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Physiological Response of Newborn to Birth

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Presentation on theme: "Physiological Response of Newborn to Birth"— Presentation transcript:

1 Physiological Response of Newborn to Birth
Chapter 23

2 Neonatal Transition Surfactant production
Breathing initiated by mechanical, sensory, chemical, thermal changes. Mechanical- pressure from chest compression, recoil Remaining fluid pulled into interstitial fluid Problems r/t inadequate chest compression

3 Chemical Stimuli Fetal acidosis, decrease in PO2,increase PCO2
Cord clamped, stress of labor Stimulation of medulla

4 Thermal and Sensory Shock of cold environment Nerve ending stimulated
Cold stress Tactile, auditory and visual stimulation Encourage skin to skin contact

5 Cardiopulmonary Adaptation
Blood flow to lungs established Oxygen saturation Newborn anatomy restricts lung expansion Periodic breathing Obligate nose breathers

6 Cardiopulmonary Adaptation
Clamping of cord, “shut off the hose”, increase in blood pressure Perfusion increased by pulmonary blood flow and dilation pulmonary vessels. Decrease in vascular resistance Pressure change closes foramen ovale Ductus arteriosis closes due to PO2 Ductus venosis closure leads to liver profuse

7 Cardiac Fx Normal rate BP Most murmurs transient and benign
Right ventricle versus left ventricle Pressure gradient changes from left to right

8 Hemodynamics RBC shorter life span Rise in HCT Stress response
Cord clamping Gestational age Presence of hemorrhage Site of blood sample

9 Temperature Metabolism and O2 consumption increase with heat loss
Thin skin, decreased fat Blood vessels close to surface Flexed posture Premature infants

10 Heat Loss Large body surface – Vessels close to skin
Convection- cool air currents, door open Radiation- heat transfers to cooler surface, place cool object on warmer Evaporation-water converted to vapor, wet baby Conduction- loss of heat due to direct contact with object

11 Thermogenesis Increase in BMR, and activity generate heat
Nonshivering thermogenesis (NST) Infant uses stores of brown fat Brown fat metabolized quickly to produce heat Do not chill newborns Cold stress can delay drug metabolism

12 Hepatic Adaptation Iron stored in fetal liver, last for 6 months
Energy crunch caused by labor and loss of maternal glucose Newborn converts from use of carbohydrate metabolism to fat metabolism

13 Conjugation of Bilirubin
Bilirubin is byproduct of breakdown of RBCs In utero bilirubun excreted by placenta Bilirubin needs to be conjugated to be excreted. Enzymes in liver conjugate bilirubin- bacteria transforms into urobilirubin Low levels of glucuronyl transferase and immature liver function

14 Physiologic Jaundice Normal response 2-3 days after birth
Caused by increase volume and RBC destruction Bilirubin not flushed from plasma Bilirubin not conjugated Decreased bacterial flora and motility

15 Nursing Room environment-avoid pink
Head to toe, blanch and assess for yellow Maintain temp Monitor for excretion Feed early Phototherapy for newborns over 13mg/dl

16 Breastfeeding Jaundice
Peaks in 2-3 weeks Composition of breast milk may interfere with conjugation If above 20mg.dl may be asked to cease Continue to pump Reassure moms

17 Coagulation Some coagulation factors are Vit. K dependent
At birth bacteria in colon not present for Vit. K synthesis Dilantin and Coumadin associated with bleeding issues

18 GI Lactose(carb.),proteins easily digested
Starches not easily digested Lack of pancreatic enzyme limits fat digest. Some regurge nl, burp do not overfeed Need 120 cal/kg/day, 5%-10% weight loss. Meconium- debris, dark, tarry Differentiate breast feed from bottle fed

19 Kidney Fx Inability to concentrate urine
Decrease in GFR, unable to diurese quickly Most void within 24 hrs., 6/day Increase 5-25/day after 2 days Blood in female diaper due to pseudomenstruation

20 Immunity Immunoglobin IgG transferred to fetus, passive acquired immunity Length of immunity to bacteria and virus vary Lack of IgM, fetus susceptible to gram - IgA protects, gi, int, eyes, high concentration in colostrum

21 Neurological Fx Able to habituate
Able to fixate on faces or objects with contrast Blinking reflex Growth is cephalocaudal Reflexes present Defensive motor ability

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