How to... measure a baby's respiratory rate

Midwives magazine: August 2010

Anglia Ruskin University’s senior lecturer in midwifery Sharon McDonald provides a guide to assessing newborn respiration rates.

Assessing respirations is an essential component of newborn care. It is crucial to ensure consistent oxygenation levels by observation and, if necessary, therapeutic intervention. All healthy newborns should be able to maintain their airway. Respiratory effort is initially assessed with the Apgar score (see table). Normally within 30 seconds of birth, the baby cries spontaneously.

Measuring the respiratory rate
We are required to inspect and record respirations, observing rate, rhythm, inspiratory volume, and effort with breathing. While observing the rate, note the inspiratory expansion of the chest cage. The expansion should be the same during each cycle.

Observation
By observing, we are looking for a baby whose colour is normal for their ethnicity, alert with good muscle tone and normal symmetrical chest movements, with no signs of respiratory distress (NICE, 2008; Davies and McDonald, 2008; Tappero and Honeyfield, 2003).

Procedure
✲ Gain informed consent from the parent/s to examine baby
✲ Ideally examine the respiratory rate when baby is quiet
✲ Count and observe respirations for a full minute, as babies’ breathing rate is often irregular. Normal is approximately 30 to 60 breaths per minute (NICE, 2006). Although with babies at rest, we can see a respiratory rate of 20 and higher when crying
✲ If respirations are difficult to observe visually, place your warmed hand lightly across the baby’s chest and count each rising movement
✲ Record the respiratory rate, breaths per minute, depth, type of breathing, and overall condition
✲ Explain to the parent/s your findings and if referral is required.

Auscultation
For those babies whose respiratory rate is not within the normal range and need to be monitored more closely, auscultation of the lungs is required.

Using a warm paediatric stethoscope, place the stethoscope (bell) at the second intercostal space, on the right and then left side of the baby’s chest. The respiratory rate should be heard quite clearly. There should be no other sounds. The lower lobes of the lungs can be heard more clearly on the baby’s back.

Lungs should sound clear with two groups of muscles, inspiratory and expiratory, producing a rhythmic respiratory rate and pattern.

Those who undertake the discharge examination of the newborn should assess six areas of the lungs on the front and back in a systematic way (Davies and McDonald, 2008).

Conclusion
Assessment of the newborn at birth involves assessing the baby’s colour, tone, breathing and heart rate (Resuscitation Council, 2005). At subsequent checks, the midwife will monitor the baby’s wellbeing, noting any deviations from normal and refer as appropriate. 


References

Davies L, McDonald S. (2008) Examination of the newborn and neonatal health: a multidimensional approach. Elsevier: London.

NICE. (2006) Postnatal care: routine postnatal care of women and their babies. NICE: London.

NICE. (2008) Intrapartum care: care of healthy women and their babies during childbirth. NICE: London.

Resuscitation Council (UK). (2005) Newborn life support. See: www.resus.org.uk/pages/NLSgClar.htm (accessed 30 June 2010).

Tappero EP, Honeyfield ME. (Eds.). (2003) Physical assessment of the newborn: a comprehensive approach to the art of physical examination (third edition). NICU Ink Books: Santa Rosa, California.