3.5: The Newborn or Neonate
- Page ID
- 233831
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)The Newborn or Neonate
During the first four weeks of life, the infant may be called a neonate.
Assessing the Newborn
Common assessments of newborns include:
- birthweight: average for full-term baby is about 7 lbs.
- head circumference: distance around the baby's head
- abdominal circumference: distance around the belly (abdomen)
- length: measurement from top of head to the heel
- temperature: stable body temperature in normal room
- head and neck: shape of head, the soft spots (fontanelles) on the baby’s skull, and the bones across the upper chest (clavicles)
- face: eyes, ears, nose, and cheeks.
- mouth: roof of the mouth (palate), tongue, and throat.
- lungs: the sounds the baby makes when he or she breathes and the breathing pattern
- heart sounds and pulses in the groin (femoral)
- abdomen: masses or hernias.
- genitals and anus: checks that the baby has open passages for urine and stool.
- arms and legs: checks the baby’s movement and development.
APGAR Score
The Apgar assessment is is a very quick way to assess the newborn's overall condition. It is conducted at both one minute and five minutes after birth. The higher the score the better the baby is doing. A score of 7 or above is normal. A one-minute score below 7 indicates that the baby needs help adjusting to being out of the mother. This is often caused by a difficult birth, c-section, fluid in the airway, etc. The baby may need oxygen or the airway cleared, physical stimulation to regulate the heartbeat. The five-minute score should show improvement. If needed, additional testing will be done until the baby reaches a score of 7.
A score of 0 to 2 pts is given on each these five measures:
- appearance/color: is the baby blue all over (0), blue extremities (1), or not blue at all (2)?
- heart rate/pulse (normally 120 to 160 beats min): does the baby have no pulse (0), a pulse less than 100 beats/min (1), or a pulse greater than 100 beats/min (2)?
- reflex response (grimace) to stimulation (usually a mild pinch): when stimulated does the baby show no response (0), grimace on stimulation (1), or cry on stimulation (2)?
- muscle tone (Babinski reflex): when the baby's foot is firmly stroked does the baby respond with no movement (0), little movement (1), or a lot of movement (2)?
- respiration/breathing (normally 40 to 60 breaths min.): does the baby show no respiration (0), weak and irregular respiration (1), or a strong cry (2)?
Figure 3.5 – Graphical chart showing the Apgar assessment as described in the section above.
Image Source: Patient Assessment. APGAR Assessment. Event Medicine Group.
Neonatal Behavioral Assessment Scale (NBAS)
Another way to assess the condition of the newborn is the Neonatal Behavioral Assessment Scale (NBAS), a neurobehavioral assessment. It is a tool used to describe an infant's interaction with their extrauterine environment during the first two weeks of life. It highlights the emerging relationship between caregiver and infant, ultimately presenting a holistic picture of clinical conditions of both full-term and preterm infants.
The NBAS assesses the baby's motor development, muscle tone, and stress response. The NBAS does not simply detect abnormalities, but highlights an infant's strengths and individualities
Newborns are also routinely screened for different conditions. Within the first 24 to 48 hours after birth, babies born in hospitals undergo a simple heel stick and a few drops of blood are collected on a special paper card. Providers test those dried blood spots for a variety of different congenital disorders, or conditions that are present when the baby is born.
Sources
- Assessments for Newborn Babies. Stanford Medicine Children's Health.
- Lally, Martha and Suzanne Valentine-French. Lifespan Development: A Psychological Perspective. (Page 63). Licensed under CC BY-NC-SA 3.0