The document discusses Apgar scoring, which evaluates newborns on factors like heart rate, breathing effort, muscle tone, and skin color to assess their transition from fetus to newborn. It notes that various medical factors can affect Apgar scores, either raising or lowering them despite the infant's actual condition. It also presents data showing greatly increased risk of neonatal death for infants with very low 5-minute Apgar scores. Additional sections cover definitions of preterm and postterm birth, risk factors for jaundice, signs that jaundice requires further evaluation, and graphs on neonatal mortality rates and average daily weight gain by postnatal age.

1. Full-term and pre-term
newborn

2. Apgar evaluation of Newborn InfantsApgar evaluation of Newborn Infants
Sign 0 1 2
Heart rate Absent Below 100 Over 100
Respiratory effort Absent Slow, irregular Good crying
Muscle tone Limp
Some flexion of the
extremities
Active motion
Response to catheter in nostril
(tested after oropharings is clear)
No response Grimace
Cough or
sneeze
Color Blue, pale
Body pink,
extremities blue
Completely
pink

3. Factors affecting the Apgar ScoreFactors affecting the Apgar Score
False-PositiveFalse-Positive
(No fetal acidosis/hypoxia; Low Apgar)
False negativeFalse negative
(Acidosis, normal Apgar)
Immaturity Maternal acidosis
Analgetics, narcotics, sedatives High fetal catecholamine level
Magnesium sulfate Some full-term infans
Acute cerebral trauma
Precipitous delivery
Congenital myopathy
Congenital neuropathy
Spinal cord trauma
Central neuros system anomaly
Lung anomaly (diaphragmatic hernia)
Airway obstruction (choanal atresia)
Congenital pneumonia and sepsis
Previous episodes of fetal asphyxia
Hemorrhage/hypovolemia

4. Incidence of neonatal death in 132,228 singleton infants born atIncidence of neonatal death in 132,228 singleton infants born at
term in relation to Apgar scores at 5 min of ageterm in relation to Apgar scores at 5 min of age
5 min Apgar
score
№ of live births
№ of Neonatal
death (rate per
1,000 Births)
Relative risk
(95% CI)
0-3 86 21 (244) 1,460 (855-2555)
4-6 561 5 (9) 53 (20-140)
7-10 131,581 22 (0.2) 1
Casey et al. New Engl J Med 2001;344:467

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6. Jaundice Risk Factors for Neonatal HyperbilirubinemiaJaundice Risk Factors for Neonatal Hyperbilirubinemia
 Jaundice visible on the 1st
day of life
 A sibling with neonatal jaundice
 Unrecognized hemolysis (ABO, Rh, other blood group
imcompatibility); UDP-glucuronyl trasferase deficiency (Crigler-
Najjar, Gilbert disease)
 Non-optimal feeding (formula or breast feeding)
 Deficiency of glucose–6-phosphate dehydrogenase
 Infection (viral, bacterial). Infant of diabetic mother. Immaturity
(prematurity)
 Chephalohematoma or bruising. Central hematocrit > 65%
(polycytemia)
 East, Asian, Mediterranean, Native American origin

7. Physiologic Jaundice in full term and preterm infantsPhysiologic Jaundice in full term and preterm infants
Jaundice Peak bilirubin concentration
Appears Disappears µmol/l Age in days
Full-term 2-3 days 4-5 days 180-220 2-3
Premature 3-4 days 7-9 days 15 6-8

8. Cause of jaundice needs to be determinedCause of jaundice needs to be determined
 Appears in the first 24-36 hr of life
 Rising at the rate faster than 5 mg/dl/day (90 umol/l/day)
 Greater than 12 mg/dl (220 umol/l) in full-term newborns
especially in the absence of risk factors) or 10-14 mg/dl
(180-250 umol/l) in preterm infants
 Jaundice persists after 10-14 days of life
 Direct reacting bilirubin greater than 2 mg/l (36 mmol/l)

9. DefinitionsDefinitions
 Pre-term – liveborn infant before 37 wk from the 1st
day of the
last menstrual period (WHO)
 Low birthweight (LBW, < 2500g)
prematurity
poor intrauterin growth
both
 Post-term – born after 42 weeks regardless of weight
 Large for gestational age > 4000 g

10. Neonatal mortality, by birthweight categoriesNeonatal mortality, by birthweight categories

11. Average daily weight (grams) vs postnatal age (days)Average daily weight (grams) vs postnatal age (days)
Wright K, et al. Pediatrics 1993; 91:922