Adaptation of the Newborn (PowerPoint) Flashcards
the neonatal period
begins at birth and ends at 28 days
at birth, factors that act as triggers responsible fro newborns taking their first breath
Chemical
Mechanical
Thermal
Sensory
during the neonatal period, the neonate must
adapt, coordinate, and integrate changes
physical changes the neonate must adapt, coordinate, and integrate
- Establish respirations
- Changing circulation route
- Regulate temperature
- Ingest, retain, and digest food
- Getting rid of waste
- Regulare weight
behavioral changes the neonate must adapt, coordinate, and integrate
- Regulate arousal and sleep
- Process, store, and organize multiple stimuli
- Establish relationships with caregivers and environment
environmental differences between intrauterine and extrauterine
Intrauterine:
- Quiet
- Warm
- Dark
- Comfortable
- Cozy/cramped
- Safe
- Familiar
Extrauterine:
- Loud
- Cold
- Bright
- Painful
- Unswaddled
- Vulnerable
- Unfamiliar
first period of reactivity
up to 30 minutes past birth
- HR increased at first but gradually falls back between 100-120 (may be tachy for 1st 30min)
- RR high at 60-80 (norm 40-60) and may hear fine crackles
- Audible grunting, nasal flaring, and chest retraction can be present but should be clear within 1hr
- This is the time to initiate breastfeeding and bonding
after the first period of reactivity, the baby
either sleeps or has a marked decreased in activity
- after 1st 30min, there is a period of decreased responsiveness where the baby will sleep and wake occasionally
(this lasts about 1-1.5 hours)
second period of reactivity
2-8hrs after birth (lasts 10min to several hours)
may have brief periods of
- tachycardia
- tachypnea
- increased muscle tone (really jumpy)
- increased mucus production (watch for gag and choking - may have to suction)
most critical after birth
- RESPIRATION
- Circulation
- Thermoregulation
- GI
(ABCs)
most critical adaptation after birth
Respirations
- 30-60 breaths/min
- shallow, irregular breaths
- short periods of apnea <15sec
- assessed over a full 60sec
- symmetrical chest movements
suction after birth
prevents infant from inhaling fluid when the nares are touched
(mouth then nose)
newborns prefer to breathe out
nose
established as the crucial site of gas exchange
the lungs
establishment of the lungs as the crucial site of gas exchange causes
- rise in blood pressure
- increase in circulation into the lungs for perfusion
establishing gas exchange in the lungs is facilitated by
several mechanisms occurring during birth, such as clamping the cord
stimulating respirations at birth
The most critical adjustment a newborn makes
The first breath of air initiates a sequence of cardiopulmonary changes
- Converting from fetal to neonatal circulation (clamp the cord)
- Emptying the lungs of fluid
- Retention of fluid interferes with ability to maintain adequate oxygenation (c/s delivery)
Establishing pulmonary function
- Diaphragm descends creating negative intrathoracic pressure
- Alveoli are lined with surfactant, which lowers surface tension, so alveoli stay open with less pressure (not every breath is a first breath)
- Chest and abdomen rise simultaneously with inspiration of air (seesaw respirations are not normal)
- When suctioning always suction mouth before nose (M before N)
at birth, transitions from intrauterine to extrauterine are essential and continue during the first
6-8 hours
transitions at birth are a predictable series of events, mediated by the
sympathetic nervous system
involving the heart rate, respiration, temperature, and GI function
transitions represent a time of
vulnerability requiring careful observation and timely intervention by the nurse
chemical respiratory transition/adaptation/integration
progressive - decrease in PO2 - increase PCO2 - decreased blood pH (respiratory center in medulla)
mechanical respiratory transition/adaptation/integration
compression increase intrathoracic pressure -> release of chest compression -> negative pressure -> drawing air in lungs
thermal respiratory transition/adaptation/integration
decreased environmental temp -> skin receptors -> respiratory center in medulla
sensory respiratory transition/adaptation/integration
handling, mouth and nose suctioning, and drying
impending respiratory problems
- Nasal flaring, grunting or retractions
- Crying
- RR <30 or >60
- Suprasternal/subclavicular retractions + stridor or gasping
- Acrocyanosis
- Seesaw or paradoxical respirations
- Skin flush or pale
- Extended posture
some of these are normal in the 1st hour, but should be assessed closely during that hour
shunt of blood from pulmonary artery to descending aorta bypassing the lungs
ductus arteriosus
- the fetal lungs do not function for respiratory gas exchange, so the ductus arteriosus created a circulatory pathway bypassing the lungs
- fetal PO2 increases from 27 mmHg (intrauterine) to 50 mmHg (extrauterine)
- ductus arteriosus constricts as a result increases O2 and prostaglandin E2 [PGE2]
- closes the Ductus arteriosus (can reopen in response to hypoxia, asphyxia, or prematurity)
valve opening allowing blood to flow directly from right to left atrium
foramen ovale
- Pulmonary pressure drops -> decrease in pressure of right atrium
- Increased pulmonary blood flow from the left side of heart increases pressure in the left atrium
- Closure of Foramen Ovale (for a few days, crying can reverse closure -> mild cyanosis)
connection of umbilical vein to inferior vena cava
shunt redirecting oxygen-rich blood into inferior vena cava bypassing liver
ductus venosus
- Umbilical vein and arteries constrict in response to cooler room temps + increased O2 from infant respirations
- Clamping + cutting cord
- Closure of Ductus venosus (within 2 hours)
*May hear a murmur until the ductus venosus completely closes
fetal circulation supplies the highest levels of oxygen and nutrients to the
head, neck, and arms
- which enhances the cephalocaudal (head-to-rump) development of the embryo/fetus
fetal circulation vs neonatal circulation
- As soon as the cord is clamped, the ductus venosus ceases to carry blood to the heart and it begins to constrict within the first few hours or days of life.
- The very first thing that happens when the fetus is born, is it takes its first breath, the lungs expand, and so the resistance, or pressure, in the lungs drop and that promotes blood flow into the lung itself
- The ductus arteriosus begins to constrict, and is typically fully closed within 24 to 48 hours of life, and blood is now then fully directed into the lung.
- As the blood returns to the left side of the heart after traversing the pulmonary circulation, picking up oxygen pressure, and left atrium rises just a bit, and the trap door of the foramen ovale, which was open before birth, now begins to close, usually within the first few days of life.
impending cardiac problems
- Persistent tachycardia
- Dyspnea
- Hypoxia
- Persistent bradycardia
- Skill pallor or cyanosis
- Jaundice
newborn temperature
97.7 - 98.9 F
thermoregulation
Ability to maintain balance heat loss vs heat production within first 12hrs after birth
homeotherms
can maintain a constant core body temperature regardless of environmental temperature
- newborns have a much narrower range than adults to which they can adapt without being stressed
shivering thermogenesis
not operable in the newborn (baby’s do not shiver)
heat production
non shivering thermogenesis
metabolism of brown fat to produce heat
- deposits of brown fat are present for several weeks after birth and are rapidly depleted with cold stress
- the less mature the infant, the less reserve of brown fat
body surface to cooler ambient air
convection (heat loss)
wrap newborn, keep nursery warm
body surface to cooler solid surface not in direct contact but in relative proximity
radiation (heat loss)
keep cribs away from windows
loss of heat when liquid is converted to a vapor
evaporation (dry infant directly after birth and bathing)
body surface to cooler surface in direct contact
conduction (heat loss)
warm crib when admitted to nursery, skin to skin contact with mother
thermoregulation in the newborn
anatomic and physiologic characteristics increase risks for hypo/hyperthermia
- > flex position helps guard against heat loss
- > larger body surface area relative to body weight (mass)
- > blood vessels closer to the skin (decrease in room temp -> temp of the blood -> temp regulation centers in the hypothalamus)
- > brown fat used for non-shivering thermogenesis
- > neutral thermal environment
impending thermoregulatory problems
- Increased muscle activity
- Crying
- Restlessness
- Cold skin
- Acrocyanosis
- Hypoglycemia
- Skin flushing or pale
- Extended posture
effects of cold stress in newborn
- Oxygen consumption increases as oxygen and energy are diverted from maintaining normal function and growth to thermogenesis for survival
- Respiratory rate increases because of demand for oxygen
- Vasoconstriction to ensure blood flow to vital organs jeopardizes pulmonary perfusion (may reopen shunt across the ductus arteriosus)
- BMR increases and may result in anaerobic glycolysis -> increased acid production
- PO2 and pH decrease
- Excess fatty acids displace the bilirubin from albumin-binding sites -> increased level of circulating unbound bilirubin that increases the risk of kernicterus
rare kind of preventable brain damage that can happen in newborns with jaundice
(bilirubin gets too high -> brain damage)
kernicterus
where conjugated bilirubin becomes unconjugated
the intestines
in the intestines, conjugated bilirubin becomes unconjugated and recirculates through the enterohepatic system which
increases serum bilirubin levels