ASSESSING THE NEWBORN

 

ASSESSING THE NEWBORN

Almost immediately after birth, after the baby and its parents have been introduced, a newborn is taken to be weighed, cleaned up, and tested for signs of developmental problems that might require urgent attention (Therrell & others, 2010). The Apgar Scale is widely used to assess the health of newborns at one and five minutes after birth. The Apgar Scale evaluates an infant’s heart rate, respiratory effort, muscle tone, body color, and reflex irritability. An obstetrician or a nurse does the evaluation and gives the newborn a score, or reading, of 0, 1, or 2 on each of these five health signs (see Figure 3.6). A total score of 7 to 10 indicates that the newborn’s condition is good. A score of 5 indicates there may be developmental difficulties. A score of 3 or below signals an emergency and indicates that the baby might not survive.

 

The Apgar Scale is especially good at assessing the newborn's ability to respond to the stress of delivery and the new environment (Reynolds, 2010). It also identifies high-risk infants who need resuscitation. For a more thorough assessment of the newborn, the Brazelton Neonatal Behavioral Assessment Scale or the Neonatal Intensive Care Unit Network Neurobehavioral Scale may be used.

The Brazelton Neonatal Behavioral Assessment Scale (NBAS) is typically performed within 24 to 36 hours after birth. It is also used as a sensitive index of neurological competence up to one month after birth for typical infants and as a measure in many studies of infant development (Mamtani, Patel, & Kulkarni, 2008). The NBAS assesses the newborn's neurological development, reflexes, and reactions to people and objects. Sixteen reflexes, such as sneezing, blinking, and rooting, are assessed, along with reactions to animate (such as a face and voice) and inanimate stimuli (such as a rattle).

An "offspring" of the NBAS, the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) provides another assessment of the newborn's behavior, neurological and stress responses, and regulatory capacities (Brazelton, 2004; Lester, Tronick, & Brazelton, 2004). Whereas the NBAS was developed to assess normal, healthy, term infants, T. Berry Brazelton, along with Barry Lester and Edward Tronick, developed the NNNS to assess the "at-risk" infant. It is especially useful for evaluating preterm infants (although it may not be appropriate for those less than 30 weeks’ gestational age) and substance-exposed infants (Boukydis & Lester, 2008). A recent NNNS assessment (at one month of age) of preterm infants who were exposed to substance abuse prenatally revealed that the NNNS predicted certain developmental outcomes, such as neurological difficulties, IQ, and school readiness at 4.5 years of age (Liu & others, 2010).