OG18.{1,3} | Newborn Assessment and Birth Asphyxia — Summary & Reflection

KEY TAKEAWAYS

Newborn assessment covers three integrated domains:

• APGAR score (0–10, at 1 and 5 min): Five parameters — Appearance (colour), Pulse (HR), Grimace (reflex), Activity (tone), Respiration. 7–10 = normal; 4–6 = moderate depression; 0–3 = severe depression. NOT synonymous with birth asphyxia alone (requires cord gas confirmation). NOT Bishop score (which assesses cervical favourability).
• New Ballard Score: 6 neuromuscular + 6 physical criteria; range -10 to +50; each 2-point increment = 1 week gestation; applied 12–96 h after birth when gestational age is uncertain.
• Systematic newborn examination: Colour, tone, cry; fontanelles (caput vs cephalhaematoma); palate inspection + palpation; cardiac murmur + femoral pulses; umbilical cord vessels; hip dislocation (Barlow/Ortolani); spine for NTD; genitalia.
• Birth asphyxia: Failure to establish breathing → hypoxia + hypercapnia + metabolic acidosis (cord pH <7.0, BE <-12). Pathophysiology: diving reflex → primary apnoea (responds to stimulation) → secondary apnoea (PPV required). Multi-organ: brain (HIE, Sarnat I–III), heart, kidneys (ATN), gut (NEC).
• Risk factors: Antenatal (IUGR, pre-eclampsia, post-term); intrapartum (cord prolapse, MSAF, prolonged second stage, abruption).
• Management: Therapeutic hypothermia for moderate-to-severe HIE ≤6 h of birth; cord gas documentation; Sarnat staging; neurodevelopmental follow-up.

REFLECT

Reflect on the gap between what APGAR scores tell us and what they do not. A score of 8 at 1 minute in a 28-week preterm is very different from a score of 8 in a term baby — yet the number is the same. How would you communicate a low APGAR score to anxious parents without either alarming them unnecessarily or understating a genuine concern? Consider also the medicolegal dimension: how would you document a birth where the APGAR was 3 at 1 minute but 7 at 5 minutes, and what elements of the resuscitation record are essential? These questions connect clinical science to communication, documentation, and professional responsibility.