Postnatal Checks for the Newborn
The Apgar Score
Within one minute of birth, and again at five minutes, every newborn in the UK is assessed using the Apgar score. The five criteria are: Appearance (skin colour), Pulse (heart rate), Grimace (reflex response to stimulation), Activity (muscle tone), and Respiration (breathing). Each is scored 0, 1 or 2, giving a maximum total of 10. A score of 7 or above indicates the baby is in good condition. A score of 4–6 suggests the baby may need some assistance, and a score below 4 indicates the baby requires immediate medical intervention. The Apgar score allows midwives and paediatricians to make rapid, objective decisions about whether a newborn needs urgent support.
The Apgar score is assessed at 1 minute and 5 minutes after birth. A total of 7–10 indicates good condition; 4–6 may need assistance; below 4 requires immediate medical intervention. Maximum score is 10 (2 for each of the five criteria).
Weight, Head Circumference and Physical Examination
All newborns are weighed at birth and their head circumference is measured. The average birth weight in the UK is approximately 3.3 kg, but a range of 2.5–4.5 kg is considered healthy. Weight below 2.5 kg classifies the baby as low birth weight, which is associated with prematurity or poor growth in the womb. Head circumference is typically 33–35 cm at term. An unusually small or large head may indicate conditions such as microcephaly or hydrocephalus respectively, and will prompt further investigation.
Within 72 hours of birth, a qualified midwife or paediatrician carries out a comprehensive physical examination. This covers: eyes (checked for cataracts and structural abnormalities using an ophthalmoscope), mouth (checked for cleft palate), heart (listened to for murmurs), lungs, abdomen (to detect enlarged organs), spine (checked for spina bifida), hips (Ortolani and Barlow manoeuvres to detect developmental dysplasia of the hip), feet (checked for talipes/club foot), genitalia, reflexes (Moro, grasp, rooting), and skin condition. This examination provides a baseline record of the baby's health and flags issues that need follow-up.
Between 5 and 8 days after birth, a midwife takes a small sample of blood from a prick on the baby's heel. This is absorbed onto a card and sent to a laboratory where it is screened for ten rare but serious conditions: phenylketonuria (PKU), congenital hypothyroidism, cystic fibrosis, sickle cell disease, MCADD (medium-chain acyl-CoA dehydrogenase deficiency), maple syrup urine disease, isovaleric acidaemia, glutaric aciduria type 1, homocystinuria, and hereditary tyrosinaemia type 1 (HT1, added to the programme in 2025). These conditions are not visible at birth but can cause severe disability or death if untreated. Early detection allows treatment to start before symptoms develop, significantly improving long-term outcomes. The test is part of the NHS Newborn Blood Spot Screening Programme and is offered to all newborns.
The Newborn Hearing Test
The newborn hearing test is offered to all babies within the first few weeks of life, ideally before leaving hospital. It uses one or both of two technologies: the otoacoustic emission (OAE) test, which plays a soft clicking sound and measures the echo from the cochlea, and the automated auditory brainstem response (AABR) test, which uses small sensors on the head to measure brainwave responses to sounds. The test is painless and usually performed while the baby is calm or sleeping. Around 1 in 1,000 babies is identified with permanent hearing loss; early identification enables earlier intervention with hearing aids or cochlear implants, and access to language support, which significantly improves communication development.
The newborn blood-spot test screens for ten conditions including phenylketonuria (PKU), congenital hypothyroidism, cystic fibrosis and hereditary tyrosinaemia type 1 (HT1, added 2025). It is carried out between 5 and 8 days after birth by pricking the baby's heel. Early detection allows treatment before symptoms and irreversible harm develop.
The Special Care Baby Unit (SCBU) is a specialist ward within a hospital that provides intensive medical care for newborns who are premature (born before 37 weeks), have a low birth weight (below 2.5 kg), or are ill following birth. Premature babies have underdeveloped lungs, poor temperature regulation, difficulty feeding, and a weakened immune system. SCBU staff include neonatologists, specialist nurses and physiotherapists who provide incubator care to maintain warmth, oxygen therapy and ventilation support, tube feeding (nasogastric or intravenous), infection monitoring, and phototherapy for jaundice. Parents are encouraged to visit as often as possible, and kangaroo care (skin-to-skin contact) is actively promoted, as it stabilises the baby's heart rate and temperature and supports bonding and breastfeeding. The length of stay depends on the baby's gestation and health; some babies remain in SCBU for several months.