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What is the Apgar score and why is it done? And what if my baby’s skin is slightly yellow? Find out what to expect in those early hours and days after your baby is born
From the moment your newborn’s head emerges from the birth canal, your medical team will begin evaluating and caring for your child. You may not notice much of the perinatal care your baby receives, but it is vital to ensure your baby is well cared for.
Once the baby is delivered, bulb suction is used to clear mucus from your baby’s airway. As soon as it is clear, you’ll hear that first beautiful cry. Shortly after, the umbilical cord is clamped and cut. If your baby is healthy, your partner can cut the cord, if desired. The baby is then dried and gently placed on your tummy for a greeting. A blanket may be used to keep the baby warm. At this point, maintaining body temperature is important for both you and the baby.
The baby will be removed from your stomach for a quick clean up and evaluation. First is a visual check for any obvious deformities. Next is the Apgar score. This is a measure of the baby’s general condition based on color, heart rate, respiration, reflex responses, and muscle tone. A score of 0, 1, or 2 is given for each of the five criteria. The criteria are explained in the table below. A score is given at one minute after birth and again five minutes after birth. A sick baby may be evaluated again at 10 minutes after birth. A total score of 7-10 is normal; 4-6 is intermediate; and 0-3 is low.
| Criteria | Score | ||
| 0 | 1 | 2 | |
| Color | All blue, pale | Pink body, blue extremities | All pink |
| Heart rate | Absent | <100 beats/min | >100 beats/min |
| Respiration | Absent | Irregular, slow | Good, crying |
| Reflex response to nasal catheter/tactile stimulation | None | Grimace | Sneeze, cough |
| Muscle tone | Limp | Some flexion of extremities | Active |
The evaluation continues with an estimation of gestational age. Babies younger than 37 weeks or older than 42 weeks, or with a weight inappropriate for their age may need special care.
Ten minutes after birth, some babies will have a tube passed through their nose and into their stomach. Babies who need this exam include babies who are born:
To help protect young eyes, the baby receives eye drops or an antibiotic ointment. Your baby will also be given an injection of vitamin K. A deficiency of vitamin K can cause hemorrhagic disease of the newborn, which is a serious disease of excess bleeding. The umbilical cord is treated with a solution to prevent infection. The baby is carefully swaddled and a knit hat placed on his or her head to maintain body temperature. If the baby’s temperature drops below 96 degrees F, he or she will be placed in an infant warmer.
As soon as possible, the baby will be returned to you for cuddling. If you plan to breastfeed, you are encouraged to start now. While you feed, take care to keep both you and your baby warm. Your partner is encouraged to join in the baby cuddling.
After delivery, you can send your baby to the nursery so you can sleep, or keep the baby in a bassinette in your room (rooming in). About every eight hours, your postpartum nurse will check your baby’s vital signs. These are temperature, heart rate, and breathing rate. When your baby has fed at least once and has normal vital signs, she will be given a bath. A mild soap is used so as not to remove all of the baby’s natural antibacterial protection. The baby gets this protection from the whitish greasy material (vernix) that covers most of his or her body.
Within twelve hours, your baby will have a thorough exam from the hospital doctor or your pediatrician. This includes measurement of weight, length, and head circumference. The major organs, such as heart, lungs, skin, and others, are closely examined as well.
Screening tests are done on healthy babies to identify possible health issues before any symptoms show up.
Newborn screening tests check for diseases that can appear early in life. These diseases are not common, but can cause serious damage if they are not treated. For these tests, blood is drawn from the baby’s heel within the first 24 hours of life. Sick or premature infants are often tested at one week of age.
Your state’s health department decides which diseases are screened for in your state. All states screen for hypothyroidism and phenylketonuria (PKU). Both of these conditions can cause mental retardation if they are not treated. Many states also test for the following:
If your baby tests positive, you will be notified. A second test will be done to be sure it is not a false positive. If your baby tests negative, you will not be notified. Your doctor will receive a copy of the results either way.
Some hospitals will check your baby’s hearing. This test is painless and can be done while your baby is sleeping. It takes only a few minutes and you will have immediate results. If your baby passes the test, there is no hearing problem at this time. If your baby does not pass, further testing is advised.
Oxygen saturation refers to the amount of oxygen in your baby’s blood. The oxygen saturation level is a measure of how well your baby’s heart and lungs are working. A tiny red light is attached to the outside of your baby’s hand, foot, or wrist. A cord attaches this light to a machine that records the amount of oxygen being carried by blood cells. The measure will be done at least three times. Ideally, the level will be greater than 94%. If the level is 94% or lower, the doctor will order further tests, such as blood pressure, electrocardiogram , chest x-ray , or echocardiogram . You will also be referred to a pediatric cardiologist.
Some babies have a slight yellow tinge to their skin and eyeballs. This is a sign of jaundice, which is an excess of bilirubin in the blood. Bilirubin is a pigment that is normally cleared from the blood by the liver. A newborn’s liver is still learning how to remove bilirubin, so many babies may appear jaundiced around the second to fifth day of life. Babies who are breastfed may develop jaundice if they do not get enough milk. This condition usually clears within two weeks without treatment. Moms are encouraged to feed often so that the baby will have more bowel movements. Billirubin leaves the body in the stool. If treatment is necessary, the baby is placed under artificial light. The light breaks down bilirubin in the baby’s skin. In rare cases, prolonged jaundice may be a sign of something more serious.
If your baby is a boy and you would like to have him circumcised , this can be done after he has urinated at least once and is feeding well. The baby is given local anesthesia, and the procedure is quick.
Take advantage of your time in the hospital. The nurses can help you with feeding, diaper changing, bathing, and other caretaking duties. They can answer any questions and provide support.
Most moms are discharged from the hospital two to three days after giving birth. Once home, though, the medical support does not end. Call your pediatrician’s office or the maternity ward if you have any questions. You’ll bring your baby to her pediatrician for her one-week old appointment. This is usually called a “well-baby checkup.” You will have these checkups regularly during the first year.
It is normal for your baby to lose weight. Most newborns lose 5%-7% of their birth weight within the first few days of life. Breastfed babies gain this back by two weeks of life. Formula fed babies often regain their weight sooner.
You’ll need to tend to your baby’s umbilical cord. Each time you change a diaper, examine the cord for signs of redness or drainage. These could signal an infection. Once a day, apply 70% alcohol to the cord. The alcohol helps dry up the cord and reduces the risk of infection.
Some parents are a bit overwhelmed in those first days or weeks home from the hospital. Try to stay calm, trust your instincts, and ask for help when you need it. There are many guidelines for how to care for your baby, but it is not an exact science. As long as you provide your baby with warmth, love, food, and cleanliness, you’re doing your job. With time and patience, you and your baby will figure each other out. Remember to enjoy this time, because despite those nights that seem unending, these early weeks will go by too quickly.
References:
Health management in normal newborns, infants, and children: initial care. The Merck Manual of Diagnosis and Therapy online. Available at: http://www.merck.com/mrkshared/mmanual/section19/chapter256/256b.jsp . Accessed August 15, 2005.
Newborn care. University of Michigan Health System website. Available at: http://www.med.umich.edu/obgyn/smartmoms/newborn/newborncare/index.htm . Accessed August 15, 2005.
Newborn care. Yale-New Haven Children’s Hospital website. Available at: http://www.ynhh.com/pediatrics/newborn/index.html . Accessed August 15, 2005.
Newborn jaundice. US National Library of Medicine website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/001559.htm . Accessed August 15, 2005.
RESOURCES:
Smart Moms
University of Michigan Health System
http://www.med.umich.edu
Womenshealth.gov
http://www.4woman.gov
Yale-New Haven Children’s Hospital
http://www.ynhh.com
Last reviewed May 2007 by Jeff Andrews, MD, FRCSC, FACOG
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.