Neonatal assessment and transitional care

The baby is pink, crying and on his mother's chest, and the midwife asks you for the 5-minute Apgar. It is the most-recorded number in obstetrics and the most misused. Get it right, get the cord gases right, and know exactly what the first six hours should look like — that trio is the whole of newborn assessment for an obstetrician, and all three turn up in medico-legal files for the same reason: they were done casually.[1][2]

Overview — what you are actually assessing

Three separate questions, answered at three different moments. [2][8]

• How is the baby right now? The Apgar score, at 1 and 5 minutes. A description of condition, nothing more.[1][2]
• What did the baby experience before birth? Paired umbilical cord gases. The only objective, contemporaneous record of fetal acid-base status at the moment of birth.[6][7]
• Is the transition working? Serial observation over the first hours — colour, breathing, tone, temperature, feeding.[15][16]

References18Show ledgerHide ledger

1. [1]Apgar V A proposal for a new method of evaluation of the newborn infant Curr Res Anesth Analg, 1953.PMID 13083014
2. [2]American College of Obstetricians and Gynecologists Committee on Obstetric Practice Committee Opinion No. 644: The Apgar Score Obstet Gynecol, 2015.PMID 26393460
3. [3]Razaz N, Cnattingius S, Joseph KS Association between Apgar scores of 7 to 9 and neonatal mortality and morbidity: population based cohort study of term infants in Sweden BMJ, 2019.PMID 31064770
4. [4]Persson M, Razaz N, Tedroff K, Joseph KS, Cnattingius S Five and 10 minute Apgar scores and risks of cerebral palsy and epilepsy: population based cohort study in Sweden BMJ, 2018.PMID 29437691
5. [5]Cnattingius S, Norman M, Granath F, Petersson G, Stephansson O, Frisell T Apgar Score Components at 5 Minutes: Risks and Prediction of Neonatal Mortality Paediatr Perinat Epidemiol, 2017.PMID 28493508
6. [6]Malin GL, Morris RK, Khan KS Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis BMJ, 2010.PMID 20466789
7. [7]Westgate J, Garibaldi JM, Greene KR Umbilical cord blood gas analysis at delivery: a time for quality data Br J Obstet Gynaecol, 1994.PMID 7826958
8. [8]American College of Obstetricians and Gynecologists' Task Force on Neonatal Encephalopathy Executive summary: Neonatal encephalopathy and neurologic outcome, second edition Obstet Gynecol, 2014.PMID 24785633
9. [9]Moore ER, Brimdyr K, Blair A, et al. Immediate or early skin-to-skin contact for mothers and their healthy newborn infants Cochrane Database Syst Rev, 2025.PMID 41120189
10. [10]Ewer AK, Middleton LJ, Furmston AT, et al. Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study Lancet, 2011.PMID 21820732
11. [11]Forsberg D, Steinhoff L, Drevin G, Idborg H, Pejovic NJ, Herlenius E Sudden Unexpected Postnatal Collapse: A Retrospective Cohort Study Describing Incidence, Risk Factors and Role of Perinatal Transition Acta Paediatr, 2026.PMID 42444072
12. [12]Gomersall J, Berber S, Middleton P, et al. Umbilical Cord Management at Term and Late Preterm Birth: A Meta-analysis Pediatrics, 2021.PMID 33632933
13. [13]Dawson JA, Kamlin CO, Vento M, et al. Defining the reference range for oxygen saturation for infants after birth Pediatrics, 2010.PMID 20439604
14. [14]Dawson JA, Kamlin CO, Wong C, et al. Changes in heart rate in the first minutes after birth Arch Dis Child Fetal Neonatal Ed, 2010.PMID 20444810
15. [15]Aziz K, Lee HC, Escobedo MB, et al. Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Circulation, 2020.PMID 33081528
16. [16]Liley HG, Weiner GM, Wyckoff MH, et al. Neonatal Life Support: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations Circulation, 2025.PMID 41122846
17. [17]Jacobs SE, Berg M, Hunt R, et al. Cooling for newborns with hypoxic ischaemic encephalopathy Cochrane Database Syst Rev, 2013.PMID 23440789
18. [18]Adamkin DH Postnatal glucose homeostasis in late-preterm and term infants Pediatrics, 2011.PMID 21357346