Editing Maternal and Newborn Nursing (section)

=== Immediate transition and the Apgar score ===

At birth the newborn must clear lung fluid, establish spontaneous respiration, and shift from fetal to neonatal circulation as pulmonary vascular resistance falls and the ductus arteriosus, foramen ovale, and ductus venosus close. The first priorities in the delivery room are, in order, '''warmth, airway, and breathing''': dry the infant, remove wet linens, provide skin-to-skin contact or a radiant warmer, position the airway, and stimulate.

The '''Apgar score''' is assigned at 1 and 5 minutes (and every 5 minutes to 20 minutes if the score stays below 7). Five parameters scored 0, 1, or 2: '''heart rate, respiratory effort, muscle tone, reflex irritability, and color'''. A total of 7 to 10 is reassuring, 4 to 6 indicates moderate difficulty, and 0 to 3 indicates severe distress. '''The Apgar score describes transition; it does not dictate resuscitation.''' Resuscitation is started based on respirations, heart rate, and tone, not on waiting for a score.