1 / 45

Newborn Adaptation to Extrauterine Life

Newborn Adaptation to Extrauterine Life. A systemic approach to life in this world~. The Lungs. The most important vital organ that needs to be adequately functional in the neonate Largely dependent on maturation of the fetus Website on fetal lung development. Fetal maturation:.

benaverill
Download Presentation

Newborn Adaptation to Extrauterine Life

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Newborn Adaptation to Extrauterine Life A systemic approach to life in this world~

  2. The Lungs • The most important vital organ that needs to be adequately functional in the neonate • Largely dependent on maturation of the fetus • Website on fetal lung development

  3. Fetal maturation: • 20-24 wks - alveolar ducts appear • 24-28 wks - alveoli remain primitive • 28-32 wks - type II (surfactant producing) cells increase • 35 wks - Lecithin production peaks

  4. phospholipid lung cell maturity (PI) lowers surface tension (PG) increased lung compliance L/S Ratios Lecithin (increases) Sphingomyelin (constant) <30 wks = low L/S 30-32 wks - L/S = 1:1 >35 wks - L/S = 2:1 Role of Surfactant

  5. Adaptation at birth-factors that foster that initial breath • Mechanical– “Vaginal squeeze” is followed by chest recoil after birth. • Chemical –Transient asphyxia at birth results in * decreased pO2* decreased pH as low as 7.25* increased pCO2These changes stimulate chemoreceptors around the aorta and carotid which tells the respiratory center in the medulla to start breathing

  6. Adaptation (cont’d) • Temperature—The drop in temperature from a cozy 98.6 to 65-70 F. stimulates the neonate’s CNS to breathe. • Sensory stimuli– all 5 senses are brought to life in the delivery room*Noise in the delivery room*Bright lights in the delivery room*Tactile stimulation– drying off the baby, stroking and caressing by parents, etc.*Smells in the delivery room*Taste when bulb syringe or gloved hand is introduced into mouth, & when mom nurses the first time.

  7. Assessment Parameters--Respiratory System • Quality of respirations-- 30-60/min. • gasping, irregular, shallow breathing is normal at first • periodic breathing is typical • true apnea= >20 sec. without breathing is abnormal • “wet” lungs– common in the first 5 minutes of life; if persistent, may require a 5 fr. Feeding tube, or, rarely DeLee suctioning.

  8. Assessment Parameters--Respiratory System(cont’d) • Obligate nose breathers • Retractions– abdomen & chest wall should rise simultaneously. “Seesaw” movements and expiratory grunting are ominous signs requiring intervention.

  9. Oxygen Transport (p. 655-6; 10th ed). • 2 types of Hemoglobin in fetus & newborn: • Fetal Hgb: HbF—70-90%. Has  O2 affinity which means if facilitates O2 transfer across the placenta and into newborn’s tissues. • Fetal PaO2—30-40mm Hg. • Fetal Hgb level—17 g/dL—allows fetus to tolerate relatively low PaO2 in utero, because the absolute O2-carrying capacity of the blood is > adult Hgb. • Adult Hgb: HbA has  O2 affinity but O2 release. HbA of 13 g/dL in adult has lower O2-carrying capacity.

  10. The Heart~ Cardiovascular Adaption • The heart goes through a series of changes: • increased aortic pressure and decreased venous pressure 2ndary to clamping the umbilical cord • increased systemic pressure and decreased pulmonary artery pressure with initiation of respirations and loss of placenta

  11. closure of the ductus venosus--fetal structure from umbilical vein to inferior vena cava carrying O2 from the placenta • closure of foramen ovale--fetal structure that connects the right atrium with the left atrium further allowing right to left shunting during fetal life. • closure of the ductus arteriosus-- fetal structure connecting the pulmonary artery with the aorta allowing right to left shunting during fetal life

  12. Fetal Circulation—video of changes beforeand after birth • Note:the Umbilical Vein carries oxygenated blood from the mother to the inferior vena cava where it mixes with unoxygenated blood from the body. This mixed blood travels through the heart and to the body oxygenating all fetal cells. The unoxygenated blood returns to the mother via the umbilical arteries.

  13. Do you hear a MURMUR? • Occur in 37% of all newborns • 90% are transient due to delayed closure of ducts (PDA &/or PFO) • These types usually disappear by 6 months of age

  14. Vital Sign Averages • Birth weight: 6-9 lbs. 2500-4000g.(wt. Loss of 5-10% of birth wt.in 1st 3-4 days is expected. Should regain birth weight by 2 week check-up.) • Length: 18-21 in. (45-52.5cm) • Head Circumference: 13-14 in.(33-35cm) • Chest Circumference:12-13 in. (30-33cm)should be ~2-3cm. < head circumference • Blood Pressure: ave. 78/42 (less for premie, more if crying. * Cause for concern: Diastolic <25 or >60

  15. Vital Sign Averages (cont’d) • Pulse: 110-160 bpm. Assess apically for 30 sec. 180 if crying 100 if sleeping • Temp: Rectal: 36.6 – 37.2 C 97.8 - 99 F Axillary: 36.5 – 37.0C 97.7 – 98.6FIf axillary temp is <36.5C, you recheck the other axilla. If it remains low, take babe out and do ‘skin-to-skin’ or double-wrap infant with hat on and recheck temp in 1 hour. If still low, place child in radiant warmer for 30 minutes and recheck temp.Temp rechecks can be done axillary. • Respirations: 30-60/min. Assess for 1 full minute.

  16. Newborns & Heat Loss • Factors that predispose a newborn to heat loss • Large surface area (especially head!) • Limited ability to control their metabolic rate • Blood vessels of the newborn are closer to the skin than adults • Decreased insulation due to less fat • It is essential to maintain a neutral thermal environment (NTE) to minimize O2 consumption. • NTE range for naked newborn~ 32-34C (89.6-93.2F) • NTE range for adults~ 26-28C (78.8-82.4F)

  17. Temperature Decrease (Hypothermia) Anaerobic Glycolysis pO2 and  pH Pulmonary Vasoconstriction Respiratory Rate

  18. Heat Production • Vasomotor control—constriction of peripheral vessels manifested as acrocyanosis • ”Non-shivering thermogenesis”– primarily occurs through “brown fat” metabolism. Brown fat cells are larger than white fat cells & are easily broken down to produce heat.

  19. Heat Production (cont’d) • Shivering- late sign of hypothermia. Indicates that metabolic rate has doubled, increased O2 consumption, increased motor activity that ultimately leads to heat production • Insulation- 11-17% of total body wt. of term neonates. Appears after 32 weeks gestation.

  20. Heat Loss • evaporation - water to vapor • radiation - body to cold object • conduction - direct skin contact • convection - body to cooler air

  21. GOAL:Keep baby in a neutral thermal environment: where the baby's metabolic rate, and therefore O2 consumption, is minimal, but the body temperature remains within the normal range.

  22. The Liver: Hepatic Functions • Conjugates bilirubin • Stores fetal iron • Stores liver glycogen for energy • coagulation

  23. Physiologic Jaundice • Why does this happen? • immature liver cannot conjugate bilirubin • increased breakdown of RBC’s (normal Hct - 55%, RBC's = 5-7 million/ul, Hgb = 15-20g/dl) • decreased clearance of bilirubin by liver due to inhibition of glucuronyl transferase = less conjugated bilirubin • reabsorption of bilirubin stuck in the intestines • obstruction or delayed meconium • hypoxia/CHD raise bilirubin levels • infection delays bilirubin excretion

  24. Common symptoms of jaundice • Yellowish tinge to skin or sclera of eyes • Test by blanching skin on bony prominence as forehead, or sternum

  25. Treatment of Physiologic Jaundice • Phototherapy – Bililights overhead in hospital settingQuartz high intensity lights in hospitalWallaby blanket wrapped around infant at home • Frequent feedingsto expel meconium more quickly from intestines

  26. Coagulation & Vitamin K • The absence of normal flora in newborn gut needed to synthesize Vitamin K results in low Vitamin K levels until 5th day of life • every newborn gets injected with Vit. K (AQUA MEPHYTON or PHYTONADIONE) to prevent bleeding problems.

  27. Coagulation & Vitamin K • Dose: • 1mg (0.5ml) IM >1500 gm • 0.5mg(0.25ml)IM<1500 gm

  28. GI Adaptation - COOL facts... • BEFORE BIRTH, baby has already swallowed and peristalsis begins • stomach holds 50-60 ml (2 ounces) • GI tract mature 36-38 wks gestation • By 24 hours, the intestines are air filled • Saliva is hardly produced until 3 months • Babies regurgitate due to immature sphincter • Newborns lose 5-10% body wt. in 5-10 day • insensible water loss & low caloric intake

  29. POOP! • Meconium • Transitional • Fecal • Breastfed

  30. Urinary Adaption • Kidneys mature by 35 wks gestation • Limited ability to dispose of excess fluid • Most void immediately after birth • First 2 days: 2-6 times/day • After that: 5-25 times/day!!!!

  31. Cool facts... • first void is cloudy due to mucous • “brick dust” urine- noted in diaper from urates (uric acid crystals)— may indicate dehydration • Pseudomenstruation =Vaginaldischarge noted as blood in diaper

  32. Neuromuscular Status Examples of neonatal reflexes

  33. Reactivity States in the Newborn • First period of reactivity - first 40 min. Baby is alert,responsive, eager to explore the world • Sleep period - 1-3 hours after birth. May continue for 3-6 hrs. Baby is in a deep sleep, difficult to arouse. Resp. rate & heart rate decrease. • Second period of reactivity – 3-6 hours after birth. Baby is awake, respirations are rapid, irregular, and may have periods of apnea. May cough and regurg mucus, etc. Keep bulb syringe handy. Heart rate again increases.

  34. Brazelton’sNBAS Each baby is born with their own traits and personality. This scale helps parents identify and get to know what is special and unique about their newborn. Temperament 1.) easy child 2.) slow-to-warm-up child 3.) difficult child

  35. Habituation Orientation Motor maturity Variation Self-quieting Social behaviors 6 categories of the NBAS Read about each of these in your OB text-- Pp.693-4 (10th ed). Link from March of Dimes

  36. Brazelton’s Infant States • SLEEP states • Deep or quiet • Active REM-light • ALERT states • drowsy • quiet alert (wide awake) • active alert • crying Know the characteristics of these states and when is the BEST time for interaction with the neonate!! Pp.926-7 (10th ed).

  37. What to Teach Parents

  38. Newborn Screening One little heel stick tests for... • Congenital hypothroidism • Galactosemia—what implications does a positive result have for breastfeeding moms? • Maple syrup urine disease-- • PKU – Phenylketonuria—why does baby have to be at least 24 hours old for this test? • Hemoglobinopathies • Sickle Cell Anemia • Thalessemia

  39. Homocysteinuria • Cystic Fibrosis (new screening) • Congenital Adrenal Hyperplasia • Biotidinase Deficiency • More info at this link for IDPH rules • March of Dimes link

  40. Newborn SAFETY • Bathing your baby--video • Positioning— “Back to Sleep” • Car seat rules—from the AAP, here are all the recommendations for car seats for parents. Remember that NO BABY leaves the nursery without being in a car seat. • CPR instruction—Here is a review of infant CPR with a quick quiz, if you need a review!  • Immunization schedule—2016 Schedule

  41. Fetal Development in utero

  42. Fetal Development Continuum

  43. That’s it!! Aren’t babies a miracle??

More Related