Every newborn is examined at the time of birth for symptoms of problems or any uncalled for complications. A thorough physical checkup including all the body systems is performed. The health of the baby is vigilantly monitored by the doctors, nurses and other health care providers as long as the baby stays in the hospital to detect signs of any disease or issue. This assessment may include:
1 – Apgar Scoring
This is one of the first assessments that is carried out at the time of birth. It is assigned within a few minutes of a baby’s birth to assist in identifying infants that have issues in breathing or are suffering from an issue that needs further examination and care. The baby is examined at one and five minutes after birth for heart and respiratory rates, muscle tone, reflexes and color.
Each parameter can have a score ranging between 0 and 10 with the maximum score of 10 meaning that the baby is in a healthy state. Almost all babies score between 8 and 10 with one or two points generally subtracted for blue hands and feet owing to immature or underdeveloped circulation. A baby undergoing tough time during delivery can have reduced oxygen levels in blood which in turn can lower the Apgar score. Apgar scores of three or less mean that a baby is in critical condition and needs immediate attention and care.
2 – Birthweight
The birthweight of a baby is a crucial indicator of health. The average weight for term babies born between 37 and 41 weeks gestation is approximately 7 pounds (3.2 Kg). Typically, very small and large babies are at greater risk of having complications. Babies are weighed on daily basis in the nursery to analyze fluid, growth and nutrition needs. More often than not, newborns lose about 5 to 7 percent of their birth weight. This means that a baby weighing about 7.3 Pounds may end up losing about 8 ounces just in the first few days of his or her birth. This weight is regained in a couple of weeks or so. However, premature or sick babies may not regain the weight right away.
Metric system is employed by most of the hospitals for measuring weight. You can use this chart to convert between grams and pounds.
3 – Measurements
Following measurements of a baby are also taken at the time of birth:
- Circumference of head: This is the distance around the baby’s head
- Abdominal circumference: This is the distance around the abdomen of a baby
- Length: The distance from the crown of the head to the heel of the baby
- Vital signs:
- The baby should be able to maintain stable body temperature at the room temperature
- The pulse should be between 120 and 160 beats per minute
- The baby should breathe at 40 to 60 breaths a minute
- General appearance: Physical activity, tone, posture and degree of consciousness
- Skin: Color, texture, nails, rashes
- Head and neck:
- Appearance, shape, presence of molding
- 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
4 – Physical Checkup
It is important to carry out a thorough physical examination of a baby. Each body system is examined with utmost care to ensure it is functioning appropriately. The doctor also ensures that there is no illness or any birth defects. The physical examination of a newborn baby generally includes the following:
- Gestational Assessment: A baby’s physical maturity has to be examined closely at the time of birth. It assists in determining a baby’s needs if the dates of pregnancy are unpredictable. For instance, a very small baby may actually be more mature than it seems by size and may require care on different lines in contrast to a premature baby
So, in order to compute the Gestation Age, The Dubowitz/Ballard Examination is employed which helps in approximately determining the baby’s gestational age. This examination analyzes a baby’s appearance, skin color, motor function and reflexes. It is conducted in the first couple of hours of a baby’s birth. The neuromuscular maturity examination is completed within the first 24 hours of birth. Here is the information that is used generally to calculate the baby’s physical and neuromuscular maturity of a baby.
- Physical Maturity: The physical characteristics are considered in this part of the Dubowitz/Ballard Examination since they vary at different points of a baby’s gestation maturity. Physically mature babies tend to score higher than the premature ones.
Each area of assessment is ranked with extreme maturity graded as -1 or -2 while post maturity scored as 4 or 5. Here are the areas of assessment:
- Skin textures: sticky, smooth, or peeling
- Lanugo (the soft downy hair on a baby’s body): Not present in immature babies, then appears with maturity, and then vanishes again with post-maturity
- 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)
- 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: A baby’s neuromuscular maturity is analyzed in six ways. Each area of assessment is ranked with a neurologically mature child getting the highest score. Here are the areas of assessment:
- Posture: The way a baby holds his or her arms and legs
- Square window: The extent to which a baby’s hands can be flexed toward the wrist
- Arm recoil: The extent to which a baby’s arms “spring back” to a flexed position
- Popliteal angle: The extent to which a baby’s knees extend
- Scarf sign: The extent to which a baby’s elbows can be moved across the chest
- Heel to ear: The extent to which a baby’s feet can be moved to the ears
The gestation age can be calculated by adding the scores attained through the physical assessment and analysis of neuromuscular maturity. Immature babies of less than 26 to 28 weeks score very low while the mature and post-mature ones can get high score.
A baby’s well-being can be determined by virtue of these assessments. The doctors and pediatricians can figure out an appropriate course of action by identifying any complications or problems.