Neonatal Assessment
There are several ways to assess the condition of the newborn. The most widely used tool is the Neonatal Behavioral Assessment Scale (NBAS) developed by T. Berry Brazelton. This tool has been used around the world to help parents get to know their infants and to make comparisons of infants in different cultures (Brazelton & Nugent, 1995). The baby’s motor development, muscle tone, and stress response are assessed.
The Apgar test is conducted one minute and five minutes after birth. This is a very quick way to assess the newborn’s overall condition.
Five criteria are assessed:
- Appearance (body color)
- Pulse (heart rate)
- Grimace (reflex response)
- Activity (muscle tone)
- Respiration (breathing)
Each criterion is assigned a score of 0, 1, or 2. Each time that scores are taken, the five scores are added together. High scores (out of a possible 10) indicate the baby has made the transition from the womb well, whereas lower scores indicate that the baby may be in distress. The technique for determining an APGAR score is quick and easy, painless for the newborn, and does not require any instruments except for a stethoscope.
Of the five APGAR criteria, heart rate and respiration are the most critical. Poor scores for either of these measurements may indicate the need for immediate medical attention to resuscitate or stabilize the newborn. In general, any score lower than 7 at the 5-minute mark indicates that medical assistance may be needed. A total score below 5 indicates an emergency situation. Normally, a newborn will get an intermediate score of 1 for some of the APGAR criteria and will progress to a 2 by the 5-minute assessment. Scores of 8 or above are normal.
Common Issues in Newborns
Low Birth weight: A child is considered low birth weight if he or she weighs less than 5 pounds 8 ounces (2500 grams). About 8.2 percent of babies born in the United States are of low birth weight (Center for Disease Control, 2015a). A low birth weight baby has difficulty maintaining adequate body temperature because it lacks the fat that would otherwise provide insulation. Such a baby is also at more risk for infection, and 67 percent of these babies are also preterm which can make them more at risk for respiratory infection. Very low birth weight babies (2 pounds or less) have an increased risk of developing cerebral palsy. Many causes of low birth weight are preventable with proper prenatal care. A number of teratogens are associated with low birth weight such as alcohol and tobacco.
Small-for-Date Infants: Infants that have birth weights that are below expectation based on their gestational age are referred to as small-for-date. These infants may be full term or preterm, but still weigh less than 90 % of all babies of the same gestational age. This is a very serious situation for newborns as their growth was adversely affected. Regev et al. (2003) found that small-for-date infants died at rates more than four times higher than other infants.
Preterm: A newborn might also have a low birth weight if it is born at less than 37 weeks gestation, which qualifies it as a preterm baby (CDC, 2015c). Early birth can be triggered by anything that disrupts the mother’s system. For instance, vaginal infections can lead to premature birth because such infection causes the mother to release anti-inflammatory chemicals which, in turn, can trigger contractions. Smoking and the use of other teratogens can lead to preterm birth. A significant consequence of preterm birth includes respiratory distress syndrome, which is characterized by weak and irregular breathing (United States National Library of Medicine, 2015).
Anoxia and Hypoxia: One of the leading causes of infant brain damage is lack of oxygen shortly after birth. Hypoxia occurs when the infant is deprived of an adequate amount of oxygen, leading to mild to moderate brain damage. Apoxia occurs when the infant undergoes a total lack of oxygen, which can lead to severe brain damage. This lack of oxygen is typically caused by umbilical cord problems, birth canal problems, blocked airways, and placenta abruption. Both hypoxia and anoxia can lead to cerebral palsy and a host of other medical disorders.
Attributions
“Lifespan Development: A Psychological Perspective” by Martha Lally and Suzanne Valentine-French is licensed under CC BY-NC-SA 3.0
“Lifespan Psychology” by Laura Overstreet is licensed under CC BY 3.0
“The Newborn, APGAR Score, and Postpartum Period” by Troianne T. Grayson, Mary Wuergler, and Michael Konrad, Child and Adolescent Psychology is licensed under CC BY 4.0
“Introduction to Birth and Delivery” by Lumen, Lifespan Development is licensed under CC BY 4.0
