Newborn Exams

1. Newborn Exams Is my baby healthy?

2. Newborns are subjected to three different types of exams during the first 24 hours of life. a. Apgar test b. Physical exam c. Screening tests

3. The Apgar Test The purpose of the Apgar test is to determine if the baby needs help to survive.

4. The Apgar test was developed by Dr. Virginia Apgar in 1952 and has been used for all hospital born babies since that time.

5. The Apgar test is given to infants within ONE minute after birth and repeated at FIVE minutes (to check for changes in baby’s survival status).

6. The test involves checking 5 factors: • heart rate, • respiratory effort, • muscle tone, • reflex irritability, and • color.

7. The baby is assigned from 0 to 2 points for each factor. • A perfect Apgar score is a 10. • Very few babies get a score of 10 (Scores of 8 and 9 are common.) • A two part score (i.e. 8/9) is reflective of the 1 minute and 5 minute test scores.

8. Apgar testing procedures: Heart Rate • Heart rate is felt by placing a finger on the baby’s chest, although it is often gauged by observing pulsation of the umbilical cord, or, if faint, by stethoscope. • A heart rate over 100 beats per minute earns a baby a top score of “2”. A slow heart rate below 100 beats per minutes is assigned a score of “1”. The absence of a heart rate results in a score of “0”.

9. Apgar testing procedures: Respiratory Effort • Respiratory effort is observed. If faint, it may be felt with fingers on the baby’s chest. • A crying baby gets a top score of “2”. Slow or irregular breathing is assigned a score of “1”. The absence of breathing results in a score of “0”.

10. Apgar testing procedures: Muscle tone • Muscle tone is evidenced by the amount of movement the baby exhibits. • Active motion (lots of kicking and arm movement) earns a top score of “2”. Some flexing and bending of extremities gets a score of “1”. A limp baby with no movement at all is assigned a score of “0”.

11. Apgar testing procedures: Reflex irritability • Reflex irritability shows up when the soles of the baby’s feet are tapped or when the nose is tickled inside with a catheter. • A crying response to the stimulation scores a “2”. A grimace or some motion scores a “1”. No response scores a “0”.

12. Apgar testing procedures: Color • Color is best observed on the lips, palms, and soles of the feet. • A score of “2” is assigned if the baby is completely pink. A score of “1” means the body is pink but the extremities are blue. Blue and pale skin tones appearing on the entire body results in a score of “0”.

13. Newborn Physical Exam • The test is performed by a pediatrician (a doctor who specializes in the care of children) or a midwife. • The test is performed within the first 12 hours after birth. • After the test, the parents visit with the pediatrician or midwife about the results of the test.

14. Screening tests • Screening tests are medical procedures which “screen” the newborn to determine if serious disorders are present. • Blood testing is used to perform the screening tests. The baby’s heel is pricked and a few drops of blood are placed on special filter paper. The paper is allowed to dry and then sent to a newborn screening laboratory for evaluation.

15. Screening tests are performed within 24 to 48 hours after birth. • All states in the U.S. require some screening, but different states require screening for different disorders. • Some states require a second screening to ensure accurate results. • TEXAS currently screens for 30 disorders, which is in alignment with the recommendations of the March of Dimes.

16. All states in the U.S. screen for the following: 1. PKU—improper digestion of a certain protein substance can result in mental retardation. • If the screening tests are positive for PKU, the baby is placed on a special diet which does not contain the problem protein substance, and the mental retardation is avoided. • The baby will probably need to remain on this diet for the rest of his/her life.

17. Galactosemia—improper digestion of milk sugar, called lactose, results in mental retardation. • Again, a special diet which excludes lactose prevents the mental retardation.

18. Hypothyroidism—improper functioning of the thyroid gland results in mental retardation. • Medication, which might be needed by the baby for the rest of his/her life, prevents the mental retardation.

19. Sickle cell anemia—an inherited blood disorder which causes pain and organ damage and in some cases, death in childhood. • Early detection and treatment reduces the symptoms and extends life.

20. Congenital adrenal hyperplasia—a disorder caused by a variety of hormonal deficiencies which affects genital development and, in severe cases, can disturb kidney function and cause death. • Early detection and hormone treatment results in normal genital development and prevents kidney malfunction.

21. Why screening tests are important: It is estimated that at least 5% of all cases of Sudden Infant Death Syndrome are actually cases of undiagnosed metabolic disorders that are detectable through newborn screening.

22. March of Dimes • http://www.youtube.com/watch?v=yqQRio1-P6c • http://www.nlm.nih.gov/medlineplus/tutorials/newbornscreening/htm/_no_50_no_0.htm To check what tests are required by every state go to: http://genes-r-us.uthscsa.edu/sites/genes-r-us/files/nbsdisorders.pdf