Clinical assessment of the newborn infant

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Abstract
! The evaluation of neonates is based on three signs: breathing, heart rate, and color ! Evaluation → Decision → Action ! The one who waits for the umbilical artery pH to come back misses the train! Breathing Immediately after the initial postnatal chest excursions, the neonate should be able to breathe spontaneously during the next few seconds, and gradually turn rosy (beginning at the torso, then the extremities) and should maintain a heart rate >100 bpm. Gasping, apnea and bradycardia (HR 100 bpm and variation with breathing are normal. If the HR is below 100 bpm in spite of 30 s of respiratory stimulation, apply (repeat) oropharyngeal suctioning quickly, then initiate mask-PPV and continue resuscitation according to the standard algorithm (Figure 2.38, p. 157). Skin color A well-adapted neonate has rosy mucous membranes without oxygen supplementation. Acrocyanosis (bluish extremities, rosy body) is usually normal for a neonate, but it may be a sign of low environmental temperature (peripheral vasoconstriction). Signs of central cyanosis are seen on the face, torso and mucous membranes. Extreme pallor can indicate reduced cardiac output, severe anemia (in which case one does not see cyanosis), infection, hypovolemia, acidosis, and/or hypothermia.

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