Chapter 25- Physiological Newborn Adaptations Flashcards
14 Questions on exam (and chapter 26)
How long is the neonate period?
Birth to 28 days
What are the 3 stages of the newborn transition period?
1) INITIAL Period of REACTIVITY
2) Period of Relative INACTIVITY
3) SECOND Period of REACTIVITY
What are the physiological changes that occur to the newborn for a successful transition?
– Spontaneous breathing
– Thermoregulation
– Successful Cardiopulmonary changes
– Independent system functioning including
Ingesting,
Retaining,
Digesting,
Eliminating waste,
Regulating weight
How long does the transition period last in a newborn?
The transition lasts about 6-8 hours
What Physiological Changes occur in the newborn in the Initial Period of Reactivity?
- HR of 160-180 bpm
- Irregular RR 60-80 breaths/min with crackles, grunting, nasal flaring, and retractions
- Alert, spontaneous startles, tremors, crying, head side to side
- Audible bowel sounds and possible meconium
How long does the Initial Period of Reactivity last?
Occurs within 30 minutes of birth
What Physiological Changes occur in the newborn in the Period of Relative Inactivity?
- Sleep and Decreased motor activity
- Pink colour
- RR rapid and shallow, 60 breaths/min; NOT laboured
- Audible bowel sounds; may note peristaltic waves over abdomen
How long does the Period of Relative Inactivity last?
Occurs 60-100 mins post birth
What physiological changes occur in the newborn in the Second Period of Reactivity?
- Brief periods of Tachycardia and Tachypnea due to increased muscle tone
- Skin colour changes
- Mucous production (higher in C-section babies)
- Passing Meconium
How long does the Second Period of Reactivity last?
Occurs 2-8 hours after birth, lasting 10 mins-several hours
What is the Average Time window for newborns to pass Meconium?
Within 24 hours of birth. Most pass Meconium by 48 hours of life.
Signs of Respiratory Distress in newborn
- Intracoastal and subcostal Retractions
- Central Cyanosis
- Pallor (acrocyanosis is normal)
- <30 or >60 breaths/min
- Apnea
- Nasal flaring, grunting
Notable in the first 2 hours after birth, should not last longer
What is Transient Tachypnea of the newborn?
It is caused by a delay in the clearance of fetal lung fluid after birth, which leads to ineffective gas exchange, respiratory distress, and tachypnea.
What is the significance of Transient Tachypnea in C-section babies?
When labour does not occur before birth (c section babies) the catecholamine surge that promotes lung fluid clearance is not effective and therefore they have more fluid retention. They are also not squeezed through the vaginal canal which would cause them to retain more mucous.
What changes occur to the Ductus Arteriosus after birth?
Prostaglandin aids in its closure. Functionally closed after birth, permanent closure 3-4 weeks after and then it becomes a ligament. Can open in response to low oxygen levels. Can be detected as a heart murmur upon auscultation.
What changes occur to the Foramen Ovale after birth?
Functionally closed after birth caused by pulmonary blood flow from the left side of the heart increasing pressure in the left atrium. Crying may temporarily reverse flow through the foramen and can cause mild cyanosis.
At what point is a newborn checked for Congenital Heart Disease?
At 24 hours of age.
What is the average Heart Rate of a newborn after birth?
- HR is 110-160 bpm, increasing with crying and decreased during sleep
What is the average Blood Pressure of a newborn after birth?
- BP is (60-80 sbp/40-50 dbp)
What are Cardiac Signs of Distress in a newborn?
- Persistent tachy/bradycardia
- Unequal or absent pulse
- Bounding pulse
- Hypertension or hypotension
- Prolonged Cyanosis or Pallor
What are positive effects of Delayed cord clamping (DCC)?
Expands blood volume, increasing BP and lowering the chance of intraventricular hemorrhage and necrotizing enterocolitis
Are Red Blood Cell levels higher or lower in a newborn? Why?
Born with increased levels of RBCs at birth to compensate for poor fetal circulation.
What is Polycythemia?
Increase in hematocrit levels in preterm newborns. Causes the blood to be thicker.
Can occur because of DCC, maternal hypertension, diabetes, intrauterine growth restriction
What is Neutrophilia?
High neutrophil count which can be a sign of a underlying condition such as infection or inflammation. Leukocytes are slow to recognize and fight infection in early life.
What is a Direct Antibody Test (DAT)?
Used to detect antibodies present in newborns blood. DAT tests for evidence of a reaction between the mother’s and baby’s blood groups. Samples obtained through cord blood. Can detect conditions such as anemia and jaundice.
What newborn Temperature reading indicates need for Increase Warming Interventions?
<36.5 degrees Celsius
Warm slowly to avoid shock