NG-325

👶 APGAR & Newborn Assessment

Scored at 1 and 5 minutes — but it never decides the resuscitation. Plus the normal findings that frighten parents.

📋 APGAR — five signs, 0 to 2 each

A newborn with a pink body and blue hands and feet, the five APGAR signs scored nought to two, the score bands, and the four routes a wet newborn loses heat by drawn as arrows. — Acrocyanosis is why a perfectly healthy baby scores 9 rather than 10. And the four heat-loss routes each have their own fix. Swipe it sideways if it is cut off, or tap to open it full size.

Sign	0	1	2
Appearance (color)	Blue or pale all over	Body pink, extremities blue	Completely pink
Pulse	Absent	<100	>100
Grimace (reflex)	No response	Grimace only	Cry, cough, sneeze
Activity (tone)	Limp	Some flexion	Active movement
Respirations	Absent	Slow, irregular, weak cry	Good strong cry

Scored at 1 minute and again at 5 minutes.

0–3 resuscitate 4–6 moderate difficulty 7–10 good adjustment

Acrocyanosis — blue hands and feet with a pink body — is normal in the first 24–48 hours, which is why a perfectly healthy newborn commonly scores 9 rather than 10.

APGAR grades the transition. It never guides the resuscitation - you do not wait a minute to act on a baby who is not breathing.

The 1-minute score reflects intrauterine conditions. The 5-minute score matters more, because it shows response to whatever was done.

🌡️ Thermoregulation — the first priority

A newborn cannot shiver. Cold stress drives up oxygen and glucose consumption, so a cold baby quickly becomes a hypoglycemic, acidotic baby.

Drying the baby immediately is the single most important thing done at birth.

Heat loss	How	Prevent
Evaporation	Wet skin	Dry immediately, remove wet linen
Conduction	Cold surface	Pre-warm the scale, warm blankets
Convection	Draughts	Away from vents, doors, fans
Radiation	Nearby cold objects	Away from cold windows and walls

Skin-to-skin with the mother regulates temperature better than a warmer, and supports bonding and breastfeeding at the same time. It is the preferred method for a stable newborn.

👀 Normal findings that alarm parents

✅ All normal

Milia — tiny white spots on the nose. Do not squeeze; resolve alone
Mongolian spots — blue-gray patches over the sacrum. Document them so they are not mistaken for bruising
Erythema toxicum — blotchy red rash with pale centers; harmless
Acrocyanosis — blue hands and feet for 24–48 h
Pseudomenstruation and swollen breasts — maternal hormones
Vernix, lanugo, molding of the head
Weight loss up to 10% in the first days, regained by 2 weeks

A newborn skull from above showing the bones and the seams between them, then a cut through the scalp. Caput sits in the loose tissue above the periosteum and spreads across the seam. A cephalhematoma sits under the periosteum, which is anchored at the seam, so it stops dead there. A subgaleal bleed sits under the galea and crosses everything. — **The periosteum is the answer.** It is a separate wrapper around each skull bone and it is anchored at every seam, so anything trapped underneath it cannot get past the seam either. Caput sits *above* it, so nothing is fencing it. Swipe it sideways if it is cut off, or tap to open it full size.

🧠 Caput vs cephalhematoma

	Caput succedaneum	Cephalhematoma
Crosses sutures?	YES	NO
Present	At birth	Appears hours later
Resolves	Days	Weeks
Jaundice risk	Low	Higher — blood breaks down

Caput Crosses. Cephalhematoma is Contained.

🚨 Jaundice — the timing decides everything

Within the first 24 hours = pathological. Usually hemolytic — Rh or ABO incompatibility. Always reported.

After 24 hours, day 2–3 = physiological. Immature liver plus rapid breakdown of fetal red cells.

Feeding is treatment - it moves bilirubin out through the stool. Phototherapy if levels rise: protect the eyes, monitor temperature and fluid balance.

🎯 NCLEX traps

Dry the baby first — before weighing, before anything
Acrocyanosis is normal; central cyanosis is not
Jaundice under 24 hours is always pathological
Caput crosses sutures; cephalhematoma does not
APGAR never delays resuscitation
Normal newborn: HR 110–160, RR 30–60, glucose above 40–45

Sources. Written from NICHD, CDC Reproductive Health, MedlinePlus and OpenStax A&P 2e (CC BY 4.0).