Assessments for newborn babies

Assessments for newborn babies may include:

• Apgar scoring: 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. Your baby is checked at one minute and five minutes after birth for heart and respiratory rates, muscle tone, reflexes and color.
  
• Birthweight and measurements: A baby's birthweight 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 and large babies are at greater risk for problems. Babies are weighed daily in the nursery to assess growth, fluid and nutrition needs.
• Head circumference - the distance around your baby's head (normally about one-half your baby's body length plus 10 cm)
• Abdominal circumference - the distance around the abdomen
• Length- the measurement from crown of head to the heel

Physical examination

A complete physical examination is an important part of newborn care. Physical examination of a newborn often includes:

• vital signs:
  • temperature - able to maintain stable body temperature 98.60 F (370 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
  • 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 your 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 (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. For example, a very small baby may actually be more mature than it appears by her size, and may need different care than a premature baby.

An examination called the Dubowitz/Ballard Exam for Gestational Age 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 after a baby's birth. The neuromuscular maturity examination is completed within 24 hours after delivery.

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 postmaturity.

• 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 postmaturity
• 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 your baby's neuromuscular system are performed. These include:

• posture- how does your baby hold her arms and legs
• square window - how much your baby's hand can be flexed toward the wrist
• arm recoil - how much your baby's arms "spring back" to a flexed position
• popliteal angle - how much your baby's knee extends
• scarf sign- how far the elbow can be moved across your baby's chest
• heel to ear- how close your baby's foot can be moved to the ear

A score is assigned to each assessment area. Typically, the more neurologically mature your 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 postmature 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.