Assessment for Well-Being
Assessment starts the moment the newborn is delivered, using standard tools that score the infant rapidly.
Apgar Scoring
Apgar scoring is done at 1 minute and 5 minutes of life. It evaluates heart rate, respiratory rate, muscle tone, reflex irritability, and color, and it sets the baseline for all future observations. Each parameter scores 0 to 2, and the five scores are added for the infant's status.
- 0-3 points: serious danger, needs immediate resuscitation.
- 4-6 points: guarded, may need more airway clearing and supplementary oxygen.
- 7-10 points: good, in the best possible health.
Respiratory Evaluation
Respiratory evaluation comes with every newborn contact, since it is the highest priority in newborn care. The Silverman and Andersen index grades respiratory distress across five criteria: chest movement, intercostal retraction, xiphoid retraction, nares dilatation, and expiratory grunt. Each criterion scores 0 to 2. The index runs opposite to Apgar: an overall score of 0 means no respiratory distress, 4 to 6 means moderate distress, and 7 to 10 means severe distress.
Physical Examination
Done to detect observable conditions and physical defects, worked quickly while noting findings and avoiding overexposing the newborn. Respiratory assessment comes before anything else. Height and weight establish maturity and baseline data, and the newborn is weighed daily at the same time to catch abnormal loss or gain. The heel-stick test draws blood for studies and measures glucose to detect hypoglycemia. Behavioral capacity is also assessed: term newborns are physically active and ready to interact with people around them, more so than preterm newborns.
Care of the Newborn at Birth
Newborn care happens immediately after birth in a separate space near the birthing area, with the radiant heat table, warm blankets, resuscitation and suction equipment, eye care, weighing scale, and oxygen setup ready to use.
Identification and registration come right after immediate care to prevent baby switching or kidnapping. An identification band on the arm or leg carries the mother's hospital number, full name, the infant's sex, and the date and time of birth. Footprints are taken and kept for permanent identification. The physician or nurse-midwife who supervised the delivery handles birth registration, recording the mother's name, father's name, infant's name and birthdate, and the place. The newborn's chart must reflect the time of birth, the Apgar score, eye care given, immunizations, and the infant's general condition.
Care of the Newborn in the Postpartum Period
Newborn care varies across cultures and regions. A term newborn can be fed immediately after birth; a formula-fed newborn is fed at 2 to 4 hours of age.
Bathing is done an hour after birth to gently wash away the vernix caseosa, then daily, focusing on the face, skin folds, and diaper area. The nurse supervises bathing alongside the parents. Keep the bath water and the room pleasantly warm to prevent chilling. Bathe before feeding, not after, to prevent aspiration and vomiting. Equipment: a basin of water, washcloth, soap, towel, diaper, clean shirt, and comb. Work from the cleanest area (the eyes) toward the dirtiest (the diaper area), and never use soap on the face, only on the body. Do not soak the cord when washing the skin around it.
Teach parents to place the infant flat on the back to sleep to prevent SIDS, and never to use a pacifier during sleep. At diaper changes, wash and dry the area well to prevent diaper rash, and apply petroleum jelly or a mild ointment to the buttocks to block ammonia buildup and lift meconium. Hepatitis B vaccination and Vitamin K administration are essential in the postpartal period.
Newborn care starts with the healthcare providers and transitions to the parents for continuity. Build the dos and don'ts of newborn care into the discharge plan so the family can care for the infant safely at home.
Frequently Asked Questions
What is the Apgar score and when is it assigned? The Apgar score is a rapid bedside scoring tool assigned at 1 minute and 5 minutes after birth. It rates five signs (heart rate, respiratory effort, muscle tone, reflex irritability, and color) from 0 to 2 each, for a total of 0 to 10. Scoring continues every 5 minutes for any infant who scores below 7 or needs resuscitation (AAP).
What do the Apgar ranges mean? A total of 7 to 10 reflects a newborn in good condition. A score of 4 to 6 is guarded and may call for airway clearing and supplementary oxygen. A score of 0 to 3 signals serious danger and the need for immediate resuscitation. The score describes status at that moment and should never delay resuscitative care or be used alone to predict long-term outcome (ACOG).
What is the first priority in newborn care? Airway and breathing. Respiratory evaluation is the highest priority at every newborn contact, which is why you clear the airway and assess respiratory effort before moving on to weight, measurements, or routine care.
Why is preventing heat loss so important right after birth? A newborn loses heat quickly and cannot shiver effectively to compensate. Chilling drives up oxygen and glucose demand and can lead to respiratory distress and hypoglycemia, so you dry the infant, use the radiant warmer and warm blankets, and keep the bath water and room warm.
How should parents position a newborn for sleep? Always flat on the back, on a firm surface, with no pacifier used during sleep. Back sleeping is the single most effective step to reduce the risk of sudden infant death syndrome (SIDS), and it belongs in every discharge teaching plan.
When is the first bath given, and in what order? The first bath is usually done about an hour after birth, once the newborn's temperature is stable, to gently remove the vernix. Bathe before a feeding rather than after to prevent aspiration and vomiting, work from the cleanest area (the eyes) toward the diaper area, and avoid soaking the umbilical cord stump.