One of the most important functions you will perform in the postpartum period are the assessment of and interventions for the newborn. This can be divided into three phases starting with birth and leading up to the period where the newborn has appropriately transitioned to life outside the womb. In this article, we’ll be focusing on the initial assessments that occur within the first few minutes to first 24 hours of birth. Show
Immediate assessmentImmediately after the infant is born, you’ll be conducting some key assessments. The most important is the APGAR score. This assessment is a quick review of the baby’s body systems and adaptation to extrauterine life. It is typically conducted at minute 1, then again at minute 5, with potential further assessment done 10, 15, and 20 minutes after birth if the score is less than 7 (though please note this can vary by policy). With this assessment, you are looking at five components: The baby’s activity, pulse, grimace, appearance and respirations. The best possible score is a 10, but anything in the 7-10 range is generally considered normal for this immediate period after birth. A score of 4-6 tells us that baby is having some difficulty adjusting to life outside the womb. This is often due to medications the mother was given during labor or in cases of a very rapid delivery or premature delivery. A score of 0 in any area or a total score below 4 is of considerable concern. This baby may have a health problem we don’t know about yet such as a cardiac abnormality, bleeding or difficulty breathing. Additionally, this baby will need immediate resuscitation, further evaluation and likely heading to the NICU. A baby whose APGAR score does not improve beyond the 0-3 range at the 20 minute mark has a high risk for mortality. As the “baby nurse” (the one who is caring for the baby) it is your responsibility to always immediately report APGAR scores to the attending practitioner (MD or Nurse Midwife) so appropriate interventions can be completed.
APGAR SCORING
Nurse interventions to improve the APGAR score include:
Other interventions during the immediate postpartum period
As soon as possible
In the post-partum period
So there you have it! Your quick guide to APGAR scores and some key nursing interventions in the immediate period following birth. References Encyclopedia of Children’s Health. (n.d.). Apgar testing. Encyclopedia of Children’s Health. http://www.healthofchildren.com/A/Apgar-Testing.html Kattwinkel, J., Perlman, J. M., Aziz, K., Colby, C., Fairchild, K., Gallagher, J., Hazinski, M. F., Halamek, L. P., Kumar, P., Little, G., McGowan, J. E., Nightengale, B., Ramirez, M. M., Ringer, S., Simon, W. M., Weiner, G. M., Wyckoff, M., & Zaichkin, J. (2010). Part 15: Neonatal resuscitation. Circulation, 122(18_suppl_3), S909–S919. https://doi.org/10.1161/CIRCULATIONAHA.110.971119 Pieron, P. P. M. P., MPH, MSN, APRN-Rx. (2012). Neonatal nursing care 101. Nursing Made Incredibly Easy!, 10(5), 30–36. https://doi.org/10.1097/01.NME.0000418034.61512.67 What is the priority nursing actions immediately after delivery of the newborn?Respiratory Evaluation. With every newborn contact, respiratory evaluation is necessary because this is the highest priority in newborn care.
What is the priority assessment immediately after an infant's birth?Apgar scoring
The Apgar score is one of the first checks of your new baby's health. The Apgar score is assigned in the first few minutes after birth to help identify babies that have difficulty breathing or have a problem that needs further care.
What is the most critical nursing action in caring for the newborn immediately after the birth?All health-care providers should know that immediate skin-to-skin contact is the best way for a newborn and mother to bond. Healthy newborns should be placed in 'skin-to-skin' contact with the mother until the first round of breastfeeding is established.
What is the primary goal of nursing care immediately after birth?The primary goal of care in the first moments after birth is to assist the newly born infant to transition to extrauterine life by establishing effective respirations. If the infant is at term, is crying or breathing, and has good muscle tone, routine care can begin (Kattwinkel, Perlman, Aziz, et al., 2010).
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