Newborn Baby Care Guide: Normal Signs, Apgar Score, Resuscitation & IUGR Explained

pediagenosis    March 30, 2026    Health , Pediatrics    Comment   

The normal newborn

The vast majority of babies are born in good condition at full term and do not require any medical involvement. Most babies in the UK are born in hospital, where a paediatrician is usually available to attend ‘high-risk’ deliveries, where it is anticipated that resuscitation will be required. A healthy newborn infant should cry soon after birth, have pink mucous membranes, good muscle tone, a normal heart rate and regular respiration. They can be dried and placed on the mother’s chest. The cord is clamped after a minute or two. Skin-to-skin care helps establish breastfeeding. Newborn babies, especially premature babies, are covered in a waxy material called vernix. Post-term infants may have very dry, cracked skin. Babies pass a green – black stool called meconium that changes to a normal yellow – brown seedy stool after a few days. It is recommended that infants be given vitamin K at birth to prevent potentially catastrophic bleeding. Newborn infants are routinely examined within the first few days to exclude congenital abnormalities (see Chapter 10) and have blood taken from a heel prick around day 5 to screen for hypothyroidism and metabolic disorders (see Chapter 7).

Asphyxia and resuscitation

The perinatal mortality rate (currently 7 per 1000) has halved in the UK over the last 20 years, largely due to improvements in obstetric care. The reduction in neonatal mortality rate (now less than 3 per 1000 live births) is due to improvements in the management of babies with complex congenital abnormalities and to improved care of preterm infants. Some babies still require immediate resuscitation after birth, and personnel attending deliveries must be trained in effective and rapid resuscitation. The need for resuscitation can often be anticipated and a skilled professional should be in attendance. Such situations include the following:

•      Prematurity

•      Fetal distress

•      Thick meconium staining of the liquor

•      Emergency caesarean section

•      Instrumental delivery

•      Known congenital abnormality

•      Multiple births.

Apgar score

The condition of the infant after birth is described by the Apgar score (see opposite). Five parameters are scored from 0 to 2. A total Apgar score of 7 – 10 at 1 min of age is normal. A score of 4 – 6 is a moderately ill baby and 0 – 3 represents a severely compromised infant who may die without urgent resuscitation. Such babies will often require intubation and may require cardiac massage. In the most depressed babies IV drugs such as adrenaline (epinephrine) and bicarbonate may be necessary to reestablish cardiac output. The outcome for these infants may be poor. Hypoxic-ischaemic encephalopathy (HIE) Some infants in poor condition at birth may have suffered a hypoxic or ischaemic insult during pregnancy or labour. A healthy fetus can withstand brief physiological hypoxia, but an already compromised fetus may become exhausted and decompensate with build-up of lactic acid. These infants may develop irreversible organ damage, in particular to the brain. Umbilical cord blood gas samples should be assessed. Evidence of severe asphyxia includes a cord blood pH < 7.0, Apgar score of <5 at 10 mins, a delay in spontaneous respiration beyond 10 mins and development of a characteristic encephalopathy with abnormal neurological signs including convulsions. Death or severe handicap occurs in more than 75% of the most severely asphyxiated term infants. Therapeutic hypothermia (cooling to 33.5 ∘C) for 72 h can prevent secondary neuronal damage in moderate-to-severe HIE. However, for normal, well babies, it is important to prevent hypothermia by careful drying and early skin-to-skin contact after birth. Preterm babies are at particular risk of hypothermia, and they should be delivered in a warm room and enclosed in clean plastic wrap before stabilization under a heater to help maintain normothermia.

Intrauterine growth retardation

A baby with a birth weight below the 10th centile is small for gestational age (SGA). This may be familial or may be due to intrauterine growth retardation (IUGR). The pattern of growth retardation gives some indication of the cause. An insult in early pregnancy, such as infection, will cause symmetrical growth retardation, where the head and length are also affected. A later insult, usually placental insufficiency, can cause asymmetric growth retardation with relative sparing of head growth due to selective shunting of blood to the developing brain. Abnormalities of blood flow in the umbilical or fetal vessels can now be detected using Doppler ultrasound; these can be used to plan when to intervene and deliver the baby.

Causes of IUGR include the following:

•      Multiple pregnancy

•      Placental insufficiency

•      Maternal smoking

•      Congenital infections (e.g. toxoplasmosis and rubella)

•      Genetic syndromes (e.g. Down’s syndrome).

Babies with severe IUGR should be screened for congenital infection—‘TORCH’ screen (Toxoplasmosis, Other [syphilis], Rubella, Cytomegalovirus, Hepatitis and HIV). In the first few days of life, babies with IUGR are at risk of hypoglycaemia and hypothermia due to low glycogen stores and lack of subcutaneous fat. Symptomatic hypoglycaemia can cause neurodevelopmental injury. If there has been poor head growth during pregnancy, intellect may be impaired. Babies with IUGR must not be overfed during infancy as there is evidence that excessive weight gain leads to hypertension, ischaemic heart disease and diabetes in later life.

Vitamin K

Vitamin K deficiency or persistent obstructive jaundice can lead to poor synthesis of vitamin K-dependent clotting factors and subsequent bleeding. The bleeding may be minor bruising or significant intracranial haemorrhage. This used to be known as haemorrhagic disease of the newborn but is now referred to as vitamin K deficiency bleeding (VKDB). Breast milk is low in vitamin K, unlike formula milk, which is supplemented. For this reason, vitamin K should be given routinely to all newborn infants, either as a single intramuscular injection or by mouth at birth, 1 and 6 weeks. Babies with persistent jaundice should receive further doses (see Chapter 51).