NG-384

👶 Apgar, cord care & circumcision

Scoring the first minutes, and the two bits of newborn care parents ask the most questions about.

⭐ The one idea

The Apgar score describes how the baby is doing. It does not decide what you do about it. Resuscitation starts on assessment, not on a score. Nobody waits until one minute to dry, warm and stimulate a baby who is not breathing.

📋 The Apgar score

Five things, 0 to 2 each, at 1 minute and 5 minutes — and again at 10 minutes if the five-minute score is under 7.

Sign	0	1	2
Heart rate	Absent	Under 100	Over 100
Respiratory effort	Absent	Slow, weak, irregular	Good cry
Muscle tone	Limp	Some flexion	Active movement
Reflex irritability	No response	Grimace	Cry, cough or sneeze
Color	Blue or pale all over	Body pink, hands and feet blue	Pink all over

🧠 Appearance, Pulse, Grimace, Activity, Respiration. The pulse is the one that matters most in a resuscitation.

🧵 Umbilical cord care

Clean and dry, and left alone. It usually separates somewhere between 7 and 14 days.

Fold the diaper down below the cord so urine does not sit against it
Sponge baths only until it has come off — no tub
Let it dry in the air; do not cover it with the vest
If it gets soiled, clean with water and let it dry

The cord should have two arteries and one vein. A single artery is noted and reported — it can go with other anomalies.

Report to the provider: redness spreading onto the abdomen, a foul smell, pus, bleeding more than a spot, or a fever. Those are omphalitis, and in a newborn that becomes serious quickly.

✂ Circumcision

Before

Informed consent, and it is the parents’ decision
Check for hypospadias — if the opening is not at the tip, the procedure is postponed, because that foreskin may be needed for the repair
Vitamin K given and the baby has voided
Pain relief is not optional — a nerve block or topical anesthetic, plus sucrose and swaddling

After — and it depends which device

Clamp method (Gomco, Mogen)	Plastibell
Apply petroleum jelly on gauze with each diaper change	No petroleum jelly — it makes the ring slip
Keeps the raw area from sticking to the diaper	The plastic ring falls off by itself in about 5–10 days

Both: clean with warm water at each change, fasten the diaper loosely, and lay him on his back or side rather than on his front.

🚨 What to report

Bleeding bigger than a coin-sized spot — apply gentle pressure and call
No urine within 6 to 8 hours after the procedure
Increasing swelling, a foul smell, or the ring not falling off after two weeks

A yellowish film over the site around day two is normal healing granulation. Tell the parents before they see it, and tell them not to wash it off.

ASSESS→ KEEP IT DRY→ TEACH THE PARENTS

NG-384 · Maternal & Newborn unit · ADHD-friendly visual edition