Presentation on theme: "Transition and Stabilization of the Newborn Letha Nix RNC."— Presentation transcript:
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
A newborn can take up to 12 hours to transition from placental support to extrauterine support.
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.
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.
Transition begins before delivery Depending on…. Gestational age placenta health/condition maternal health Any limitations to major organs physical defects/anomalies
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
Transition begins before delivery During Labor… placenta stress hormones
Review: Placental Circulation Exchanges O 2 and CO 2 by simple diffusion Eliminates waste products Does the work of the lungs in utero Uterine venous blood has PCO 2 =38 mmHg PO 2 =40-50 mmHg pH=7.36
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
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.
Newborn Circulation Umbilical cord is clamped Placenta is separated systemic blood pressure Three major shunts close
Newborn Circulation Circulatory Changes Fetus separation mother/placenta Lungs begin to function First breath
Considerations For Newborns in Transition Period History… Maternal…Medications Illness Labor and Delivery… Fetal Distress Delivery Complications Types Delivery Resuscitation Measures
Assessment Vital Signs Measurements Gestational Age Assessment Head to Toe Exam Glucose/Feeding
Assessment-continued Normal head to toe assessment findings for infant in transition Skin Head Respirations/Breath Sounds Heart Sounds Intestines Urine Extremities
Thermoregulation normal ranges 97.7F - 98.6F results of cold stress: O 2 consumption & use of glucose stores radiant warmer/isolette bathing
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
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
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
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
Recognition of the Sick Newborn Perinatal History Physical Assessment Skin Respiratory Cardiovascular Central Nervous System Morphologic Features GI Tract
Tools Used to Diagnosis? With MD order of course!!!
Common Problems Seen In Transition Birth Trauma Birth Asphyxia Pulmonary Cardiovascular Hemodynamics Metabolic Problems Infection Congenital Anomalies
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
Parental Support Before Delivery At Delivery During Transition Transfers
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