PEDIATRICS: Essential Intrapartum Newborn Care (EINC), APGAR, and Ballard Scoring of Newborn

Introduction

This tutorial outlines essential intrapartum newborn care (EINC), along with the methods for assessing a newborn's health using APGAR and Ballard scoring. These assessments are crucial for ensuring the well-being of newborns immediately after birth and are important tools for healthcare providers in pediatrics.

Step 1: Understand Essential Intrapartum Newborn Care

EINC focuses on the immediate care provided to newborns at birth. This care includes:

• Thermal Protection: Keep the newborn warm to prevent hypothermia. Use skin-to-skin contact with the mother or a warm blanket.
• Breathing Assessment: Check if the newborn is breathing well. If not, initiate resuscitation protocols.
• Cord Care: Delay cord clamping for at least 1-3 minutes to allow for adequate blood transfer from the placenta.
• Immediate Assessment: Quickly evaluate the newborn's condition and provide immediate interventions if necessary.

Practical Tips:

• Ensure the delivery room is warm to maintain the newborn's body temperature.
• Prepare necessary equipment before delivery for quick access.

Step 2: Perform APGAR Scoring

APGAR scoring is a quick assessment performed at 1 and 5 minutes after birth to evaluate the newborn’s condition. The scoring criteria include:

• Appearance (Skin Color)
• Pulse (Heart Rate)
• Grimace Response (Reflexes)
• Activity (Muscle Tone)
• Respiration (Breathing Effort)

Scoring System:

• Each category is scored from 0 to 2, with a maximum score of 10.
• A score of 7-10 indicates a healthy newborn, while lower scores may require further evaluation and intervention.

Steps to Score:

1. Assess skin color:
   • 0 points for blue/pale all over.
   • 1 point for body pink, but blue extremities.
   • 2 points for completely pink.
2. Check heart rate:
   • 0 points if no pulse.
   • 1 point for pulse less than 100 bpm.
   • 2 points for pulse over 100 bpm.
3. Evaluate reflexes:
   • 0 points for no response.
   • 1 point for grimace during stimulation.
   • 2 points for crying upon stimulation.
4. Assess muscle tone:
   • 0 points for limp.
   • 1 point for some flexion.
   • 2 points for active movement.
5. Observe breathing efforts:
   • 0 points for absent breathing.
   • 1 point for slow and irregular.
   • 2 points for good, strong cry.

Step 3: Conduct Ballard Scoring

Ballard scoring is a method used to estimate the gestational age of a newborn based on physical and neurological criteria. It includes:

Physical Maturity Assessment:

• Evaluate features such as skin texture, lanugo, and breast tissue.
• Score each feature on a scale based on maturity.

Neurological Maturity Assessment:

• Assess motor activity, posture, and reflexes.
• Score each neurological aspect to determine gestational age.

Steps to Score:

1. Examine physical signs such as:
   • Skin:
     • 0 points for transparent skin (28 weeks).
     • 5 points for peeling skin (40 weeks).
   • Lanugo:
     • 0 points for abundant (28 weeks).
     • 5 points for none (40 weeks).
2. Assess neurological signs:
   • Posture:
     • 0 points for flaccid (28 weeks).
     • 5 points for fully flexed (40 weeks).
   • Reflexes:
     • Score based on the presence of primitive reflexes.

Common Pitfalls:

• Ensure to score consistently according to the criteria for accurate assessments.
• Avoid rushing the evaluation to ensure each feature is properly assessed.

Conclusion

The essential intrapartum newborn care, along with APGAR and Ballard scoring, is vital for assessing and ensuring the health of newborns immediately after birth. Healthcare providers should practice these assessments to gain familiarity and confidence. Regular training and updating on best practices in neonatal care can significantly impact newborn outcomes.