Complications of the Newborn

Assessing the Neonate

There are several ways to assess the condition of the newborn. The most widely used tool is the Neonatal Behavioral Assessment Scale (NBAS) developed by T. Berry Brazelton. This tool has been used around the world to help parents get to know their infants and to make comparisons of infants in different cultures (Brazelton & Nugent, 1995). The baby’s motor development, muscle tone, and stress response are assessed.

The Apgar test is conducted one minute and five minutes after birth. This is a very quick way to assess the newborn’s overall condition. Five measures are assessed: the heart rate, respiration, muscle tone (quickly assessed by a skilled nurse when the baby is handed to them or by touching the baby’s palm), reflex response (the Babinski reflex is tested), and color. A score of 0 to 2 is given on each feature examined. An Apgar of 5 or less is cause for concern. The second Apgar should indicate improvement with a higher score.

Low Birth Weight

Figure 1. The Apgar score is named after physician Virginia Apgar, shown here with a newborn baby in 1966. The word was later turned into an acronym: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration.

We have been discussing a number of teratogens associated with a low birth weight such as cocaine, tobacco, etc. A child is considered to have a low birth weight if they weigh less than 5.8 pounds (2500 grams). About 8.17 percent of babies born in the United States are of low birth weight and 1.4 percent are born very low birth weight.^[1] A low birth weight baby has difficulty maintaining adequate body temperature because it lacks the fat that would otherwise provide insulation. Such a baby is also at more risk of infection. And 67 percent of these babies are also preterm which can make them more at risk for a respiratory infection. Very low birth weight babies (2 pounds or less) have an increased risk of developing cerebral palsy. Many causes of low birth weight are preventable with proper prenatal care.

Premature Birth

A child might also have a low birth weight if it is born at less than 37 weeks gestation (which qualifies it as a preterm baby). In 2016, 9.85 percent of babies born in the U.S. were preterm.^[2] Early birth can be triggered by anything that disrupts the mother’s system. For instance, vaginal infections or gum disease can actually lead to premature birth because such infection causes the mother to release anti-inflammatory chemicals which, in turn, can trigger contractions. Smoking and the use of other teratogens can also lead to preterm birth.

Anoxia and Hypoxia

One of leading causes of infant brain damage is lack of oxygen shortly after birth. Hypoxia occurs when the infant is deprived of the adequate amount of oxygen, leading to mild to moderate brain damage. Anoxia occurs when the infant undergoes a total lack of oxygen, which can lead to severe brain damage. This lack of oxygen is typically caused by umbilical cord problems, birth canal problems, blocked airways, and placenta abruption. Both hypoxia and anoxia can lead to cerebral palsy and a host of other medical disorders. ^[3]

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