Evaluating a Newborn's Health

By Dana Sullivan
CONSUMER HEALTH INTERACTIVE

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What are the doctors looking for? Are there any other exams I should expect? What will my newborn look like? What if my baby needs extra care?

You've waited patiently for months to greet this little person, and now suddenly, here he is. Meeting your newborn for the first time is likely to be one of the most memorable moments of your life so you may not even notice that immediately following your baby's birth, a nurse, midwife or physician will assess your baby to see how he is coping with life outside the womb.
What are the doctors looking for?

Physicians use the Apgar scale to gauge a baby's initial health based on factors such as his skin tone and his facial expressions. The scale was developed by Dr. Virginia Apgar in 1952 to determine whether a newborn infant needed special attention to stay alive during the first minutes after birth. A "perfect" Apgar score is a 10, but a baby who rates a 7 is considered healthy. A baby whose score ranges from 0 to 3 needs resuscitation and babies with scores in the middle -- 4 to 6 --may require various interventions, including extra oxygen. The test is administered immediately after delivery and again five minutes later. Don't worry if your child gets an initial low score. Usually a baby who has a low score the first time will get a "better" score the second time around. Points given: 0 points 1 point 2 points A Activity and muscle tone Limp Some motion of extremities Active motion P

Pulse rate Absent Below 100 beats per minute Above 100 beats per minute G Grimace (response to catheter inserted in nostril) No response Grimace Cough or sneeze A Appearance; skin color Blue or pale Extremities blue and body pink Pink all over R Respiration Absent Slow, irregular Regular, crying
Are there any other exams I should expect?

Besides the Apgar test, you can expect your baby's health-care providers to measure the diameter of your baby's head and his height from head to toe, examining the placenta and umbilical cord to see if they look normal. Your newborn will also be weighed and measured and all his statistics are recorded for his birth record. A nurse will then dry him off and wrap him, and put a cap on his head to keep him warm. Newborns actually lose a large amount of heat through the head, so keeping the cap on in the first few days after birth is actually important, since newborns can take a while to be able to regulate their temperature. The baby usually gets an injection of vitamin K to prevent bleeding problems. This helps some babies, especially if they are immature or born with an immature liver that has not yet produced enough vitamin K to allow for normal clotting. Your health care team may apply erythromycin gel in your baby's eyes to prevent infection. In some cases, your doctor may order blood tests in the first hours after birth, such as a blood count, blood

glucose test, or a blood culture. Before discharge, there are additional blood tests that are routinely performed to make sure your baby does not have important inherited disorders. If you have concerns about which tests might be done, talk with your doctor about this in the months before your baby is delivered. Although most doctors recommend all of these tests for good reasons, some patients do decline them. It's a good idea to take an active role in advance so that you can make informed decisions at the time of delivery. Every hospital and doctor has a slightly different approach to these issues. If you deliver your baby at home, your midwife will usually send you to a doctor in the first day or two after birth to have some of these tests done.
What will my newborn look like?

When you gaze at your newborn, you'll notice the color of his hair and eyes, the shape of his nose and the curve of his mouth. But you may also notice some lumps and bumps that you didn't expect, but of course your baby will still be the most beautiful creature you've ever seen. Among the things that you perhaps didn't expect to observe, but that your health-care provider will assure you are entirely normal: A cream-like coating covering baby's skin. Known as vernix, this sometimes thick substance forms a protective coating on baby's skin. It will be absorbed into the skin so it's not necessary to wipe off.

Tiny dark hairs covering large parts of baby's body (commonly on the back and shoulders). Lanugo is hair that sometimes covers parts of a newborn's body. If the baby is premature, he may be nearly covered in it. Lanugo generally falls off within a few weeks of birth.

A large, soft bump on baby's head. Some babies are born with a bump on the top of the head. This bump, called a caput succedaneum, occurs to some extent in most babies delivered vaginally. The caput does not affect the baby's brain and will disappear within a few days.

Elongated skull. Sometimes called moulding, this elongation of your baby's head occurs when its movable bones shift slightly to help a baby pass through the birth canal. The shape of the head becomes somewhat oblong or even cone-shaped. In this process there can be some swelling of the tissues on the head.

Blue-gray patches on baby's tummy or back -- most common location is actually on the buttocks. These spotsalarmingly resemble bruises and are very common in babies born to parents who are of African, Asian, Indian, Latino, or Mediterranean descent. They also occasionally appear in babies whose parents are light-skinned. The spots generally disappear after one or two years.

Very obvious sexual characteristics. It's common for premature babies to have startlingly enlarged genitals. There may also be a tiny bit of milk in the breasts of both girls and boys, and sometimes baby girls will have a tiny bit of bloody vaginal discharge. None of this is anything to worry about, it's the result of exposure to high levels of hormones that the baby received during pregnancy, and things will look more to scale within a few weeks.

He or she may initially appear very alert and look around, and may even be interested in breastfeeding right away. Your nurse can help you get started with breastfeeding, often within several minutes of delivery. The next day or two, your baby will probably spend most of his or her time sleeping, only waking when hungry or needing a diaper change.
What if my baby needs extra care?

If your baby is born prematurely, or has other medical problems at birth, he will probably be transferred to a unit where a higher level of observation and treatment can take place. If highintensity care is needed, your baby may need to be admitted to the neonatal intensive care unit

(NICU). This is a hospital unit where the staff is trained to meet the unique needs of newborns who are ill. If your hospital doesn't have a NICU, and your baby requires certain kinds of medical attention, he may be transferred to another hospital that has the equipment and the special staff that he needs. The unique challenges your baby faces in the NICU will determine the scope of his care. At the very least you can expect to meet a neonatologist who will head up the team of people who will care for your baby. The team may also include a neurologist, a cardiologist, a respiratory therapist (a specialist who administers treatments that help with breathing), a pharmacist, a nutritionist, and perhaps a surgeon. Rest assured that the people who choose to attend to ailing newborns are among the kindest and most devoted people you will ever meet. And they want be as helpful as they can in what is always a very difficult situation. Your NICU team will patiently listen to your concerns and answer your questions and teach you the best ways to touch your baby if you can't hold him. If your baby can be held, they will help you maneuver around any IVs or other medical devices that may be attached to him, and also help you learn to bathe and diaper your baby. If your baby is unable to breastfeed, the nurses will likely encourage you to pump your breast milk so they can feed it to him through a feeding tube as soon as he's able to eat. These things may sound trivial but in fact they are essential and will convince you that you are an important part of your baby's care. -- Dana Sullivan is a writer in Reno, Nevada. Her work has appeared in several national magazines, including Parenting, Parents, Fit Pregnancy, Real Simple and Self. She is co-author of The Essential C-Section Guide (Broadway Books/Random House, 2004).

References

American Academy of Pediatrics. Caring for Your Baby and Young Child. Stephen P. Shelov and Robert E. Hannemann, Editors. Bantam Books. June 1998. Nemours Foundation. What Is the Apgar Score?

http://kidshealth.org/parent/pregnancy_newborn/medical_care/apgar.html
Dr. Spock. The Apgar Score: What Is It? http://www.drspock.com/article/0,1510,4494,00.html University of Washington School of Medicine. Pediatric Physical Examination Benchmarks.

http://depts.washington.edu/peds/students/core_materials/ped_exam_benchmarks.htm
March of Dimes. Umbilical Cord Abnormalities. http://www.marchofdimes.com/professionals/681_4546.asp University of Chicago Hospitals. Care of the Baby in the Delivery Room. http://www.uchospitals.edu/online-

library/library.php?content=P01197
Rowe MI, et al. Reduction of neonatal heat loss by an insulated head cover. Journal of Pediatric Surgery. December 1983.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6663422&dopt=Abstract
American College of Obstetricians and Gynecologists. Planning for Pregnancy, Birth & Beyond. New American Library (Penguin Publishers). Second Edition. 1995. Mayo Clinic. Pink Eye (Conjunctivitis). http://www.mayoclinic.com/printinvoker.cfm?objectid=FA6233FA-4850-401188D0123DDD87F129&dsection=8

Nemours Foundation. The First Day of Life.

http://kidshealth.org/parent/pregnancy_newborn/pregnancy/first_day_p2.html
Nemours Foundation. Newborn Screening Tests. http://kidshealth.org/parent/system/medical/newborn_screening_tests_p2.html Rush University Medical Center. Newborn Appearance. http://www.rush.edu/rumc/page-P06993.html Fuloria, M et al. The Newborn Examination Part I. Emergencies and Common Abnormalities Involving the Skin, Head, Neck, Chest, and Respiratory and Cardiovascular Systems. American Family Physician. Volume 65, Number 1, January 2002. http://www.aafp.org/afp/20020101/61.html Nelson, Waldo E, Richard E. Behrman, et al (editors). Nelson Textbook of Pediatrics, 15th edition. Philadelphia: W.B. Saunders, 1996.

Reviewed by Michael Potter, MD, an attending physician and associate clinical professor at the University of California, San Francisco. He is board-certified in family practice.

Our reviewers are members of Consumer Health Interactive's medical advisory board. To learn more about our writers and editors, click here.