Overview of Newborn Examination
Newborn infants are examined by a pediatrician at birth. Because the birth process is physically stressful for the infant, the physical examination performed in the delivery room usually is not extensive. In most cases, this evaluation consists of listening to the heart and lungs using a stethoscope (called auscultation [pronounced aw-skul-TAY-shun]) and examining the infant for birth trauma (e.g., fractured collar bone [clavicle]) and congenital conditions.
Additional information used to evaluate health in newborns includes the following:
- Birth weight, length, and head circumference
- Gestational age, which may be determined using prenatal information (e.g., date of the last menstrual period, initial detection of fetal heart beat, fundal height (i.e., the height of the pregnant uterus), ultrasound) and postnatal information (e.g., neuromuscular signs, foot length, presence or absence of the anterior vascular capsule in the lens of the eyes [blood vessels cover the lens until about 28 weeks’ gestation])
- History of previous pregnancies and course of the current pregnancy
- Medical history (including genetic history) of the mother, father, and sibling(s)
The Apgar (pronounced ap-gär) score was developed in the 1950s by Dr. Virginia Apgar as a way to assess newborns quickly and detect the need for intervention to help establish breathing. The Apgar score is recorded at 1 and 5 minutes after birth. In some cases, the infant also is assessed at 10 minutes of age.
The Apgar score is only one indicator of newborn health and this assessment alone is not used to predict long-term health of the infant. Although it has a number of limitations (e.g., healthy preterm infants may receive a low score due to immaturity), the Apgar score can be used to detect decreased respiration and evaluate the newborn's response to resuscitation efforts.
In this assessment, the baby's heart rate, breathing (respiration), muscle tone, reflex irritability (response to insertion of a thin tube [catheter] into the nostril), and color are evaluated and each assigned a value ranging from 0 to 2.
|Heart Rate||Absent||Slow (<100/minute)||>100/minute|
|Respiration||Absent||Slow, irregular, weak cry||Good, strong cry|
|Muscle Tone||Limp||Some flexion (bending)||Active motion|
|Reflex Irritability||No response||Grimace||Cry, cough, sneeze, active withdrawal|
|Color||Blue or pale||Acrocyanotic (body pink, arms and legs blue)||Completely pink|
In most cases, a 5-minute Apgar score of 710 is considered normal and a score of 46 is considered intermediate. A 5-minute Apgar score of 03 is considered low and may indicate a neurological condition (e.g., cerebral palsy). In newborns with a 5-minute score of less than seven, the evaluation should be repeated at 5-minute intervals for as long as 20 minutes after birth.
The umbilical cord and placenta also are examined in the delivery room. In most cases, these examinations are performed by the physician (e.g., obstetrician) or midwife who delivers the infant. The umbilical cord, which connects the placenta to the developing fetus, normally has three blood vesselstwo arteries and one vein. The arteries carry blood from the fetus to the placenta where it receives oxygen and nutrients. This oxygenated blood then returns to the fetus through the umbilical vein.
The placenta, which supplies oxygen and nutrients to the developing fetus, is expelled after birth. This structure is examined to make sure that it is intact and that no portion has been left inside the uterus, to identify membranes and blood vessels, and to detect areas of tissue death (placental infarct) or blood clots.