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22.1 Apgar Scoring

Assessing a newborn as they transition from intrauterine to extrauterine life is a critical job for the nurse. To do it competently, the nurse must know what normal newborn behavior is in order to recognize what is not normal. The nurse auscultates newborn heart tones quickly and efficiently and recognizes lung sounds that are normal. The nurse also recognizes and reports sounds that are adventitious, and has situational awareness in the birthing room to quickly assess newborn tone, color, respiratory effort, and reflex responses in the first moments after birth. Most postbirth moments now occur on the birthing person’s chest or abdomen (as discussed in the Chapter 23 Newborn Assessment chapter) unless there is an emergency or the newborn needs additional attention. The nurse who assesses for Apgar scores has a challenging role and needs their assessment skills to be effective and accurate. With competence and capability, a nurse can make a huge difference in this new person’s life.

22.2 Physiological Adaptation and Transition

The neonatal transition period is an important time for careful assessment, early recognition of neonatal distress, and initiation of proper management. Successful transition from the intrauterine to extrauterine environment provides a solid foundation for continued normal neonatal transition. The nurse providing surveillance of the neonatal transition has a responsibility to keep the neonate safe, but also to keep the neonate with the birthing person, if possible, to achieve parent-newborn attachment in the first hours of life. Recognizing normal changes that occur in the newborn provides a foundation for initial, ongoing, and supportive care. It is critical for the nurse to perform accurate and frequent assessments to have early recognition of deviations from normal. Generally, within the first 4 hours after birth, the nurse will determine if the neonate has transitioned successfully or will need additional support. The infant should be monitored carefully during the first 4 hours of life. In general, however, the initial resuscitation period (the first 10 minutes or so of life) are the most critical.

22.3 Neutral Thermal Environment

Neonatal hypothermia and cold stress are a global concern, significantly affecting neonatal morbidity and mortality, especially for newborns who are premature or experienced growth restriction. Neonates have a limited ability to thermoregulate, and they experience heat loss rapidly in the immediate care period through four different avenues: radiation, evaporation, conduction, and convection. Prevention is the key to avoiding cold stress. By understanding thermoregulation, cold stress, and the complications and causes of cold stress, the nurse can be well equipped to prevent this fatal complication.


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