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High-Risk Newborns - Assessments for Newborn Babies

Assessments for newborn babies

Each newborn baby is carefully checked at birth for signs of problems or complications. A complete physical assessment will be performed that includes every body system. Throughout the hospital stay, physicians, nurses, and other healthcare providers continually assess a baby for changes in health and for signs of problems or illness. Assessment may include:

  • Apgar scoring. The Apgar score is one of the first checks of your new baby's health. 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. The baby is checked at one minute and five minutes after birth for heart and respiratory rates, muscle tone, reflexes, and color.

    Each area can have a score of zero, one, or two, with ten points as the maximum. A total score of ten means a baby is in the best possible condition. Nearly all babies score between eight and ten, 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. However, only 1.4 percent of babies have Apgar scores less than seven at five minutes after birth.

SignScore = 0Score = 1Score = 2
Heart Rate Absent Below 100 per minute Above 100 per minute
Respiratory Effort Absent Weak, irregular, or gasping Good, crying
Muscle Tone Flaccid Some flexion of arms and legs Well flexed, or active movements of extremities
Reflex/Irritability No response Grimace or weak cry Good cry
Color Blue all over, or pale Body pink, hands and feet blue Pink all over
  • 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 babies and very large babies are at greater risk for problems. Babies are weighed daily in the nursery to assess growth, fluid, and nutrition needs. Newborn babies may often lose 5 to 7 percent of their birthweight. 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 by 2 weeks of age. 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.

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. Other measurements are also taken of each baby. These include the following:
    • Head circumference. The distance around the baby's head.
    • Abdominal circumference. The distance around the abdomen.
    • Length. The measurement from crown of head to the heel.
  • Picture  of a newborn in the neonatal intensive care unitPhysical examination. A complete physical examination is an important part of newborn care. Each body system is carefully examined for signs of health and normal function. The physician also looks for any signs of illness or birth defects. Physical examination of a newborn often includes the assessment of the following:
    • Vital signs.
      • 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 30 to 60 breaths per minute in the newborn period)
    • General appearance. Physical activity, tone, posture, and 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 the 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. For 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. Maturity assessment is helpful in meeting a baby's needs if the dates of a pregnancy are uncertain. For example, a very small baby may actually be more mature than it appears by size, and may need different care than a premature baby.

    An examination called The Dubowitz/Ballard Examination for Gestational Age is often used. A baby's gestational age often can be closely estimated using this examination. The Dubowitz/Ballard Examination 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. Information often used to help estimate babies' physical and neuromuscular maturity are shown below.

  • Physical maturity. 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.

    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. Areas of assessment include the following:

    • Skin textures (i.e., sticky, smooth, peeling).
    • Lanugo (the soft downy hair on a baby's body). Absent in immature babies, then appears with maturity, and then disappears again with postmaturity.
    • Plantar creases. These creases on the soles 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 ring around each nipple) are assessed.
    • Eyes and ears. Eyes fused or open and amount of cartilage and stiffness of the ear tissue.
    • 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 the baby's neuromuscular system are performed. These include:
    • 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 far 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.

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

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