A Newborn’s First Hour of Life

A Newborn’s First Hour of Life

A newborn begins his or her life with a cry, a positive sign according to the APGAR scoring system. APGAR scoring, conducted by doctors once the baby is out of the uterus, is a way to assess the health of the baby during the first minute and fifth minute after birth.Babies with an APGAR score between zero and three after five minutes are believed to have some neurologic damage.

Newborns with a score between seven and ten within five minutes of life are considered to be healthy and mentally fit. If the initial score at one minute, which displays the condition the newborn was in within the uterus, was not at least a seven, the doctor reassesses at the fifth minute to see if resuscitation has the potential to save the child or not.

The following table displays what the APGAR scoring system assesses and how points are awarded.

APGAR Scoring System for Newborns
Components 0 points 1 point  2 points
Heart Rate 0 Less than 100/min More than 100/min
Respiration None Irregular, gasps Crying
Skin Colour Blue Pale, blue toes & fingers Pink
Muscle Tone None weak Moving hands or legs
Reflexes None Facial grimace Withdrawing actively

Newborn Care in the First Minute

Maintaining Temperature

The temperature outside the uterus is colder than uterus, which keeps the foetus warm during the pregnancy. Thus, when a baby is born, they should first be placed over the mother’s chest for warmth. Additionally, a few seconds after the detachment of umbilical cord, a baby’s temperature must be stabilized by wrapping a towel around him or her, aiding in the prevention of a cold.

Cleaning belly button and saving the Umbilical Cord

The umbilical cord of the baby must be checked and cleaned with a warm soap solution, and then, rinsed with water. Within a couple days of birth, the umbilical cord diminishes in size and becomes the umbilicus.

This causes it to be important to clean the cord with bacitracin, a bactericidal agent that prevents the baby from any infectious agents, placental tissues, blood remnants, and waste products that may be present on the umbilical cord. Learn more about cleaning your baby’s belly button here.

Additionally, some parents opt to save their children’s umbilical cord blood to identify genetic abnormalities and to treat cancer and bleeding disorders. Learn more about cord blood banking here.

Cleaning the Eyes

After birth, a newborn’s eyes are cleaned gently with a wet wipe by nurses to get rid of any irritants. A baby’s eyes may also be treated with 1% silver nitrate drops or with a 0.5% erythromycin eye ointment.

Blood Clotting Factor

A newborn lacks in blood clotting factors, leading him or her to be prone to haemorrhagic diseases.Breast milk, also, lacks clotting factors. Thus, it is crucial that the healthcare department injects the newborn with one milligram of Vitamin K to prevent bleeding disorders.

Clotting factors actually begin to develop later in a child’s life as they begin to intake food with more nourishment. The initial Vitamin K injection given to a newborn supports them until this time. Finally, any bleeding disorders that run in the family ought to be discussed with your family physician.

Hearing Tests

A doctor may examine the ears of a newborn to look for any abnormalities. They may search for pits, tags, sensorineural hearing loss, and/or auricular anomalies.

Newborn Screening

If needed, your physician may order neonatal screening tests. These tests would be conducted within the first five days of life. It is best, however, to get the screening done within the first two days of life as this would provide a better picture of the baby’s health.

The screening itself may assess enzymatic defects in the baby, which may cause mental retardation, indigestion, and/or seizures later in life. Therefore, it is important to test newborns that are presenting symptoms of or have a family history with such an issue that can cause diseases like phenylketonuria, galactosemia, and hypothyroidism. Enzymatic defects are only one example of what this type of screening can detect. Learn more about newborn screening tests here.

Examination during the First Hour

After all of the aforementioned steps are completed, the newborn is breastfed, and the baby is calm, the mother must undress her baby and allow the doctors to conduct a thorough examination of the newborn. Below is described to what detail the doctor will check your newborn’s body:

Check the Skin

For the most part, the doctor checks for any malignant items on the skin such as a port wine stain, a generally permanent vascular malformation that usually exists on only one side of the head and neck. Additionally, a newborn may have acne which goes away on its own with time.

Palpate the Neck

The doctors search for any nodule or goitre that may be present around the neck of the newborn that could indicate the possibility of hypothyroidism or the presence of a sternocleidomastoid tumour.

Look at the Eyes

A physician may move a pencil or their own face in front of the newborn’s eyes to see if the baby follows the object and to check all the ocular muscles.

Feel the Head

The skull and the fontanelles of the newborn are checked and the circumference of the head measured. If the fontanelles are sunken, it could be a sign of dehydration. Additionally, the doctor may find skull fractures that were caused during delivery due to pressure being applied to the bones or due to a forceps delivery.

Check for Anatomical Defects

The examiner will open the neonate’s mouth to check for a cleft palate and a cleft lip, two issues that can be dealt with surgically. Additionally, he or she will check for polydactyly, a condition in which individuals have more than five fingers on one hand.

Listen to the Chest

The doctor ought to listen to the chest for respiratory distress.This test is done, for the most part, on babies with respiratory rates of less than 60.

Heart Sounds

A good percentage of babies are born with heart defects which usually require surgical treatments to improve survival rates. These defects are initially detected by listening for murmurs.

Examine the Abdomen

The doctor will feel the abdomen to look for pyloric stenosis, umbilical hernias,and masses,which may prove to be polycystic kidneys in the future.

Inspect External Genitalia

The doctor will search for any presentation of chromosomal abnormalities that would hint at diseases like Turner’s syndrome and Klinefelter’s Syndrome.

Check the Reflexes

Reflexes can tell the doctor if the brain of the baby is functioning normally or not. One reflex that may be checked is the Moro reflex. This reflex is assessed by seeing whether the baby extends their arms and legs when they are picked up in an effort to balance themselves, and then, relax their arms and legs once they are safely in the arms of the examiner.

Check Muscle Activity

To check muscle tone, the baby must lie face down with his or her head facing to the side. With this, the doctor will examine the anus and look for spinal abnormalities (i.e. scoliosis, spina bifida, etc.).

Examine Hips

The newborn’s hips are checked to determine if any bone malformations are present and to listen to the movement of the baby’s joints. This examination can help identify any bone diseases such as osteogenesis imperfecta.