APGAR, Vital Signs, New Ballard Scale, Thermoregulation, Height/Weight - Maternity | @LevelUpRN

Summary

In this educational video, Meris from Level Up RN covers essential newborn assessment topics, including the Apgar scoring system, which evaluates an infant's adaptation to extra-uterine life at one and five minutes post-birth. She explains the scoring criteria for activity, pulse, reflex irritability, appearance, and respiration. Meris also discusses newborn vital signs, the New Ballard scale for assessing maturity, thermoregulation challenges, and anthropometric measurements. The video concludes with quiz questions to test viewers' understanding.

Takeaways

• 📝 The Apgar score is a system used to assess the condition of a newborn baby immediately after birth.
• 🕒 Apgar scoring is performed at one and five minutes after birth to evaluate the baby's adaptation to life outside the womb.
• 🔢 The score ranges from 0 to 10, with 10 being the best and 0 the worst, indicating the level of distress.
• 🏥 A score of 7 to 10 indicates minimal difficulty adapting to extra-uterine life, which is the desired outcome.
• 👶 The Apgar score assesses five categories: activity or muscle tone, pulse, grimace or reflex irritability, appearance or color, and respiration.
• 🌡️ Newborn vital signs include temperature (97.4 to 99.6°F), pulse (100 to 160 beats per minute), respirations (30 to 60 breaths per minute), and blood pressure (systolic 65 to 90 and diastolic 45 to 65).
• 📏 The New Ballard scale is used to determine if a baby is premature or fully mature, including neuromuscular and physical maturity assessments.
• 👶🏻 Physical maturity assessment in the New Ballard scale includes evaluating skin texture, lanugo, plantar surface creases, and the development of eyes, ears, and genitals.
• 🌡️ Newborns struggle with thermoregulation due to their different body composition and lack of adipose tissue.
• ❄️ Heat loss in newborns can occur through conduction, convection, evaporation, and radiation, emphasizing the need for proper保暖措施.
• 📏 Anthropometric measurements for newborns include weight (2,500 to 4,000 grams), length (48 to 53 cm), head circumference (13 to 15 inches), and chest circumference (12 to 14 inches).

Q & A

What is the purpose of Apgar scoring?

Apgar scoring is done one and five minutes after the birth of an infant to assess how well the baby is adapting to extra-uterine life, meaning outside of the uterus.

What is the range of Apgar scores and what do they indicate?

Apgar scores range from 0 to 10, with 10 being the best and 0 being the worst. A score of 0 to 3 indicates severe distress, 4 to 6 indicates moderate distress, and 7 to 10 indicates minimal difficulty adapting to extra-uterine life.

What are the five categories assessed in the Apgar score?

The five categories assessed in the Apgar score are activity or muscle tone, pulse, grimace or reflex irritability, appearance or color, and respiration.

How is the Apgar score determined for activity or muscle tone?

For activity or muscle tone, a baby gets 0 points if flaccid, 1 point for some flexion, and 2 points for well-flexed active motion.

What pulse rate corresponds to the different point values in the Apgar score?

In the Apgar score, a pulse rate of absent corresponds to 0 points, less than 100 beats a minute gets 1 point, and above 100 beats a minute gets 2 points.

How is the Apgar score assessed for grimace or reflex irritability?

For grimace or reflex irritability, 0 points are given if there is no grimace, 1 point if the baby is grimacing but not crying, and 2 points if the baby is crying.

What are the point values for appearance or color in the Apgar score?

For appearance or color, 0 points are given if the whole body is blue or pale, 1 point if there is acrocyanosis (trunk is pink, but extremities are blue), and 2 points if the whole body is pink.

How is the Apgar score determined for respiration?

For respiration, 0 points are given if the baby is not breathing, 1 point if they have a slow or weak cry, and 2 points if they have a good cry.

What is the expected range for a newborn's temperature, pulse, and respirations?

The expected ranges for a newborn are temperature 97.4 to 99.6 degrees Fahrenheit, pulse 100 to 160 beats per minute, and respirations 30 to 60 breaths a minute.

What is the New Ballard scale and why is it used?

The New Ballard scale is used to determine if a baby is premature or fully mature. It is important in cases where prenatal care was not done, or the mother was unaware of her pregnancy, or in cases of trauma where the mother cannot provide information about gestational age.

What are the two parts of the New Ballard scale?

The two parts of the New Ballard scale are the neuromuscular assessment and the physical maturity assessment.

How does the New Ballard scale assess for maturity in terms of posture?

For posture, a premature baby will have an extended posture with no tone, while a mature baby will be well-flexed with resistance against pulling.

What does a zero-degree square window on the New Ballard scale indicate?

A zero-degree square window on the New Ballard scale indicates a mature infant, as the wrist can be bent all the way down to the arm.

What does the presence of creases covering the entire plantar sole on the New Ballard scale suggest about the infant's maturity?

Creases covering the entire plantar sole on the New Ballard scale suggest a mature infant.

How does thermoregulation differ in newborns compared to adults?

Newborns have a harder time regulating their own temperature due to their different body makeup, lacking adipose tissue like adults and having brown fat instead. They are at risk for heat loss through conduction, convection, evaporation, and radiation.

What are the common anthropometric measurements for newborns?

Common anthropometric measurements for newborns include weight (2,500 to 4,000 grams), length (48 to 53 centimeters or 19 to 21 inches), head circumference (13 to 15 inches), and chest circumference (12 to 14 inches).

What is the significance of the head circumference being larger than the chest circumference at birth?

At birth, the head circumference is 2 to 3 centimeters larger than the chest circumference, which is significant because it indicates the baby's head is proportionally larger compared to the body, resembling a 'pumpkin on a broomstick'.

Outlines

00:00

👶 Newborn Assessment Introduction

Meris from Level Up RN introduces the newborn assessment section of their educational deck. She suggests using the maternity flashcards available on LevelUpRN.com for better understanding. The video covers important newborn assessment concepts, starting with Apgar scoring created by Dr. Virginia Apgar. Apgar scoring is conducted at one and five minutes after birth to evaluate an infant's adaptation to extra-uterine life. The score ranges from 0 to 10, with 10 being the best. The scoring system evaluates five categories: activity or muscle tone, pulse, grimace or reflex irritability, appearance or color, and respiration. Each category is scored from 0 to 2 points, with specific criteria for each level. A score of 7 to 10 indicates minimal difficulty, 4 to 6 indicates moderate distress, and 0 to 3 indicates severe distress.

05:02

📏 Newborn Vital Signs and Ballard Scale

The script discusses newborn vital signs, including temperature, pulse, respirations, and blood pressure, highlighting the differences from adult ranges. It then introduces the New Ballard scale, used to determine if a baby is premature or fully mature. The Ballard scale consists of a neuromuscular assessment and a physical maturity assessment. The neuromuscular assessment evaluates posture, square window, arm recoil, popliteal angle, scarf sign, and heel to ear. The physical maturity assessment examines the skin, lanugo, plantar surface creases, and the development of eyes, ears, and genitals. Each assessment provides indicators of the baby's maturity level.

10:03

🌡 Thermoregulation in Newborns

This section focuses on the importance of thermoregulation for newborns, who have difficulty maintaining their body temperature due to their different body composition and lack of adipose tissue. The script explains the risks of heat loss through conduction, convection, evaporation, and radiation. It emphasizes the need to keep newborns warm by drying them thoroughly, wearing a cap, wrapping in a blanket, and avoiding contact with cold surfaces.

15:06

📏 Anthropometric Measurements and Quiz

The final paragraph discusses anthropometric measurements for newborns, including weight, length, head circumference, and chest circumference. It points out that at birth, the head circumference is larger than the chest circumference. The script concludes with a quiz to test the viewer's knowledge on the Apgar score components, scoring an infant based on given conditions, assessing gestational age using the Ballard scale, and identifying the type of heat loss when a newborn is placed on a cold surface.

Keywords

💡Apgar Scoring

Apgar Scoring is a method developed by Dr. Virginia Apgar to assess the physical condition of a newborn baby immediately after birth. It evaluates five categories: Appearance, Pulse, Grimace, Activity, and Respiration. Each category is scored from 0 to 2, with a total score ranging from 0 to 10. A score of 7 to 10 indicates the infant is adapting well to extra-uterine life, while a lower score may indicate the need for medical intervention. In the script, Apgar scoring is used to illustrate the initial health assessment of newborns and how it reflects their adaptation to the outside environment.

💡Extra-uterine life

Extra-uterine life refers to the condition of a baby being born and living outside the womb. The video script uses this term to emphasize the importance of the Apgar score in assessing how well a newborn is adapting to life outside the uterus. It highlights the critical transition from the controlled environment inside the mother to the external world.

💡Neuromuscular assessment

Neuromuscular assessment is part of the New Ballard scale, used to determine if a baby is premature or fully mature. It evaluates the baby's muscle tone and reflexes. The script mentions posture, square window, arm recoil, popliteal angle, scarf sign, and heel to ear as components of this assessment. These tests help medical professionals understand the baby's physical maturity and readiness for life outside the womb.

💡Physical maturity assessment

Physical maturity assessment is the second part of the New Ballard scale, focusing on the baby's physical characteristics such as skin texture, lanugo, plantar surface creases, eye and ear development, and genital development. The script uses this assessment to show how different physical features can indicate a baby's level of maturity and gestational age.

💡Thermoregulation

Thermoregulation in the context of the video refers to the newborn's ability to maintain a stable body temperature. Newborns have a harder time regulating their temperature due to their different body composition, such as the presence of brown fat instead of adipose tissue. The script discusses various types of heat loss, such as conduction, convection, evaporation, and radiation, and how to prevent them to ensure the baby stays warm.

💡Anthropometric measurements

Anthropometric measurements are the body measurements of newborns, including weight, length, head circumference, and chest circumference. The script provides expected ranges for these measurements, which are crucial for assessing a baby's growth and development. These measurements help healthcare providers identify any potential issues or deviations from the norm.

💡Acrocyanosis

Acrocyanosis is a condition where a baby's extremities, such as hands and feet, are blue or have a bluish tint while the trunk is pink. This term is used in the script to describe a scenario in the Apgar scoring, where a baby might receive a certain score based on the presence of acrocyanosis, indicating a specific level of adaptation to extra-uterine life.

💡Gestational age

Gestational age refers to the time elapsed between the start of a pregnancy and the birth of the baby. In the script, the New Ballard scale is used to assess the gestational age of a newborn, especially in cases where prenatal care was not received or the mother was unaware of her pregnancy. Determining gestational age is important for understanding the baby's level of physical maturity and potential health risks.

💡Brown fat

Brown fat is a type of fat tissue in babies that plays a crucial role in thermoregulation. Unlike white fat, which is used for energy storage, brown fat generates heat when the baby is cold. The script mentions brown fat in the context of explaining why newborns have difficulty maintaining their body temperature and why they are more susceptible to heat loss.

💡Evaporative heat loss

Evaporative heat loss is a type of heat loss that occurs when a liquid on the surface of the body evaporates, taking heat away from the body. The script discusses this concept in relation to newborns, who are at risk of losing heat through evaporation if they are wet from amniotic fluid or a bath. This is why it's important to dry newborns thoroughly and keep them warm.

💡Plantar surface creases

Plantar surface creases refer to the lines or wrinkles on the sole of a baby's foot. In the script, the presence and depth of these creases are used as an indicator of maturity in the New Ballard scale. A mature infant is likely to have creases that span across the entire sole, while a premature infant may have a smoother, less creased plantar surface.

Highlights

Introduction to newborn assessment section using Level Up RN maternity flashcards.

Explanation of Apgar scoring and its purpose to assess newborn adaptation to extra-uterine life.

Description of Apgar scoring categories and the scoring system from 0 to 10.

Details on scoring activity or muscle tone in Apgar assessment.

Information on pulse rates and how they are scored in Apgar scoring.

Explanation of grimace or reflex irritability scoring in Apgar.

Appearance or color scoring criteria in Apgar assessment.

Respiration scoring in Apgar, including not breathing, slow or weak cry, and good cry.

Expected vital signs for newborns, including temperature, pulse, respirations, and blood pressure.

Importance of understanding normal newborn vital signs for assessing health.

Introduction to the New Ballard scale for assessing gestational age of newborns.

Explanation of neuromuscular assessment in the New Ballard scale.

Demonstration of physical maturity assessment using a doll named Molly.

Details on how to assess posture, square window, arm recoil, popliteal angle, scarf sign, and heel to ear in the New Ballard scale.

Physical maturity assessment criteria including skin, lanugo, plantar surface creases, eyes and ears, pinna, and genitals.

Importance of thermoregulation for newborns and methods to prevent heat loss.

Types of heat loss including conduction, convection, evaporation, and radiation.

Anthropometric measurements for newborns, including weight, length, head circumference, and chest circumference.

Quiz questions to test knowledge on Apgar score components, scoring examples, and heat loss types.

Transcripts

Hi. I'm Meris with Level Up RN. And in this video,  I'm going to be starting the newborn assessment  

section of our deck. I'm going to be following  along with our maternity flashcards, which are  

available on our website LevelUpRN.com if you  want to grab a set for yourself. If you have a  

set of your own, I would invite you to follow  along with me as we go through a lot of these  

really important concepts for newborn assessment.  All right. So let's go ahead and get started.  

So first up, we're going to be talking about Apgar  scoring, and Apgar scoring was created by Dr.  

Virginia Apgar, who wanted to use her last name to  be part of this score, which I totally get because  

I would do the same thing. Shuwarger does not  really lend itself to a catchy mnemonic though.  

So the thing about Apgar scoring you'll see  is that there is the category that she came  

up with based on her name. And then there's kind  of the category that you will hear it referred to  

more frequently. That kind of makes a little bit  more sense rather than having to fit in with the  

letters of her name. So Apgar scoring is done one  and five minutes after the birth of an infant. And  

the point of it is to see how they are adapting to  extra-uterine life, meaning outside of the uterus.  

Now that they are in the world, how are we  doing? So the score can go from 0 to 10,  

and 10 being the best and 0 being the worst.  And all along that number line there, we have  

different variables for what it means. So 0 to  3 means that the infant is in severe distress;  

4 to 6 means moderate distress; and 7 to  10 means minimal difficulty adapting to  

extra-uterine life. So that's what we  want. We want something 7 or higher.  

So the categories here are activity or muscle  tone is what you'll hear it called most often,  

pulse, grimace or reflex irritability, appearance  or color, and respiration. So you can get 0,  

1, or 2 points for activity. If the baby is  flaccid, no tone at all, they get 0 points.  

1 point for some flexion. And 2 points  for well-flexed active motion. For pulse,  

if it's absent, 0 points. If it is less  than 100 beats a minute, 1 point. Remember,  

infants have higher pulse rates than adults. And  if it is above 100 beats a minute, 2 full points.  

Grimace or reflex irritability, if there  is no grimace, then we're going to say 0  

points. If they are grimacing, but not crying,  then they get 1 point. And if they are crying,  

then they get 2 points. For appearance or color,  if their whole body is blue or pale, 0 points.  

If they have acrocyanosis, meaning that their  trunk is pink, but their extremities are blue,  

then they get1 point. And if their whole  body is pink, then they get both points,  

2 points. And then for respirations. If the  baby is not breathing, 0 points. If they have  

a slow or a weak cry, 1 point. And if they  had a good cry, they get the full 2 points.  

Okay. So now moving on to newborn vital signs, we  talked slightly in this previous card about them.  

But these are the expected ranges for newborn  vital signs. Temperature 97.4 to 99.6 degrees  

Fahrenheit. Pulse 100 to 160 beats per minute.  That is, I think it's kind of easy to remember  

because it's kind of the opposite of the adults.  Adults are 60 to 100; newborns are 100 to 160.  

Respirations 30 to 60 breaths a minute.  That is so rapid when compared to adults,  

but that is absolutely the case so we need it to  be above that 30 mark. And then blood pressure,  

although this is not something that is  necessarily routinely measured on an infant,  

systolic blood pressure would be 65 to 90 and  diastolic would be 45 to 65. So basically,  

everything, heart rate and respirations are going  to be increased. Blood pressure is the one that  

is the opposite; it is decreased for adults.  Remember that infants have to adapt to being  

on the outside and breathing air, so it is normal  for them to have brief periods of apnea, like less  

than 15 seconds. That is okay and normal. All right. Moving on, we're going to talk  

about the New Ballard scale. And I just want  to point these out because I think that this  

is a really good set of cards that shows you  really what we're talking about here. So New  

Ballard scale is a type of scale that helps us to  determine if a baby is premature or fully mature.  

The reason that this matters is sometimes we could  have an infant where there was no prenatal care  

done, or perhaps the mom had no idea that they  were pregnant, right? That happens as well. There  

could be something like if there were a trauma and  the baby were born, and mom is not conscious to  

be able to tell us about how far along they  were, that sort of a thing. So there's two  

parts. There's the neuromuscular assessment and  then there's the physical maturity assessment.  

So I have my daughter's doll here. Her name is  Molly. Say, Hi, Molly. So she's going to help us  

do our New Ballard scale assessment here. So with  neuromuscular, one of the things is posture. So  

this has to do again with the tone of the infant.  Molly has no tone. She's very flaccid. She is  

extended. This is not normal. This is what would  be considered for a premature baby. A fully mature  

baby is going to be, well-flexed. They're going to  have those arms in, and everything's going to be  

pulled in, and there's going to be resistance  against you as well if you pull on them. So that  

would be a mature baby. Now, square window has to  do with the wrist. Now Molly can't do anything,  

so I'll show you on myself. Square window refers  to, can I bend the wrist all the way down to the  

arm? I mean, I can't. But in a mature infant,  you can. And we would call that a 0-degree  

square window, meaning that there is no space  between the wrist and the arm versus a 90-degree  

square window like this would be indicative  of a premature infant. They're not going to be  

able to get that wrist all the way down. Now,  arm recoil. So again, here's Molly. She's got  

her arms up here. She's well flexed. I pull  on her arm and she brings it right back up.  

That's going to be a mature infant. Versus if  it's a premature infant, if I pull on that arm,  

they may not recoil at all. They may not bring it  up at all. Or if they do, it would be delayed.  

Moving on to popliteal angle. That's going to  have to do with extension of the baby's knee,  

so I can't bend hers very well. But if you  were able to bend it and we had less than--  

if we had 90 degree where we were able to get  that up, that would be a mature infant. Versus  

if I'm able to get it all the way up to her head,  that's going to be 180 degrees, premature infant.  

Moving on to scarf sign. I always think of this  as like throwing a scarf over; if you're throwing  

that tail of a scarf over. So scarf sign here.  If I go to pull Molly's arm over her neck, she's  

resisting me pretty strongly, it's difficult to  do, that would be indicative of a mature infant.  

If I take baby's arm and we're able to get it all  the way over across their neck like a scarf with  

little to no resistance, that would be indicative  of a premature infant. And then heel to ear,  

again if I am able to bring Molly's heel all  the way up to her ear, this is indicative of a  

premature infant. Think about how folded up they  are when they're little like that in the womb  

versus if I have some resistance doing that, that  would be more indicative of a mature infant.  

Now, the second part of New Ballard is the  physical maturity assessment here. So this has  

to do with more like looking at them. So looking  at Molly, I'm going to see does her skin look  

leathery and wrinkled? Or does it look sticky and  transparent? Sticky and transparent is going to be  

indicative of a premature infant. But a leathery  and a wrinkled, if it's to the extreme, it could  

actually be indicative of a post-mature infant.  But think about the fact that as I age, I'm going  

to have more wrinkles. That's how I remember that  the wrinkles are going to be for a mature baby.  

Lanugo. Lanugo is that very fine hair that covers  an infant's body. We have kind of three things  

here that we can talk about. A very premature  infant is going to have no lanugo. They will  

not have developed that yet. A premature infant  is going to have abundant lanugo that is keeping  

them warm; it's helping with thermo regulation.  And a mature infant is going to have very little;  

they're going to be mostly bald by the time  they are born. Now plantar surface creases.  

If you look at the surface of the baby's  foot, plantar surface, if it is smooth and  

there are no creases that seem to go across  the sole, then this is a premature infant.  

Molly looks pretty premature to me here.  But if I look at the plantar surface and I  

see wrinkles or creases that go all the way  across the sole, that is a mature infant.  

Then eyes and ears. Remember that the eyes don't  really open until a certain point in the baby's  

development. So if the eyes are kind of fused  shut, then that would be a premature infant. If  

the eyes open spontaneously, most likely mature.  The pinna. If I pulled the pinna of an infant's  

ear forward and it immediately pops back into  place, that is a mature infant. Versus premature,  

it might sort of slowly unfold or get back  to that point, but it's not going to kind of  

pop right back. And then the genitals. If we have  a baby with a penis, if we see a smooth scrotum  

and we don't really have wrinkles or anything  like that in the scrotum, that's premature.  

Versus a mature infant with a scrotum is going  to have what we call pendulous testicles, meaning  

they're hanging down and then they will have  rugae, which are wrinkles. So we will have  

a wrinkled scrotum indicating maturity.  If we have an infant that has a vulva,  

a premature will have a prominent clitoris and the  labia will be flatter. So you'll be able to see  

the clitoris extending past the labia, perhaps.  Whereas with a mature infant who has a vulva,  

the labia will be fully developed and the labia  majora will cover the clitoris and labia minora.  

And so that would be the thing that you  would see most prominently with that infant.  

Up next, we're talking about thermo regulation,  which is very important for newborns because  

they have a very hard time regulating their own  temperature. You and I do a much better job at it,  

but these are newborns who come out of the uterus  wet. First of all, they have a different sort of  

body makeup than an adult, and they don't have  adipose tissue in the way that we do. They have  

something called brown fat. So we have a  lot of risk factors for losing heat here,  

but it's important to understand the  different ways in which we can lose heat.  

So we have a few types of heat loss. Conduction,  it's going to be heat loss from direct contact  

with a cooler surface, such as if I placed  an infant on a metal scale without anything  

in between, they're going to lose heat through  conduction by touching that cold metal surface.  

Convection, heat loss from cooler air. So like  a fan, circulating air past the newborn that  

would be convection heat loss. Evaporation comes  from heat loss when surface liquid is converted  

into a vapor. So, for instance, immediately  after birth, they come out covered in fluid,  

right? They are at risk for losing heat through  evaporation. Or if we were to give them a bath  

and now they are wet, then they are at risk for  evaporative heat loss. And then radiation. So  

this is heat loss from proximity to a closer  surface. For instance, if I have a crib for  

my newborn that is right next to a cold window,  they could lose some heat through radiation. So  

important things would be make sure to dry the  newborn thoroughly right after birth. Put a cap  

on their head, wrap them up tightly in a blanket,  do skin-to-skin care with mom or another parent,  

and make sure that we are always protecting them  from contact with cold or cooler surfaces because  

we need them to keep all of that heat inside. And then lastly, in this video, we're talking  

about anthropometric measurements, which just  means what is their body measurements like?  

So we have some important stuff here. We put it  in a table for you. Bold, red text. We love to see  

it. So weight is one of those things that I would  know because weigh every baby, right? So we need  

to know what a normal range is. So 2,500 to 4,000  grams is the expected range, which is 5 pounds 8  

ounces to 8 pounds 13 ounces. It's much easier  to remember the metric measurements though here.  

Length would be 48 to 53 centimeters or a 19  to 21 inches; more narrow of a window there.  

Head circumference 13 to 15 inches. And chest  circumference 12 to 14 inches. But we do have a  

key point here that says at birth, the head  circumference is 2 to 3 centimeters larger  

than the chest circumference. It's not until one  year of age that the head and chest circumference  

approximate one another. So I always think  that these are pumpkins on broomsticks, right?  

Babies and children have big heads compared to  adults. So big head on a smaller body at birth.  

I hope this review was helpful for you. I'm  going to ask you some quiz questions to test  

your knowledge of key facts I provided you.  So let me know how you do in the comments.  

First up, I want you to name the five components  of the Apgar score. So you can remember them  

either with Dr. Apgar's name, or  you can try and remember the more  

commonly used ones as well. So the  five components of the Apgar score.  

Next, I'm going to tell you about  an infant, and I want you to tell  

me what Apgar score you would give them.  So we have a newborn with a strong cry.  

Their body is pink, but their extremities have  a blue tint to them. Their pulse is 95, and they  

are actively moving all of their extremities.  What Apgar score would you give to this infant?  

Okay. Next, I want you to imagine that you are  assessing a newborn of unknown gestational age.  

And you note that they have a zero-degree square  window. They do show resistance to the scarf sign.  

They have creases covering the entire plantar  sole, and they have very little lanugo. So  

you, as the nurse, do you interpret these findings  to indicate a premature or a mature infant?  

Okay. And lastly, what type of heat loss is  experienced if the nurse were to place a newborn  

onto a cold metal scale? What is the type of  heat loss that that infant would experience?