1. Developed by D. Ann Currie, RN, MSN

2. Physiological Responses of the Newborn to Birth Respiratory Adaptations: Mechanical changes Chemical changes Thermal changes Sensory changes

3. Fetal and Neonatal Circulation

4. Normal Term Newborn Cord Blood

5. Neutral Thermal Environmental Temperatures

6. Physiologic Adaptations to Extrauterine Life

7. Newborn Urinalysis Values

8. Cardiovascular Adaptations Decreased pulmonary vascular resistance and increased blood flow Increased systemic pressure and closure of ductus venosus Increased left atrium and decreased right atrium pressure Closure of foramen ovale Reversal of blood flow through ductus arteriosus and increased PO2 Closure of ductus arteriosus

9. Transitional circulation: conversion from fetal to neonatal circulation.

10. Fetal-neonatal circulation. A, Pattern of blood flow and oxygenation in fetal circulation. B, Pattern of blood flow and oxygenation in transitional circulation of the newborn. C, Pattern of blood flow and oxygenation in neonatal circulation.

11. Fetal Laboratory Value Changes Decreased erythropoietin production Rise of hemoglobin concentration Physiologic anemia of infancy Leukocytosis Decreased percentage of neutrophils

12. Thermogenesis in the Newborn Large body surface area compared to mass Types of heat loss Convection Radiation Evaporation Conduction

13. Convection

14. Radiation

15. Evaporation

16. Conduction

17. Types of Bilirubin Unconjugated bilirubin Conjugated bilirubin Total bilirubin

18. Conjugation and Excretion of Bilirubin Bilirubin is transported in blood via albumin Bilirubin is transferred into the hepatocytes Attachment of unconjugated bilirubin to glucuronic acid Excreted into bile ducts, then into the common duct and duodenum Bacteria transform it into urobilinogen and stercobilinogen Bilirubin is excreted in urine and stool

19. Jaundice

20. Physiologic Jaundice Accelerated destruction of fetal RBCs Increased amounts of bilirubin delivered to liver Inadequate hepatic circulation Impaired conjugation of bilirubin Defective uptake of bilirubin from the plasma Defective conjugation of the bilirubin

21. Physiologic Jaundice (continued) Increased bilirubin reabsorption Defect in bilirubin excretion Increased reabsorption of bilirubin from the intestine

22. Liver Adaptations Iron content stored in liver Low carbohydrate reserves Main source of energy is glucose Liver begins to conjugate bilirubin Lack of intestinal flora results in low levels of vitamin K

23. GI Adaptations Sufficient enzymes except for amylase Digests and absorbs fats less efficiently Salivary glands are immature Stomach has capacity of 50-60 mL Cardiac sphincter is immature

24. Fluid and Electrolyte Balance Less able to concentrate urine Limited tubular reabsorption of water Limited excretion of solutes Limited dilutional capabilities

25. Immunologic Responses in the Newborn IgG – passive acquired immunity via placenta IgM – usually not passively transferred Elevated levels may indicate fetal antigenic activity in utero IgA – passive acquired immunity via colostrum

26. Periods of Reactivity First period of reactivity Sleep phase Second period of reactivity

27. Mother and baby gaze at each other. This quiet alert state is the optimal state for interaction

28. Behavioral and Sensory Capabilities Habituation Orientation Auditory Olfactory Tasting and Sucking Tactile

29. End of Part 1