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Transition and Stabilization of the Newborn

Transition and Stabilization of the Newborn. Letha Nix RNC. How long should it take to transition from intrauterine life to extrauterine life? A.) 1-2 hours B.) 2-3 hours C.) 3-6 hours D.) 6-12 hours. D.) 6-12 hours A newborn can take up to 12 hours to

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Transition and Stabilization of the Newborn

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  1. Transition and Stabilization of the Newborn Letha Nix RNC

  2. How long should it take to transition from intrauterine life to extrauterine life? A.) 1-2 hours B.) 2-3 hours C.) 3-6 hours D.) 6-12 hours

  3. D.) 6-12 hours A newborn can take up to 12 hours to transition from placental support to extrauterine support.

  4. Definition • Transition is a process of physiologic change in the newborn infant that begins in utero as the child prepares for transition from intrauterine placental support to extrauterine self-maintenance.

  5. Objectives • Identify primary features of fetal and newborn circulation. • Identify physiologic changes during transition to extrauterine life. • Identify routine care considerations for a newborn during the transition period. • Identify signs and symptoms of common problems during transition period. • Discuss methods for parental support.

  6. Transition begins before delivery Depending on…. • Gestational age • placenta health/condition • maternal health • Any limitations to major organs • physical defects/anomalies

  7. Transitional begins before delivery The infant prepares by… • Fetal breathing (producing surfactant at 34 weeks) • storing glycogen in the liver • producing catecholamines • depositing brown fat

  8. Transition begins before delivery During Labor… • placenta • stress hormones

  9. Review: Placental Circulation • Exchanges O2 and CO2 by simple diffusion • Eliminates waste products • Does the work of the lungs in utero • Uterine venous blood has PCO2=38 mmHg PO2=40-50 mmHg pH=7.36

  10. Review: Fetal Circulation • One Umbilical Vein-oxygenated blood • Two Umbilical Arteries-deoxygenated blood • Three Fetal Shunts… • Ductus Venosus- hepatic system • Foramen Ovale- between right & left atrium • Ductus Arteriosus- vein connects pulmonary artery to descending aorta

  11. Fetal Circulation Foramen Ovale • Shunt • Right atrium • Left atrium • Right Ventricle

  12. Fetal Circulation Ductus Arteriosus • Shunt • Unsaturated blood • Pulmonary Artery • Aorta

  13. Fetal Circulation Fetal Lungs • Fluid filled • Resistant • Nourishment

  14. Fetal Circulation • Systemic Vascular Resistance • Pulmonary Vascular Resistance • Pulmonary Arterioles Resistant

  15. Transition to Extrauterine Life begins when the cord is CUT. • Placenta no longer works as lungs • Lungs begin to exchange gases • First breath inflates lungs and causes circulatory changes • Lungs inflate -  resistance to blood flow through lungs &  blood flow from pulmonary arteries • This results in Newborn Circulation.

  16. Newborn Circulation Umbilical cord is clamped • Placenta is separated •  systemic blood pressure • Three major shunts close

  17. Newborn Circulation • Circulatory Changes • Fetus separation mother/placenta • Lungs begin to function • First breath

  18. Newborn Circulation • Lung fluid cleared • Lungs fill with O2 • Systemic vascular resistance increases • Initiation of respiration • Pulmonary arterioles •  Pulmonary Vascular Resistance •  Pulmonary Blood flow

  19. Newborn Circulation • Blood flow resistance • Blood flows through pulmonary arteries • Foramen ovale closes • Blood pressure increases

  20. Newborn Circulation • Left atrial pressure  • Right atrial pressure  • Foramen functional closure • Ductus arteriosus

  21. Newborn Circulation • Postnatal • Right Atrium, SVC, IVC • Poorly oxygenated blood • Right ventricle, pulmonary artery, pulmonary circulation • Oxygenated blood • Left atrium, pulmonary veins • Left ventricle, aorta, systemic circulation

  22. Physiologic Changes During Transition • Cardiovascular • Respiratory • Hematologic • Gastrointestinal • Renal • Immunologic

  23. Considerations For Newborns in Transition Period History… • Maternal…Medications Illness • Labor and Delivery… Fetal Distress Delivery Complications Types Delivery • Resuscitation Measures

  24. Assessment • Vital Signs • Measurements • Gestational Age Assessment • Head to Toe Exam • Glucose/Feeding

  25. Assessment-continued Normal head to toe assessment findings for infant in transition • Skin • Head • Respirations/Breath Sounds • Heart Sounds • Intestines • Urine • Extremities

  26. Thermoregulation • normal ranges 97.7F - 98.6F • results of cold stress:  O2 consumption & use of glucose stores • radiant warmer/isolette • bathing

  27. Medications • 0.5% Erythromycin eye ointment • give within 1 hr of birth! • Vitamin K (phytonadione) • give within 1 hr of birth! • Hepatitis B vaccine & Hepatitis B immunoglobulin (HBIG) • give within 12 hrs if mom + or unknown • vaccine only at d/c if negative

  28. Glucose Needs & Feeding • Delivery stress  conversion of fats and glycogen to glucose for energy • At 1-2 hours of age glucose level falls • Baseline glucose 30 mins-1 hr of age • Goal-Glucose level > 40 ml/dl on first day >40-50 ml/dl thereafter

  29. Glucose Needs & Feeding-continued • Risk Factors for Hypoglycemia • Asphyxia • Cold stress •  work of breathing • Sepsis • Premature or SGA • Infants of mother with diabetes or gestational diabetics • LGA babies

  30. Glucose Needs & Feeding-continued • S/S of Hypoglycemia • Treatment of Hypoglycemia • Feed early on demand in first hour • Evaluation before feeding • Contraindication before nipple/breast feeding • Contraindications to gavage feeding • Guidelines for feeding • Indication for IV glucose infusion

  31. Recognition of the Sick Newborn • Perinatal History • Physical Assessment • Skin • Respiratory • Cardiovascular • Central Nervous System • Morphologic Features • GI Tract

  32. Tools Used to Diagnosis? With MD order of course!!!

  33. Common Problems Seen In Transition • Birth Trauma • Birth Asphyxia • Pulmonary • Cardiovascular • Hemodynamics • Metabolic Problems • Infection • Congenital Anomalies

  34. Stabilization of the Transitioning Newborn Use Mnemonics! • S = Sugar • T = Temperature • A = Artificial Breathing • B = Blood Pressure • L = Labs • E = Emotional Support for the Family

  35. Parental Support • Before Delivery • At Delivery • During Transition • Transfers

  36. Review • Transition period can last 6-12 hours • Three phases of transition • Phase One- “Period of Reactivity” 1-2 Hours • Phase Two- “Sleep Period” 1-4 Hours • Phase Three- “Second Period of Reactivity” 2-8 Hours

  37. Any Questions ?

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