Delivery-room physicians are now able to intervene aggressively if they detect a problem with a newborn's breathing or heart.

"Increased awareness and technical advances have allowed us to save a growing number of lives," said Dr. Karen Hendricks-Munoz, director of the Division of Neonatology at New York University Medical Center.One out of 10 newborns in the United States requires some type of intensive care.

Most delivery suites now have artery and vein lines in place to administer medication and test blood in case of an emergency. Many hospitals include resuscitation areas within delivery suites, as well as a neonatologist, a specialist in newborn care.

"Babies born prematurely are rapidly provided with a tube that helps ensure the lungs receive sufficient oxygen," Hendricks-Munoz said. If their heart rates are low, infants receive artificial respiration and may be given stimulants such as epinephrine.

"Very small premature infants who have problems breathing receive assisted respiration within minutes of birth," she said. "Glucose is administered very early if a baby has had episodes of decreased blood flow and decreased oxygen. Nutrition is important from the beginning."

Many of the newborn's needs are better understood today. Delivery suites used to be kept cool because the adults are gowned. "We now know babies tend to lose a lot of warmth into the environment," she explained. "Delivery suites are now warmed by overhead lamps. Warmed towels and hats wrap the baby and prevent decreases in temperature."

As a result of these developments, the widely used Apgar test is becoming of less diagnostic value in determining when to start resuscitation, and they no longer have to rely on a test done at five minutes," Hendricks-Munoz said. "They continuously evaluate a newborn every 30 to 60 seconds. New tests can provide more objective results."

The Apgar score, based on a standardized testing method devised in 1952 by anesthesiologist Virginia Apgar, has been used worldwide to assist the delivery room physician assess whether a newborn needed resuscitation or was being effectively resuscitated.

While not mandatory, the test is performed on nearly all the 4 million babies born in hospitals in the United States each year.

The score indicates how a newborn has reacted to the outside world during the first five minutes, called the transitional period.

A value from zero to 2 is assigned to each of five criteria: heart rate, respiratory effort, muscle tone, response to stimulation and skin color. An overall score of 10 indicates the best possible condition.

While useful, Apgar figures can be misleading. The scoring may be performed by a physician, nurse aide or technician, and the final number may reflect subjective judgments.

"The score cannot measure events that took place before, during or after delivery," Hendricks-Munoz added.