O&G · Neonatal care — assessment and transition
Neonatal assessment and transitional care
Also known as Apgar score · Newborn assessment · Cord blood gases · Umbilical cord gas analysis · Transitional care · Newborn transition
Exam-exhaustive FRANZCOG fellowship reference on newborn assessment and transitional care — the Apgar score reproduced correctly and what it must never be used for, paired cord gas technique and interpretation with the acidaemia thresholds, the physiology of normal transition minute by minute, escalation triggers on the postnatal ward, and sudden unexpected postnatal collapse. ANZ-primary, globally tagged.
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Target exams
Red flags
- Writing 'birth asphyxia' on the basis of a low Apgar score alone — the score describes the baby, it never names the cause
- A single cord sample: a normal venous gas can sit alongside a severely acidotic artery and reassure you into a coroner's court
- The quiet, cold, poorly feeding baby at 12 hours — hypothermia and lethargy are how sepsis and hypoglycaemia announce themselves
- Unobserved skin-to-skin with an exhausted mother in the first hours — this is when sudden unexpected postnatal collapse happens
- Discharge before the pulse oximetry screen, before feeding is established, or before a temperature has been recorded
- Bile-stained vomiting in a newborn — that is malrotation until a surgeon says otherwise, not 'a bit of mucus'
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]
References18ShowHide
- [1]Apgar V A proposal for a new method of evaluation of the newborn infant Curr Res Anesth Analg, 1953.PMID 13083014
- [2]American College of Obstetricians and Gynecologists Committee on Obstetric Practice Committee Opinion No. 644: The Apgar Score Obstet Gynecol, 2015.PMID 26393460
- [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]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]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]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]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]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]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]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]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]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]Dawson JA, Kamlin CO, Vento M, et al. Defining the reference range for oxygen saturation for infants after birth Pediatrics, 2010.PMID 20439604
- [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]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]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]Jacobs SE, Berg M, Hunt R, et al. Cooling for newborns with hypoxic ischaemic encephalopathy Cochrane Database Syst Rev, 2013.PMID 23440789
- [18]Adamkin DH Postnatal glucose homeostasis in late-preterm and term infants Pediatrics, 2011.PMID 21357346