Physiological and Behavioral responses of the neonate- 15 Flashcards
protect and support neonates by:
● Maintaining body heat.
● Maintaining respiratory function.
● Decreasing risk for infection.
● Assisting parents in providing appropriate nutrition and hydration.
● Assisting parents in learning to care for their newborn.
Two factors that negatively affect the transition to extrauterine respirations are:
● Decreased surfactant levels related to immature lungs.
● Persistent hypoxemia and acidosis that leads to constriction of the pulmonary arteries.
establishment of extrauterine respirations
Mechanical and chemical stimuli
initiated by compression of the thorax, which forces amniotic fluid from the lungs; lung expansion; increase in alveolar oxygen concentration; and vasodilatation of the pulmonary vessels.
Signs of Fetal Respiratory Distress
- Cyanosis
- Abnormal respiratory pattern such as apnea and tachypnea
- Retractions of the chest wall
- Grunting
- Flaring of nostrils
- Hypotonia
First breath
↑ alveolar oxygen tension (Pao2) and ↓ arterial pH → dilation of pulmonary arteries → ↓ pulmonary vascular resistance → ↑ blood flow through pulmonary vessels → ↑ oxygen and carbon dioxide exchange within the lungs
transition to neonatal circulation
The decrease in pulmonary vascular resistance causes an increase in pulmonary blood flow, and the increase in systemic vascular resistance influences the cardiovascular changes
ductus venosus
connects the umbilical vein to the inferior vena cava, closes by day 3 of life and becomes a ligament. Blood flow through the umbilical vein stops once the cord is clamped.
foramen ovale
an opening between the right atrium and the left atrium, closes when the left atrial pressure is higher than the right atrial pressure. Significant neonatal hypoxia can cause a reopening of the foramen ovale.
ductus arteriosus
connects the pulmonary artery with the descending aorta, usually closes within 15 hours postbirth. It will remain open when the lungs fail to expand or when Pao2 levels drop.
neutral thermal environment (NTE)
environment that maintains body temperature with minimal metabolic changes and/or oxygen consumption.
The neonate responds to cold by:
● An increase in metabolic rate.
● An increase of muscle activity.
● Peripheral vascular constriction.
● Metabolism of brown fat.
Brown adipose tissue (BAT) promotes
● An increase in metabolism.
● Heat production through intense lipid metabolic metabolism of BAT.
● Heat transfer to the peripheral system
Neonates are at higher risk for thermoregulatory problems related to:
● Higher body-surface-area-to-body-mass ratio.
● Higher metabolic rate.
● Limited and immature thermoregulatory abilities.
Factors that negatively affect thermoregulation are:
● Decreased subcutaneous fat.
● Decreased BAT in preterm neonates.
● Large body surface.
● Loss of body heat from evaporation, conduction, convection, and/or radiation
Evaporation
Loss of heat that occurs when water on the neonate’s skin is converted to vapors, such as during bathing or directly after birth
Conduction
Transfer of heat to cooler surface by direct skin contact, such as cold hands of caregivers or cold equipment
Convection
Loss of heat from the neonate’s warm body surface to cooler air currents, such as air conditioners or oxygen masks
Radiation
Transfer of heat from the neonate to cooler objects that are not in direct contact with the neonate, such as cold walls of the isolette or cold equipment near the neonate
Possible consequences of cold stress are:
● Hypoglycemia.
● Metabolic acidosis.
● Decreased surfactant production.
● Respiratory distress that can lead to neonatal death.
● Hypoxemia.
● Increased indirect bilirubin.
● Delayed transition from fetal to neonatal circulation.
● Weight loss.
Cold stress s/s
● Axillary temperature at or below 36.5°C (97.7°F)
● Cool skin
● Lethargy
● Pallor
● Tachypnea
● Grunting
● Hypoglycemia
● Hypotonia
● Jitteriness
● Weak suck
Hypoglycemia
Hypoglycemia is defined as a blood glucose level below 40 mg/dL in the neonate.
Risks for Hypoglycemia
- Neonates of diabetic mothers
- Neonates weighing more than 4,000 g or large for gestational age
- Post-term neonates
- Preterm neonates
- Small-for-gestational-age neonates
- Hypothermia
- Neonatal infection
- Respiratory distress
- Neonatal resuscitation
- Birth trauma
hypoglycemia s/s
- Jitteriness
- Hypotonia
- Irritability
- Apnea
- Lethargy
- Temperature instability
Functions of the liver
●carb metabolism ●amino acid metabolism ●lipid metabolism ●synthesis of plasma proteins ●blood coagulations- vit k given ●conjugation of bilirubin ●phagocytosis by kupffer cells ●storage of fat soluble vitamins ●detoxification