Newborn Adaptations (Respiratory)

Question 1

How does clamping the cord inhbit (to prohibit from doing something) respirations?

Answer 1

Another chemical factor may also play a role: it is thought that, as a result of clamping the cord, there is a drop in levels of a prostaglandin that can inhibit respirations.

Question 2

During the first breaths what must be retained? Why?

Answer 2

With the first breaths, some air must be retained in the alveoli so subsequent breaths are easier

Question 3

How long does the first phase of transition last for?

Answer 3

The first phase of the transition period lasts up to 30 minutes after birth and is called the first period of reactivity

Question 4

What does the transition period represent?

Answer 4

This transition period represents a time of vulnerability for the newborn and warrants careful observation by nurses. To detect disorders in adaptation soon after birth, nurses must be aware of normal features of the transition period

Question 5

What is acrocyanosis?

Answer 5

Acrocyanosis, the bluish discoloration of hands and feet, is a normal finding in the first 7 to 10 days after birth.

Question 6

What is a late sign of respiratory distress in newborns? What is a result of?

Answer 6

*Centeral Cyanosis signifies hypoxemia (low levels of O2 in the blood)

central cyanosis the lips and mucous membranes are bluish. It can be the result of inadequate delivery of oxygen to the alveoli, poor perfusion of the lungs that inhibits gas exchange, or cardiac dysfunction. Because central cyanosis is a late sign of distress, newborns usually have significant hypoxemia when cyanosis appears.

Question 7

After the first period of reactivity, the newborn either sleeps or has a marked decrease in motor activity, what is this refered to as?

Answer 7

The period of decreased responsiveness

Question 8

What are the 4 respiratory system adaptations that help respirations begin?

Answer 8

1.) Chemical
2.) Mechanical
3.) Thermal
4.) Sensory

Question 9

How do mechanical factors help respirations begin? (2 main things)

Answer 9

1.) Respirations in the newborn can be stimulated by changes in intrathoracic pressure resulting from compression of the chest during vaginal birth.

1.5) As the fetus passes through the birth canal, the chest is compressed. With birth this pressure on the chest is released, and the negative Intrathoracic pressure helps draw air into the lungs.

2.) Crying increases the distribution of air in the lungs and promotes expansion of the alveoli. The positive pressure created by crying helps to keep the alveoli open.

Question 10

What can tachypena in newborns be a result from?

Answer 10

Tachypnea can result from inadequate clearance of lung fluid, or it can be an indication of newborn respiratory distress syndrome (RDS).

Question 11

Characteristics of normal newborn respirations?

Answer 11

1.) Shallow and irregular
2.) 30-60 breaths/min
3.) Respiratory rate increases with activity
4.) Periodic breathing includes pauses lasting less than 20 seconds

Question 12

Before the onset of labour, what apperars to promote fluid clearnce from the lungs?

Answer 12

Catecholamine Surge

-Shortly before the onset of labour there is a catecholamine surge that appears to promote fluid clearance from the lungs, which continues during labour. The movement of lung fluid from the air spaces takes place through active transport into the interstitium, with drainage occurring through the pulmonary circulation and lymphatic system

Question 13

In newborns in the lungs what must be replaced?

Answer 13

Liquid must be replaced with an equal volume of air

Question 14

When does the “second stag of reactivity” occur? How long does it last for?

Answer 14

occurs roughly between 2 and 8 hours after birth and lasts from 10 minutes to several hours

Question 15

Characteristics of the “period of decresed responsiveness?
(How long does it last for? resperations characteristics? Bowel sounds? Abdomen characteristics?)

Answer 15

usually lasts from 60 to 100 minutes. During this time the newborn is pink and respirations may be rapid and shallow (up to 60 breaths/min) but not laboured. Bowel sounds are audible, and peristaltic waves may be noted over the rounded abdomen.

Question 16

uring the first phase of transition, how alert will the newborn be? are bowel sounds audible? will meconium be passed?

Answer 16

The newborn is alert and may have spontaneous startles, tremors, crying, and movement of the head from side to side. Bowel sounds are audible, and meconium may be passed

Question 17

Characteristics of the “second stage of reactivity”?

(HR, Muscle tone, Meconium,)

Answer 17

Brief periods of tachycardia and tachypnea occur, associated with increased muscle tone, skin colour changes, and mucus production. Meconium is commonly passed during this phase. Most healthy newborns experience this transition regardless of type of birth. Physiological immaturity prevents this in very preterm newborns.

Question 18

How do thermal factors help respirations begin?

Answer 18

*With birth the newborn enters the extrauterine environment, in which the temperature is significantly lower.

1.) Exposure to the profound change in environmental temperature stimulates receptors in the skin, resulting in stimulation of the respiratory centre in the medulla.

*Cold stress may be important for initializing breathing, but prolonged exposure should be avoided.

Question 19

In very preterm babys, what prevents the second period of reactivity? Why?

Answer 19

Physiological immaturity prevents this in very preterm newborns.

Question 20

During the first stage of transition what is the fetuses HR, respirations, like?

Answer 20

The newborn’s heart rate increases rapidly to 160 to 180 beats per minute (bpm) but gradually falls by 30 minutes of age to a baseline rate between 100 and 160bpm. Respirations may be irregular, with variation in the rate between 60 and 80 breaths/min. Fine crackles may be present on auscultation; audible grunting, nasal flaring, and retractions of the chest may also be noted, but these should resolve within the first hour of birth

Question 21

How do Type 2 cells decease surface tension?

Answer 21

Subsequently, with lower surface tension the pressure required to keep the alveoli open with inspiration is reduced, which prevents total alveolar collapse on exhalation, thereby maintaining alveolar stability

Question 22

What must the first breaths be strong enough to move/do?

Answer 22

Lung expansion and first breaths must be strong enough to move fluids that fill the fetal airway from the trachea to the terminal air sacs

Question 23

What type of alveoli cells produce surfactant?

Answer 23

The type II cells make and produce surfactant, a group of phospholipids that reduce the alveolar surface tension.

Question 24

How do chemical factors begin respirations? (4 things)

Answer 24

1.) The activation of chemoreceptors in the carotid arteries and aorta results from the relative state of hypoxia associated with labour.

2.) there appears to be a cumulative effect that results in progressive decline in Po2, increased Pco2, and lowered blood pH.

3.) Decreased levels of oxygen and increased levels of carbon dioxide are involved in initiating newborn breathing by stimulating the respiratory centre in the medulla.

4.) Another chemical factor may also play a role: it is thought that, as a result of clamping the cord, there is a drop in levels of a prostaglandin that can inhibit respirations.

Question 25

What is functional residual capacity?

Answer 25

Functional residual capacity (i.e., air remaining in the lungs at the end of expiration), must be established

Question 26

When is fetal lung maturity determined?

Answer 26

Fetal lung maturity can be determined via amniocentesis after the 35th week, i.e., analysis of amniotic fluid; lecithin-to-sphingomyelin ratio

Question 27

When do teh major adaptations that are associated with transition from intrauterine to extrauterine occur?

Answer 27

The major adaptations associated with transition from intrauterine to extrauterine life occur during the first 6 to 8 hours after birth.

Question 28

What does “surfactant” allow alveoli to do?

Answer 28

Surfactant allows alveoli to remain open instead of collapsing completely during exhalation and provide the lungs stability needed for gas exchange

Question 29

How does breathing occur/work during utero?

Answer 29

. In utero, fetal blood was shunted away from the lungs, but when birth occurs the pulmonary vasculature must be fully perfused for this purpose

Question 30

How is breathing initiated after delivery?

Answer 30

Clamping the umbilical cord causes a rise in blood pressure (BP), which increases circulation and lung perfusion.

Question 31

What respiratory issue commonly occurs in infants who are delived via C-section? Why? How long does it take for it to usally resolve?

Answer 31

transient tachypnea of the newborn (TTNB) (fluid retention in the lungs) caused by the lower levels of catecholamines . TTNB usually resolves in 24 to 48 hours.

Question 32

What can be the first sign of respiratory, cardiac, metabolic, or infectious illnesses?

Answer 32

Tachypena

Question 33

What triggers repirations in a newborn after delivery?

Answer 33

It has been recognized that there is no single trigger for newborn respiratory function. The initiation of respirations in the newborn is the result of a combination of chemical, mechanical, thermal, and sensory factors.