Neonatal Vital Signs

A newborn’s vital signs reflect the success of the transition from placental support to independent breathing and circulation. When the lungs expand and oxygenation improves, the heart rate should remain strong and the respiratory effort should become effective. A change in one value can therefore signal a problem in another system. The experienced nurse looks at the infant before looking at the monitor. Tone, colour, respiratory effort, responsiveness, and perfusion give the number meaning. A newborn who is pale, limp, grunting, or poorly responsive requires a different response from a vigorous infant whose heart rate is briefly elevated while crying. For a term newborn from 0 to 28 days, the usual heart rate is 120–160 beats per minute and the usual respiratory rate is 30–60 breaths per minute. These are reference ranges, not permission to ignore the infant’s appearance. Prematurity, illness, medications, recent handling, and the transition after birth can alter the expected findings, so the infant’s gestational age and clinical state must be considered. Bradycardia is particularly urgent in a newborn because it commonly reflects inadequate oxygenation or ineffective...