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    Assessments for Newborn Babies

    Each newborn baby is carefully checked at birth for signs of problems or complications. The healthcare provider will do a complete physical exam that includes every body system. Throughout the hospital stay, doctors, nurses, and other healthcare providers continually look at the health of the baby. They are watching for signs of problems or illness. Assessments may include the below.

    Picture of a newborn in the neonatal intensive care unit

    Apgar scoring

    The Apgar score helps find breathing problems and other health issues. It is part of the special attention given to a baby in the first few minutes after birth. The baby is checked at 1 minute and 5 minutes after birth for heart and respiratory rates, muscle tone, reflexes, and color. A baby who needs help with any of these issues is getting constant attention during those first 5 to 10 minutes. In this case, the actual Apgar score is given after the immediate issues have been taken care of.

    Each area can have a score of 0, 1, or 2, with 10 points as the maximum. Most babies score 8 or 9, with 1 or 2 points taken off for blue hands and feet because of immature circulation. If a baby has a difficult time during delivery and needs extra help after birth, this will be shown in a lower Apgar score. Apgar scores of 6 or less usually mean a baby needed immediate attention and care.

    Sign

    Score = 0

    Score = 1

    Score = 2

    Heart rate

    Absent

    Below 100 per minute

    Above 100 per minute

    Breathing effort

    Absent

    Weak, irregular, or gasping

    Good, crying

    Muscle tone

    Flaccid

    Some flexing of arms and legs

    Well-flexed, or active movements of arms and legs

    Reflex or 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

    A baby's birth weight is an important marker of health. Full-term babies are born between 37 and 41 weeks of pregnancy. The average weight for full-term babies is about 7 pounds (3.2 kg). In general, very small babies and very large babies are at greater risk for problems. Babies are weighed every day in the nursery to look at growth, and the baby’s need for fluids and nutrition. Newborn babies may often lose 5% to 7% of their birth weight. This means that a baby weighing 7 pounds 3 ounces at birth might lose as much as 8 ounces in the first few days. Babies will usually gain this weight back within the first 2 weeks after birth. Premature and sick babies may not begin to gain weight right away.

    Most hospitals use the metric system for weighing babies. This chart will help you convert grams to pounds.

    Converting grams to pounds and ounces:

    1 lb. = 453.59237 grams; 1 oz. = 28.349523 grams; 1000 grams = 1 Kg.

    Pounds

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    Ounces

    2

    3

    4

    5

    6

    7

    8

    9

    0

    907

    1361

    1814

    2268

    2722

    3175

    3629

    4082

    1

    936

    1389

    1843

    2296

    2750

    3203

    3657

    4111

    2

    964

    1417

    1871

    2325

    2778

    3232

    3685

    4139

    3

    992

    1446

    1899

    2353

    2807

    3260

    3714

    4167

    4

    1021

    1474

    1928

    2381

    2835

    3289

    3742

    4196

    5

    1049

    1503

    1956

    2410

    2863

    3317

    3770

    4224

    6

    1077

    1531

    1984

    2438

    2892

    3345

    3799

    4252

    7

    1106

    1559

    2013

    2466

    2920

    3374

    3827

    4281

    8

    1134

    1588

    2041

    2495

    2948

    3402

    3856

    4309

    9

    1162

    1616

    2070

    2523

    2977

    3430

    3884

    4337

    10

    1191

    1644

    2098

    2551

    3005

    3459

    3912

    4366

    11

    1219

    1673

    2126

    2580

    3033

    3487

    3941

    4394

    12

    1247

    1701

    2155

    2608

    3062

    3515

    3969

    4423

    13

    1276

    1729

    2183

    2637

    3090

    3544

    3997

    4451

    14

    1304

    1758

    2211

    2665

    3118

    3572

    4026

    4479

    15

    1332

    1786

    2240

    2693

    3147

    3600

    4054

    4508

    Measurements

    The hospital staff takes other measurements of each baby. These include:

    • Head circumference. The distance around the baby's head.

    • Abdominal circumference. The distance around the belly (abdomen).

    • Length. The measurement from top of head to the heel.

    The staff also checks these vital signs:

    • Temperature. This checks that the baby is able to have a stable body temperature in normal room.

    • Pulse. A newborn’s pulse is normally 120 to 160 beats per minute.

    • Breathing rate. A newborn’s breathing rate is normally 40 to 60 breaths per minute.

    Physical exam

    A complete physical exam is an important part of newborn care. The healthcare provider carefully checks each body system for health and normal function. The provider also looks for any signs of illness or birth defects. Physical exam of a newborn often includes:

    • General appearance. This looks at physical activity, muscle tone, posture, and level of consciousness.

    • Skin. This looks at skin color, texture, nails, and any rashes.

    • Head and neck. This looks at the shape of head, the soft spots (fontanelles) on the baby’s skull, and the bones across the upper chest (clavicles).

    • Face. This looks at the eyes, ears, nose, and cheeks.

    • Mouth. This looks at the roof of the mouth (palate), tongue, and throat.

    • Lungs. This looks at the sounds the baby makes when he or she breathes. This also looks at the breathing pattern.

    • Heart sounds and pulses in the groin (femoral)

    • Abdomen. This looks for any masses or hernias.

    • Genitals and anus. This checks that the baby has open passages for urine and stool.

    • Arms and legs. This checks the baby’s movement and development.

    Gestational assessment

    The healthcare provider will check how mature the baby is. This is an important part of care. This check helps figure out the best care for the baby if the dates of a pregnancy are uncertain. For example, a very small baby may actually be more mature than he or she appears by size, and may need different care than a premature baby needs.

    Healthcare providers often use an exam called the Dubowitz/Ballard Examination for Gestational Age. This exam can closely estimate a baby's gestational age. The exam looks at a baby's skin and other physical features, plus the baby’s movement and reflexes. The physical maturity part of the exam is done in the first 2 hours of birth. The movement and reflexes part of the exam is done within 24 hours after birth. The provider often uses the information from this exam to help with other maturity estimates.

    Physical maturity

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

    Points are given for each area of assessment. A low of -1 or -2 means that the baby is very immature. A score of 4 or 5 means that the baby is very mature (postmature). These are the areas looked at:

    • Skin textures. Is the skin sticky, smooth, or peeling?

    • Soft, downy hair on the baby’s body (lanugo). This hair is not found on immature babies. It shows up on a mature infant, but goes away for a postmature infant.

    • Plantar creases. These are creases on the soles of the feet. They can be absent or range up to covering the entire foot.

    • Breast. The provider looks at the thickness and size of breast tissue and the darker ring around each nipple (areola).

    • Eyes and ears. The provider checks to see if the eyes are fused or open. He or she also checks the amount of cartilage and stiffness of the ears.

    • Genitals, male. The provider checks for the testes and how the scrotum looks. It may be smooth or wrinkled.

    • Genitals, female. The provider checks the size of the clitoris and the labia and how they look.

    Maturity of nerves and muscles

    The healthcare provider does 6 checks of the baby's nerves and muscles.

    A score is given to each area looked at. Typically, the more mature the baby is, the higher the score. These are the areas checked:

    • Posture. This looks at how the baby holds his or her arms and legs.

    • “Square window.” This looks at how far the baby's hands can be flexed toward the wrist.

    • Arm recoil. This looks at how much the baby's arms "spring back" to a flexed position.

    • Popliteal angle. This looks at how far the baby's knees extend.

    • “Scarf sign.” This looks at how far the baby’s elbows can be moved across the baby's chest.

    • Heel to ear. This looks at how near the baby's feet can be moved to the ears.

    When the physical assessment score and the nerves and muscles score are added together, the healthcare provider can estimate the baby’s gestational age. Scores range from very low for immature babies to very high scores for mature and postmature babies.

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

    Online Medical Reviewer: Donna Freeborn PhD CNM FNP
    Online Medical Reviewer: Heather Trevino
    Online Medical Reviewer: Liora C Adler MD
    Date Last Reviewed: 2/1/2019
    © 2000-2019 The StayWell Company, LLC. 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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