5 to 7% of their birthweight. However babies usually gain this weight back by 2 weeks of age. Premature and sick babies may not gain weight right away.

Measurements

Other measurements that may be taken of each baby include the following :

• • Head circumference
  • Abdominal circumference
  • Length which is measurement from head to the heel
  • Vital stats which includes
    • Temperature  (able to maintain stable body temperature in normal room environment).
    • Pulse (normally 120 to 160 beats per minute in the newborn period)
    • Breathing rate  (normally 40 to 60 breaths per minute in the newborn period).
  • General appearance : This includes physical  activity, tone, posture, and level of consciousness.
  • Skin : This includes the color, texture,nails and presence of rash.
  • Head and neck :
    • Appearance, shape, presence of molding (shaping of the head from passage through the birth canal)
    • Clavicles (bones across the upper chest)
    • Fontanels (the open “soft spots” between the bones of the baby’s skull)
  • Face : Eyes, nose , ears and cheeks.
  • Mouth :  Palate, tongue and  throat.

• Abdomen : Presence of masses of hernias.
• Lungs: Breathing sounds and breathing pattern
• Heart sounds and femoral (in the groin) pulses
• Arms and legs: Movement and development
• Genitals and anus :  For open passage of urine and stool

Physical examination

A complete physical examination is done to check the normal function of body systems. They look for signs of birth defects and other illnesses. Physical examination of newborns include the following assessments.

• Gestational assessment : It assesses a baby’s physical maturity. An examination called The Dubowitz/Ballard Examination for Gestational Age is often used. It evaluates a baby’s appearance, skin texture, motor function, and reflexes. The physical maturity part of the examination is done in the first two hours of birth.The neuromuscular maturity examination is completed within 24 hours after delivery.
  • The physical assessment part of the  Dubowitz/Ballard Examination 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. It checks for skin texture, Lanugo (the soft downy hair on a baby’s body), eyes and ears, breasts, male and female genitals and plantar creases which are creases on the soles of the feet range from absent to covering the entire foot, depending on the maturity.
  • The neuromuscular maturity are performed based on 6 evaluations which are
    • Posture :How does the baby hold his or her arms and legs.
    • Square window :How far the baby’s hands can be flexed toward the wrist.
    • Arm recoil : How much the baby’s arms “spring back” to a flexed position.
    • Popliteal angle : How far the baby’s knees extend.
    • Scarf sign :How far the elbows can be moved across the baby’s chest.
    • Heel to ear :How close the baby’s feet can be moved to the ears.

The physical assessment score and the neuromuscular score are added together, to estimate the gestational age. Scores range from very low for immature babies (less than 26 to 28 weeks) to very high scores for mature and postmature babies.