APGAR Score
Assessed at 1 and 5 minutes (and 10 if needed). Components: Appearance (color), Pulse (HR), Grimace (reflex irritability), Activity (muscle tone), Respiration. Each scored 0, 1, or 2. Total: 7โ10 = normal, 4โ6 = moderately depressed, 0โ3 = severely depressed (resuscitation needed). HR and RR are most important.
Physical Assessment
Head: fontanelles (anterior closes 12โ18 mo, posterior 2โ3 mo), molding, caput (edema, crosses suture) vs. cephalohematoma (blood, doesn't cross). Eyes: subconjunctival hemorrhage, red reflex (absence = congenital cataracts or retinoblastoma). Skin: mongolian spots, milia, erythema toxicum (normal). Heart: murmurs common (PDA). Hips: Barlow/Ortolani (developmental dysplasia).
Newborn Reflexes
Moro (startle): symmetrical extension then flexion โ disappears 3โ6 mo. Rooting: turns toward touch on cheek โ helps find nipple. Suck: rhythmic suck in response to oral stimulus. Palmar grasp: fingers close around object. Babinski: toes fan upward (normal in newborns โ abnormal in adults). Stepping:ๆจกๆ walking when held upright.
Feeding
Breastfeeding: colostrum first 2โ3 days (immunoglobulins), mature milk by day 3โ5. Feed on demand, 8โ12 times/day. Signs of adequate feeding: 6+ wet diapers, 3+ stools, gaining weight, content after feeding. Formula: iron-fortified, 2โ3 oz/kg/day divided q3โ4h. Vitamin K injection at birth (prevent hemorrhagic disease).
Common Conditions
Jaundice: physiologic (day 2โ3, peaks 5โ7, resolves 2 weeks) vs. pathologic (first 24h, bilirubin >15, direct >2). Treatment: phototherapy. Hypoglycemia: <40 mg/dL โ feed or give glucose. Respiratory distress: grunting, flaring, retractions โ assess for sepsis, RDS, TTN. Imperforate anus, congenital hip dysplasia โ routine screening.
Important Notes
- Absent red reflex: urgent ophthalmology referral โ rule out congenital cataracts or retinoblastoma.
- Pathologic jaundice (first 24 hours) is always abnormal โ check bilirubin and assess for hemolysis (blood type incompatibility).
Clinical Tips
- APGAR mnemonic: Appearance, Pulse, Grimace, Activity, Respiration. HR and RR are the two most critical โ if HR <100, begin resuscitation.
Summary
Newborn assessment requires knowledge of normal findings, reflexes, and common conditions. Early identification of jaundice, congenital anomalies, and respiratory distress ensures timely intervention.
