You might be wondering: What are “normal” NICU vital signs and how do we assess them in our newborn patients? Here, you’ll find out all you need to know!
NICU NURSE VITALS
Collecting and documenting vital signs is an essential part of being a nurse. No matter what speciality or clinical setting you work in, you’ll be expected to assess your patient’s vital signs to monitor their stability and health status. It’s no surprise that part of being a NICU nurse means collecting vital signs on their newborn patients. However, vital sign parameters are different in the NICU, and we collect our readings differently than nurses in other specialties. Below, I’ll answer the following questions:
What vital signs are most important when working in the NICU?
How do you conduct a newborn assessment and collect infant vital signs?
What equipment is needed to obtain newborn vitals?
What Vital Signs Do NICU Nurses Monitor?
Similar to nurses in other intensive care unit specialties, most NICU nurses document the following six vital signs:
1. Heart Rate
2. Respiratory Rate
3. Oxygen Saturation
4. Blood Pressure
5. Temperature
6. Pain
In addition to these vital signs, assessing newborn measurements is also essential to documenting developmental progress. These include:
Head circumference (the distance around a baby's head)
Abdominal circumference (the distance around a baby’s abdomen at the level of their belly button).
Length (the measurement from crown of the head to the heel)
Weight (usually measured in grams)
What Are Normal NICU Vital Sign Parameters?
The normal ranges for NICU vital signs might look different than those for adults or older children:
1. Heat Rate: 100-200 beats per minute
2. Respiratory Rate: 10-100 breaths per minute
3. Temp 36.5 C - 37.5 C
4. Oxygen Sats - 85-100%
5. Blood pressure: depends on gestation
6. Pain: NPASS scores between 0-4
Collecting Patient Vitals in the NICU: 3 Important Steps
Part of what makes working in the NICU so unique is the complexity of our patient population.
Each baby will have different “normal” vital sign parameters according to their gestational age.
Step 1: Assess Your Patient
Before documenting an infant’s vital signs, you’ll want to perform two types of assessments:
A full-body physical assessment
A maturity/gestational assessment
These can give insight into particular findings and can highlight areas of concern. Then, once you’ve done that, you can proceed with vital sign collection. We outline how to carry out these important steps below:
a. Infant Full-Body Physical Assessment
Before you check a NICU patient’s vitals, you’ll want to take a look at their general appearance. If you’re just starting out your shift, you’ll want to do a thorough physical assessment. If you’re collecting repeat vitals, a quick look-over will suffice.
Before you check a NICU patient’s vitals, you’ll want to take a look at their general appearance. If you’re just starting out your shift, you’ll want to do a thorough physical assessment. If you’re collecting repeat vitals, a quick look-over will suffice.
When conducting your physical assessment, take note of the following characteristics:
1. General appearance: Physical activity, tone, posture, and level of consciousness
2. Skin: Color, texture, nails, presence of rashes
3. Head and neck: Appearance, shape, presence of molding (shaping of the head from passage through the birth canal) Fontanels (the open "soft spots" between the bones of the baby's skull) Clavicles (bones across the upper chest)
4. Face: Eyes, ears, nose, cheeks
5. Mouth: Palate, tongue, throat
6. Lungs: Breath sounds, breathing patterns
7. Heart sounds and femoral (groin) pulses: Strength and palpability
8. Abdomen: Presence of masses or hernias
9. Genitals and anus: Open passage of urine and stool
10. Arms and legs: Movement and development.
b. Maturity/Gestational Assessment
In most NICUs, an examination called The Dubowitz/Ballard Examination for Gestational Age is often used to estimate a baby’s gestational age. This exam evaluates a baby's appearance, skin texture, motor function, and reflexes. The physical maturity part of the examination is done in the first two hours of birth. The neuromuscular maturity examination is completed within 24 hours after delivery.
Information collected from this exam is often used to help estimate babies' physical and neuromuscular maturity. These help us ensure that we’re providing appropriate care and are meeting the infant’s developmental needs. For example, a very small baby may actually be more mature than it appears by size, and may need different care than a premature baby.
Step 2: Document Infant Measurements
Once you’ve completed your assessment, you’ll want to measure the infant's head circumference, abdominal circumference, and length. These are usually measured with paper measuring tapes using centimeters.
Next, you’ll want to get your patient’s weight. A baby's birth weight is an especially important indicator of health. The average weight for term babies (born between 37 and 41 weeks gestation) is about 7 lbs. (3.2 kg). In general, super small babies and very large babies are at greater risk for problems.
To prevent complications, babies are usually weighed daily or every 12 hours to assess their growth, fluid, and nutrition needs. It’s important to remember that newborn babies often lose 5 to 7 percent of their birth weight within the first few days.
For example, a baby weighing 7 pounds 3 ounces at birth might lose as much as 8 ounces in the first few days. Babies will usually gain this weight back by 2 weeks of age. However, premature and sick babies may not begin to gain weight right away.
Most hospitals use the metric system for weighing babies (grams/kilograms). This chart can help you convert grams to pounds. You can also download a conversion app on your phone!
Step 3: Collect Vital Signs
Finally, you’re ready to collect vital signs. Most readings will show up on the patient’s electronic monitor, but you’ll need to know how to assess each vital sign. Let’s dive in.
1. Heart Rate
Normal Range: 100-200 beats per minute
Heart rate & pulse are monitored with 3-lead ECG stickers placed over chest & lung areas. These stickers are usually changed everyday or every other day and remain connected to the patient at all times. You should also manually listen to the infant’s heart rate using a stethoscope to ensure the stickers are reading appropriately. The best time to measure an infant’s heart rate is while they’re sleeping!
Equipment Needed: ECG leads/stickers, stethoscope
2. Respiratory Rate
Normal Range: 10-100 breaths per minute
The same 3-lead ECG stickers you use to collect an infant's heart rate will be used to measure their breathing rate. You can also usually visualize a patient's breathing rate to assess for depth of breaths and breathing effort.
Equipment Needed: ECG leads/stickers, stethoscope (same as heart rate leads)
3. Oxygen Saturation
A pulse ox probe (attached to hand, wrist, or foot) monitors the oxygen saturation. This tells us how well a baby is perfusing.
Equipment Needed: Pulse-Ox sticker and probe
4. Blood Pressure
Most NICUs will use automatic blood pressure cuffs to analyze an infant’s blood pressure. These blood pressure cuffs are sized based on weight. For infants who have an umbilical artery catheter (UAC) or arterial line, we can measure their blood pressure continuously, like we do their heart rate and oxygen saturation.
Equipment Needed: Blood pressure cuff OR UAC/arterial line tubing/cables
5. Temperature
Temperatures are usually taken via the axilla (armpit). If a baby is in an isolette, a skin probe (attached to the baby) displays the baby's temperature. This is how we keep them nice and toasty.
Equipment Needed: Thermometer or temperature probe
6. Pain
Pain is usually scored every 3-4 hours with some form of the standard pain scale, though it should be measured more frequently for patients on IV pain medication or for those infants who may be withdrawing from long-term/maternal use pain medication. “NPASS” is the most common pain scale used in the NICU.
Equipment Needed: None/visual assessment only
Looking for More Tips on Providing Great Care?
So there you have it — now, you understand how to appropriately collect infant vital signs! If you’re looking for additional information on how to provide safe and effective infant care, check out our other resources, toolbooks, and guides on NICUity’s webpage!
NICU Nurse Essential Resources
March of Dimes! Resources for parents & providers
Tori Meskin MSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, Sponsored Capella University MSN graduate a Barco Uniforms Ambassado & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com or info@tipsfromtori.com