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Transition and Normal Newborn Care

Transition and Normal Newborn Care. Monica L. Scrudder, RNC-NIC, BSN, MSN Franciscan Health System Regional Nurse Educator, Nursery Services. Objectives. Identify primary features of fetal circulation.

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Transition and Normal Newborn Care

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  1. Transition and Normal Newborn Care Monica L. Scrudder, RNC-NIC, BSN, MSN Franciscan Health System Regional Nurse Educator, Nursery Services

  2. Objectives • Identify primary features of fetal circulation. • Identify physiological changes that occur at birth in the newborn’s transition to extrauterine homeostasis. • Identify routine care for the newborn in the transition period. • Identify signs and symptoms of common problems in the transition period. • Identify nursing intervention that promote parental bonding.

  3. What Is Transition???

  4. The Transition Period • Birth to 6 hours of age • Physiological change from placental support to self-maintenance • Fetus prepares for transition over the course of gestation • Transition depends on gestational age and quality of placental support

  5. The Cardiac Puzzle

  6. Anatomy and Physiology • Placental Fetal Circulation • Blood follows the path of least resistance • Low pulmonary blood flow (only 8-10% of right ventricular output secondary to high pulmonary vascular resistance

  7. The Fetal Circulation

  8. Ductus Venosus

  9. Foramen Ovale

  10. Ductus Arteriosis

  11. Fetal Lungs

  12. Fetal Metabolism and Hematology Glucose Fetal concentrations 70-80% of maternal glucose concentrations Glycogen Large glycogen stores provide large energy reserves to sustain newborn through transition period Brown Fat Unique to newborn Metabolized for heat

  13. Cardiopulmonary Adaptation at Birth

  14. Cardiovascular Adaptations At Birth • Umbilical cord is clamped. • Three major shunts functionally close during transition • Ductus Arteriosis • Foramen Ovale • Ductus Venosus

  15. Pulmonary Adaptation At Birth • Stimuli for initiating respiration • Mild hypercapnia, hypoxia and acidosis • Light, noise, touch • Thoracic squeeze during vaginal delivery • Empties approximately 1/3 of fetal lung fluid

  16. First Breath • Air enters lungs at 2x normal pressure • 40-80 cm H2O • Pulmonary vessels vasodilate in response to increased oxygen • Pulmonary vascular resistance decreases • Pulmonary blood flow increases

  17. Continued Pulmonary Adaptations • Pulmonary vascular resistance (PVR) decreases to reach adult levels at 2-3 weeks of age • Lung compliance improves

  18. Measurements • Apgar score • Done at 1 minute and 5 minutes of age • If apgar less than 7 at 5 minutes of age, continue every 5 minutes until greater than 7 for maximum of 20 minutes

  19. The Apgar Score

  20. Assessment Findings During Transition • Head circumference, length, weight • Gestational age assessment • Skin • Head • Respiratory assessment • Cardiac assessment • Gastrointestinal assessment • Extremities

  21. Medications in Transition • Erythromycin Ointment • Vitamin K (AquaMEPHYTON) • Hepatitis B vaccine/Hepatitis B Immunoglobulin

  22. Glucose Needs

  23. Feeding

  24. Contraindications to Feeding • Cyanosis • Shock or asphyxia • Increased work of breathing • Ongoing oxygen requirement

  25. Routine Care Considerations

  26. AAP/ACOG/AWHONN Guidelines • Proper identification of newborn • Initial assessment within 2 hours of birth • Develop a plan of care • Document observations at least every 30 minutes until stable for 2 hours • Prophylactic eye care within 1 hour of birth • Primary health care provider • Perform initial physical exam no later than 24 hours of birth • Perform physical exam within 24 hours before discharge • Document daily weight • Perform metabolic screening • Instruct parent in care of infant

  27. Guidelines (Cont) • Implement emergency measures, including resuscitation, when necessary using such programs as the Neonatal Resuscitation Program • Observe parent-infant interactions • Identify with parent(s) the appropriate facility for follow-up • Inform parent(s) of importance of immunizations • Identify high-risk mothers • Evaluate home environment

  28. Nursing Considerations • Observations must be documented every 2 hours according to the State of Washington. • Follow hospital policy regarding this guideline. • Vital sign routine • Daily weight • Physician notification • Timing of metabolic screening • Specific teaching issues for population

  29. Nursing Observations • Cardiac and Respiratory Status • Feeding • Temperature • Color • Tone • Activity • Output • Parent-infant bonding

  30. Parent-Infant Bonding • Bonding • Attachment • “En face” • “Parentese” • Red Flags

  31. Assess Parenting Styles and Abilities • Parents’ level of knowledge • Family’s communication • Parental expectations • Infant’s responses to parenting activities • Parental feelings about self and infant • Parental support • Cultural beliefs • Potential need for referral

  32. Routine Care and Documentation • Documentation of birth • Measurements • Medications • Physical assessment • Abduction prevention • Bathing/Hygiene • Cord Care • Feeding assessment • Metabolic screening • Elimination

  33. Discharge Criteria • Feedings • Discharge weight • Metabolic screening • Birth certificate worksheet/paternity papers • Teaching documented • Hearing screening

  34. Discharge Teaching • Begins on admission • Assess Mother’s readiness to learn • Assess Father’s involvement • Involve Grandparents, siblings, and other significant people

  35. Teaching Documentation • Thermoregulation • Holding and Positioning • Hygiene • Feeding • Bulb syringe • Choking • Elimination • Circumcision Care • Safety • When to Call the Physician

  36. References • Askin, DF. (2002) Complications in the Transition from Fetal to Neonatal Life. JOGNN 31(3): 318-27 • Buschbach, D., Schaub-Bordeaux, M. (2002) Newborn Physiological and Developmental Transitions: Integrating Key Components of Perinatal and Neonatal Assessment. Association of Women’s Health, Obstetric and Neonatal Nurses. • Kenner, C., Wright-Lott, J. (2003) Comprehensive Neonatal Nursing: A Physiological Perspective. Philadelphia:Saunders • Sansoucie DA, Cavaliere, TA. (1997) Transition from Fetal to Extrauterine Circulation. Neonatal Network, 16(2):5-12 • Verklan,TM, Walden, M., editors (2004) Core Curriculum for Neonatal Intensive Care Nursing (3rd ed.) St. Louis:Elsevier

  37. References (2) • http://www.cayuga-cc.edu/people/web_pages/greer/biol204/heart4/heart4.html • http://dic.academic.ru/pictures/enwiki/80/Patent_ductus_arteriosus.jpg • http://www.007b.com/breastfeeding_pictures.php • http://pregnancy.about.com/od/newbornbabies/ig/Newborn-Photo-Gallery/index.01.htm

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