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Newborn Babies at Birth

Doctor holding up newborn in delivery room
Your baby is finally here! At birth, she may look different from what you expect. Caucasian babies are often dull red or dull bluish gray in colour, and dark-skinned babies are often purplish-gray. Newborn babies may be born covered in waxy vernix, and their skin might look mottled at first. They may turn red from head to foot if they are crying furiously. Don’t worry, though; within 48 hours or so, your baby’s skin colour will look more normal, with the exception of bluish hands and feet when she is cold.

If your newborn baby was born vaginally, she may have a bit of a conehead. This is because her skull bones shifted and overlapped during delivery so her head could fit through the birth canal. This is called moulding, and it will be particularly apparent if you had a very long labour. Don’t worry about her somewhat pointy head; it will round itself out with time, and soon she’ll look as perfect as those cherubic babes so often seen on television advertisements.

Physical changes at birth

Newborn babies go through many physical changes when they are first born. The most dramatic change at birth is when the newborn baby takes her first breath. The lungs inflate and fill the air sacs within the lungs. Blood starts to flow to the lungs and gas exchange begins. A newborn baby’s first breath will be the most difficult of her life. Your baby’s initial breaths may fluctuate between 15 and 100 breaths per minute. After the first few minutes, her breathing will settle to 30 to 50 breaths per minute.

The baby’s first breath triggers changes in the function of the heart. Special ducts and blood vessels that were essential to the baby’s cardiovascular system while in the womb close rapidly because they are no longer needed. Blood flow through the umbilical cord drops to nothing once the cord is clamped.

Apgar score and physical examination

At one and five minutes after birth, babies are assessed and given an Apgar score. This scoring system assesses newborn babies’ well-being using five different factors: heart rate, respiratory effort, muscle tone, reflex ability, and colour. Each factor is given a score of 0, 1, or  2. The best possible total score is 10. The Apgar score is checked periodically for several minutes to give an idea of how well the newborn baby is doing and whether his condition is improving or not. A newborn baby who scores between 4 and 7 needs careful monitoring at regular intervals, and possible treatment. A newborn baby with a low score would need resuscitation.

Apgar scores are not a useful predictor for future problems. Initially low Apgar scores do not tell the whole story; at birth, many rapid changes are taking place which need only a few minutes or hours to resolve themselves. A newborn baby who is having some trouble breathing in the first few minutes of life may only need time to clear her lungs of amniotic fluid and might be breathing normally once this natural process has occurred.

A physical examination is done to make sure that the newborn baby is in good health. This type of examination can also reveal certain conditions or problems. Physical examination is an ongoing process. A newborn baby’s first examination is likely to be the most complete, but it will not be the last. Many examinations will occur over time to assess a newborn baby’s progress and to spot new problems if they arise.

Chances are that the Apgar score and physical examination will show that your newborn baby is in great health. However, if the Apgar score and physical examination of your baby show that there is a serious medical problem, your baby may need to be transferred to another hospital that provides specialty or subspecialty services. These are hospitals that have neonatal intensive care units (NICUs) with doctors called neonatologists who specialize in the care of newborn babies. They will take excellent care of your newborn baby and do the best they can to improve his health.

The first four weeks of life

The first four weeks of life are referred to as the newborn or neonatal period. We tend to think of newborn babies as helpless. However, newborn babies are able to search for their mother’s breast and suckle when they do find it. Most newborn babies can breathe without assistance and cry surprisingly loudly. Newborn babies have a wide repertoire of reflex and voluntary movements, some of which disappear during the first few months. For example, at birth a newborn baby has such a strong grip that it is possible to lift her up entirely by her grasp. By six weeks, this is no longer possible. Newborn babies can also “walk” if held firmly under their arms with their feet on a flat surface. This walking reflex also disappears by about six weeks after birth.

Newborn babies seem to love human faces, and they can focus well on their mother’s face when being held to the breast. Newborn babies are able to follow a light with their eyes and turn toward lights. However, their eye movements may not be well-coordinated at first and their eyes may move independently of each other.

Newborn babies tend to prefer female voices. They usually recognize their own mother’s voice right away, since this is the voice they have heard, albeit a bit muffled, throughout the previous nine months of pregnancy.

Feeding your newborn baby

Breast milk is the ideal food for your newborn baby. Breast milk is a combination of fat, protein, carbohydrates, sugar, minerals, and almost all the vitamins a newborn baby needs. Breast milk also contains antibodies that can help your newborn baby fight many infectious diseases. This is important because your newborn baby’s immune system is immature at first, and is not able to fight disease very efficiently on its own.

Nicolette Caccia, MEd, MD, FRCSC

Rory Windrim, MB, MSc, FRCSC

Andrew James, MBChB, MBI, FRACP, FRCPC

9/11/2009




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