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Newborn Adaptataion Prepared By : HamzeH HarayzeH Al-Abbadi Present for : Dr Gounan Samhan { ٍ ن يِ ط نِ ّ مٍ ةَ الَ لُ س نِ مَ انَ س نِ اْ ال اَ نْ قَ لَ خْ دَ قَ لَ ى: و ل عا ت لة لل ا ا ق12 { ٍ ن يِ كَ ّ مٍ ارَ رَ ق يِ فً ةَ فْ طُ نُ اهَ نْ لَ عَ A جَ ّ مُ D ث} 13 َ ةَ فْ طُ ّ ن ل ا اَ نْ قَ لَ خَ ّ مُ D ث} َ ن يِ قِ ل اَ خْ ل اُ نَ سْ حَ N اُ َ ّ اَ P كَ ارَ A نَ تَ S قَ رَ خV ا اً قْ لَ خُ اهَ نْ N اَ D س نَ N اَ ّ مُ D ث اً مْ حَ لَ امَ ] ظِ عْ ل ا اَ نْ وَ سَ كَ S ق اً امَ ] ظِ عَ ةَ غْ ضُ مْ ل ا اَ نْ قَ لَ خَ فً ةَ غْ ضُ مَ ةَ فَ لَ عْ ل ا اَ نْ قَ لَ خَ فً ةَ فَ لَ ع{ 14 } .

Newborn adaptation

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complete presntation about newborn adaptation اعداد حمزة الحرايزة العبادي جامعه العلوم والتكنولوجيا الاردنية - اربد كلية التمريض..قسم الامومة وحديثي الولادة

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Page 1: Newborn adaptation

Newborn Adaptataion

Prepared By : HamzeH HarayzeH Al-Abbadi

Present for : Dr Gounan Samhan

ل)ة م%ن ط#ين } ال) ان) م#ن س+ #نس) ن)ا اإل1 ل)ق1 د1 خ) ل)ق) ع)ل1ن)اه+ 12قال الله تعالى: و) { ث+مD ج)ك#ين } Dار م ر) ةM ف#ي ق) غ)ةM 13ن+ط1ف) ة) م+ض1 ن)ا ال1ع)ل)ق) ل)ق1 خ) ةM ف) ة) ع)ل)ق) ن)ا النUط1ف) ل)ق1 { ث+مD خ)

ك) ت)ب)ار) ر) ف) ا آخ) Mل1ق 1ن)اه+ خ) أ ا ث+مD أ)نش) Mم ن)ا ال1ع#ظ)ام) ل)ح1 و1 ك)س) ا ف) Mغ)ة) ع#ظ)ام ن)ا ال1م+ض1 ل)ق1 خ) ف)ين) } ال#ق# ن+ ال1خ) .{14اللDه+ أ)ح1س)

Page 2: Newborn adaptation

Outlines -Objectives

-Introduction -Cold stress

-Jaundice -Periodic breathing

-Neutral thermal -Meconium

-Thermoregulation -Neoatal period

-Reflex -Fetal stuctures

-Fetal circulation -NTE

-kernicterus -Natural and acquired immunity

-Fetal Immunoglobulins -Behavioral patterns

Page 3: Newborn adaptation

Objectives

-Define outlines and key term used in outline -Identify the major changes in body,systems that

occur as the newborns adapt to extrauterine life. -List the primary challenges faced by the

newborns during the adaptation to extrauterine life.

-Explain the three behavioral patterns of newborn behavioral adaptaion.

-Discuss the five typical behavioral responses of the newborn

-Discuse and have to understand fetal circulation -Know blood component for newborns.

-Know about surfactant hormone and wat it function in the body.

Page 4: Newborn adaptation

IntroductionThe neonatal period: Is defined as the first 28 days of life.

-After Birth the newborn is exposed to a whole newSoundColorsSmellsSensation

**the newborn previously confined to the warm,dark,wet intra-uterine environment.Now is thrust into environment that much brighter and color.

Page 5: Newborn adaptation

In this presentation we have to descripe the physiologic changes of the newborn’s major body systems.it also discusses the behavioral adaptaions.Including behavioral patterns and the newborn’s behaviroal respones < that occur during this transition period.

Page 6: Newborn adaptation

Physiologic adaptations

The mechanics of birth require a change in the newborn for survival outside the uterus.Immediately,respiratory,gas exchange,along with circulatory modification, must be occur to sustain extrauterine life.during this time,as newborns strive to attain homeostasis.

The also experience complex changes in major organ system.

Although the transition usually takes place within the first 6-10 hours of life ..many adaptation take weeks to attain full maturity

Page 7: Newborn adaptation

Respiratory system

fetus :fluid-filled,high-pressure system cause blood to be shunted from the lungs through the ducts arterious to the rest of the body.

Newborn :Air-filled,low-pressure system encourge blood flow through the lungs for gas exchange;increase o2 content of blood in the lungs contributes to the closing of the ducts arteriosus(becomes a ligament).

Page 8: Newborn adaptation

Site of gas exchange

Fetus:

Placenta

Newborn:

Lungs

Page 9: Newborn adaptation

Hepatic portal circulation

Fetus: Ductus venosus bypasses;maternal liver performs filtering fuction.

Newborn: Ductus venosus closes(becomes a ligment);hepatic portal circulation begin.

Page 10: Newborn adaptation

Circulation through the heart

Fetus:

Pressure in the right atrium are greater than in the left,encourging blood flow through the foreman ovale

Newborn:

Pressure in the left atrium are greater than in the right, causing circulation begins.

Page 11: Newborn adaptation

Thermoregulation

Fetus :

Body temperature is maintained by maternal body temperature and the warmth of the intrauterine environment.

Newborn:

Body temperature is maintained through a flexed posture and brown fat

Page 12: Newborn adaptation

Cardiovasular system adaptations

Page 13: Newborn adaptation
Page 14: Newborn adaptation
Page 15: Newborn adaptation

Cardiovasular system adaptations

-The umbilical vein carries oxygenated bld from placenta to the fetus.

-The ductus venosus allows the majority of the umbilical vein bld to bypass the liver and merge with bld moving through the vena cava, bringing it to the heart sooner.

-The foramen ovale allows more than half the bld entering the right atrium to cross immedediatly to the left artium,thereby passing the pulmory cicrulation

-The ducuts arterious connects the pulmonary artery to the aorta, which allow bypassing of pulmonary circuit..

Page 16: Newborn adaptation

At birth : placental (fetal) circ~~~> pulmonary (newborn) gas exchange

The physical forces of the contractions of labor and birth,mild asphyxia, increased intracranial pressure as a result of cord compression and uterine contraction,as well as cold stress immediately experienced after birth lead to an increased release in catecholamines that is critical for the changes involved in the transition to extrauterine life.

The increased level epinephrine and norepinephrine stimulate increase cardiac output and contractility. surfactant release and promotion of pulmonary fluid clearance.

Page 17: Newborn adaptation

Fetal Structures

When umbilical cord is clamped---the first breath is taken and the lungs begin to function as a Result

- systemic vascular resistance increase and bld return to the heart via the inferior vena cava decrease.

-With this change there is rapid decrease in pulmonary vascular resistance and increase in pulmonary bld flow

The foramen ovale functionally closes with a decrease in pulmonary vascular resistance

-Ductus arteriosus,ductus venosus,umbilical vessels that were vital during fetal life are no longer needed.

-the increase left atrail pressure causes the foramen ovale to close ..(Why..??)

Page 18: Newborn adaptation
Page 19: Newborn adaptation

-Foramen ovale closes with decrease pulmonary vascular resistanceIncreases pressure to left side of heart

-4 chambers

-Ductus arteriosis closes due to increase of O2 to lungs.. ..( close within few hours after birth )

-Ductus venosus close bcoz liver is activated..(close within few days after birth) ~~~> convert to ligament in extrauterine life.

Page 20: Newborn adaptation

Heart rate -During the first few minutes after birth,HR=120-180 bpm.

Thereafter begin decrease to average 120-130 pbm.

THE newborn is highly dependent on heart rate for maintenance of cardiac output and BP.

-Transient functional cardiac murmurs may be heard during the neonatal period as a result of changing dynamics of the cardiovascular system at birth.So It’s Normal during first 12 hours at nb age..

But after 12 hours we have to do evolution for nb

Page 21: Newborn adaptation

Heart rate- 120-180 fluctuations due to activity

An increase in activity, such as

wakefulness,movement,or crying, corresponds to an increase in HR and bld pressure.

Tachycardia :> volume depletion,cardiorespiratory dss,drug withdrawal and hyperthyroidism

Bradycardia :> associated with apnea and hypoxia

Page 22: Newborn adaptation

Blood Volume

-The blood volume of the nb depend on the amount of bld transferred from the placenta at birth.It’s usually estimated to be 80-85 ml\kg of body with the term infant.

The volume may vary as much as 25%-40%,depending on where clamping of umbilical cord occurs.

-Recent studies show the benefits of delayed cord clamping as improving the nb cardiopulmonary adaptation ,preventing childhood anemia without increase hypervolemia-related risks, increasing bld pressure, improving o2 transport.abd increase RBC flow.

Page 23: Newborn adaptation

Blood Components

-Rbcs newborn life span= 80-10 days/120 in adult

-Hb initially declines as a result of decrese in neonatal red cell mass(physiolgic anemia of infancy).

-Leukocytosis (elevated white bld cell) is present as a result of birth trauma soon after birth.

-The newborn platelet count and aggregation ability are the same as adult.

Page 24: Newborn adaptation

HB …17-20G-DL

Hematocrit …52%-63%

platelets … 100.000-300.000-Ul

Red blood cells … 5.1-5.8

White blood cells … 10-30/mm3

Page 25: Newborn adaptation

The nb hematologic values are affected by:

- the site of the bld sample (capillary bld has higher levels of hb and hematocrit compared with venous bld.

-placental transfusion (delayed cord clamping and normal shift of plasma of extravascular spaces,which cause higher levels of hb and hemoatocrit).

-Increse GA _ Increase RBS and Hb

Page 26: Newborn adaptation

One of the most crucial adaptations that the nb makes at birth is adjusting from a fluid-filled intrauterine environment to a gaseous extrauterine environment.during fetal life,the lungs are expanded with an ultrafiltrate of the amniotic fluid.during and after birth,this fluid must be removed and replaced with air.passage through the birth canal allows intermittent compression of the thorax,which helps eliminate the fluid in the lungs.

Respiratory System Adap..

Page 27: Newborn adaptation

Respiratory System Cont

The first breath of life is a gasp that generates an increase in transpulmonary pressure and result in diaphragmatic descent.hypercapnia,hypoxia,and acidocis resulting from normal labor become stimuli for initiating respirations.=↑ Tidal Volume

Surfactant is a surface tension-reducing lipoprotien found in the nb lungs that prevents alveolar colapse at the end of expiration and loss of lung volume

Q : wat G-age surfactant Hormone is Formed and wats it function for newborn body ??. and if surfactant dos’t complete form in newborn

baby..the baby maybe birth with???..-,

-Normal lung function is dependent upon surfactant,which permits a decrease in surface tension at end-expiration( to prevent atelectasis) and an increase in surface tension during lung expansion( to facilitate elastic recoil on inspiration).

Page 28: Newborn adaptation

Note-:

Baby born by cesarean delivery does not have the same benefit of the birth canal squeeze as does the nb born by vaginal delivery.

Closely observe the respirations of the nb after cesarean delivery.

Page 29: Newborn adaptation

Before the nb lungs can maintain respiratory function,the following

events must occur: -*Initiation of respiratory movement

-*expansion of the lungs-*establishment of functional residual

capacity) ability to retain some air in the lungs on expiration.(

-*increased pulmonary bld flow-*redistribution of cardiac output.

Page 30: Newborn adaptation

Respirations

After respiration are established in the nb,they are shallow and irregular,ranging from 30 to 60 breaths per minute,with short periods of apnea(less than 15 second).Signs of respiratory distress to observe for include cyanosis,tackypnea,expiratory grunting,sternal retractions and nasal flaring.In some cases, periodic breathing may occur,which is the cessation of breathing that lasts 5 to 10 seconds without changes in color or HR.

Apneic periods lasting more than 15 seconds with cyanosis and HR changes require further ecaluation.

Page 31: Newborn adaptation

Body Temperature Regulation

One of the most important elements in a nb survival is obtaining a stable body temperature to promote an optimal transition to extrauterine life.

Nb T= 36.5 to 37.5c

*Thermoregulation?? ..

Page 32: Newborn adaptation

Heat loss

Newborn have several ch-ch that predispose them to heat loss:

-*thin skin with bld vessels close to the surface.

-*lack of shivering ability to produce heat involuntarily

-*limited use of voluntary muscles activity or movement to produce heat.-*large body surface area relative to body weight.-*lack subcutaneous fat, which provide insulation.

-*no ability to adjust their own clothing or blankets to achieve warmth.

-*Inability to communicate that they are too cold or too warm.

-*little ability to conserve heat by changing posture (fetal postions).

Page 33: Newborn adaptation

Types of Heat Loss

-Conduction- heat loss by contact with cooler surface.

-Convection- warm body to cool air currents.

- Evaporation- water converts to vapor.

-Radiation-heated body to cooler object (no direct contact).

Page 34: Newborn adaptation
Page 35: Newborn adaptation

Thermoregulation

Thermoregulation, the balance between heat loss and heat production, is related to the newborn’s rate of metabolism and oxygen consumption.

-An environment in which body temperature is maintained without an increase in metabolic rate or oxygen use is called neutral thermal environment NTE

-Bcoze the nb have difficulty maintaining their body heat through shivering or other mechanisms, they need higher environmental Temperature to maintain NTE…If environmental decrease, the newborn respond by~~~>increase in O2 consumping..the RR increase(tackypnea) in response to increase o2.As a result , the newborn’s metabolic rate increase.

Page 36: Newborn adaptation

The newborn’s primary method of heat production is through nonshivering thermogenesis.a process in which brown fat (adipose tissue) is oxidizes in response to cold exposure.Brown fat is special kind of highly vascular fat found only in newborn.

-Nb can experience heat loss through all four mechansim,ultimately resulting in cold strees,COLD STRESS is excessive heat loss that requires newborn to use compensatory mechanism(such as nonshivering thermogenesis and tackypnea).

---Body T decrease and Nb be less active,lethargic,hypotonic and weaker.

Preterm baby have chance for cold stress great from term baby..

WHY!!..

-Cold stress can lead to problems in newborn if n’t reversed: depleted brown fat stores,increase O2 need,Rd,increase glucoze

consumption (haypoglycemia,metabolic acidosis,jaundice, and decrease in surfctant production

Page 37: Newborn adaptation

Hepatic system function

Placenta function in fetus = liver function in newborn:

- Iron storge

-Carbohydrate metabolism

-Blood coagulation

-Conjuction of bilirubin.

Page 38: Newborn adaptation

Bilirubin Conjugating

-It’s a yellow to orange bile pigment produced by breakdown of Rbcs.

Bilirubin normally circulates in plasma,is taken up by liver cells,and is changed to a water-soluble pigment that excreted in the bile.This conjugated form of bilirubin is excreted from the liver cells as a constituent of bile.

Page 39: Newborn adaptation

Failure of the liver cells to breakdown and excrete bilirubin can cause an increase amount of bilirubin in bloodstream, leading to Jaundice.

-When bilirubin pigment is deposited in the skin and mucous membranes,jaundice typically results.

-jaundice also known as icterus,refers to the yellowing of the skin,sclera,and mucous membranes that result from increase bilirubin blood levels.

-Extremely elevated blood levels of bilirubin during the first week of life can cause Kernicterus…~~>(a permanent and devastating form brain damage.)

Page 40: Newborn adaptation
Page 41: Newborn adaptation

The cause of newborn jaundice can be classified into three groups based on the mechanism of

accumlation:

1 -Bilirubin overproduction)bld incompatibilty Rh or ABO,drugs,trauma(

2 -Decrease bilirubin conjugation.)hypothyridism,breastfeeding(3 -Impaired bilirubin excertion.

)biliary atresia,sepsis,steriods,alcohol(

Page 42: Newborn adaptation

Gastrointestinal system adaptations

The full-term newborn has the capacity to swallow,digest,metabolize,and absorb food taken in soon after birth.At birth, the ph of stomach contents is mildly acidic, reflecting the ph of the amniotic fluid.the oncesterile gut changes rapidly,depending on what feeding is received.

Page 43: Newborn adaptation

Stomach and Digestion

The stomach nb=30-90mlImmaturity of the pharyngoesophageal sphincter and absence of lower esophageal peristaltic waves also contribute to the reflux of gastric content.

Avoiding overfeeding and stimulating frequent burping may minimize regurgitation. most digestive enzymes are available at birth, allowing nb to digest simple protein and carbohdrate.they have limited ability to digest complex carbohyrates and fats,because amylase and lipase level are low at birth.

Page 44: Newborn adaptation

Bowel Elimination

The evolution of a stool pattern begins with newborns first stool,which is Meconium.Meconium is comosed of amniotic fluid, shed mucosal cells,intestinal secretions and blood.It’s a greenish black tarry consistency..and usually passes within 12-24 hours of birth….(It’s sterile)

The stools of the breast-fed nb are yellow-gold,loose and stringy to pasty in consistency,and typically sour-smelling.The stools of the formula-fed nb vary depending on the type of formula ingested.They may be yellow,yellow green.or greenish and loose,pasty,or formed in consistency,and they have an unpleasant odor.

Page 45: Newborn adaptation

Renal System Changes

Although the nb kidneys can produce urine,they are limited in their ability to concentrate it until about 3months of age,when the kidney mature.

AT birth the glomerular filtration rate(GFR) is approximately 30% of normal adults values.reaching approximately 50% of normal adult values by the 10th day of life and full adult values by the first year of life.

The low GFR and limited excertion and conservation capabilty of the kidney affect the nb abilty to excerte salt,waterloads and drugs.

Page 46: Newborn adaptation

Immune System Adapt..The newborn’s immune system begins working early in gestation,but many of respones to not function adequtely during the early neonatal period.The intrauterine environment usually protect the fetus from harmful microorganisms and the need for defensive immunologic responses.

Responses of the immune system serve three purpose:

1 -defence(protection from inavding organism).2 -homeostasis(elimination of worn-out host cells).

3 -surveillance(recognition and removal of enemy cells.).

the nb immune system response involves recognition of the pathogen or other foreign material,followes by activation of mechanisms to react against and eliminate it.

-The immune system’s responses can divided into two categories1 -natural

2 -active

Page 47: Newborn adaptation

Natural Immunity

Natural immunity includes responses or mechanism that do not require previous exposure to the microogansim or antigen to operate efficiently.

-physical barriers)such as intact skin and mucous membranes(

-chemical barriers)such as gastric acids and digestive enzymes(

and resident nonpathologic organsims make up the nb natural immune system.

Natural immunity involve the most basic host defense responses ingestion and killing of micro organsims by phagocyric cells.

Page 48: Newborn adaptation

Acquired Immunity

It have 2 primary processes:

1 -the development of circulating antibodies or immunoglobulins capable of targeting specific

invading agents(intigens)for destrcution.

2 -formation of activated lymphocytes desinged to destroy foreign invaders.acquired immunity is absent until after the first invasion by foreign organism or toxin.

Page 49: Newborn adaptation

In adult Immunoglobulins are subdivided five classes: IgA,IgD,IgE,IgG,IgM.

The newborn depends largely on three immunoglobulins for defense mechansim:IgG,IgA,IgM.

-IgG is the major immunoglobulin and the most abundant,making up about 80% of all circulating antibodies.(it’s found in serum&interstitial fluid)..It is the only class able to cross the placenta,with active placental transfer beginning at approximately 20 to 22 weeks’ gestation.IgG PRODUCE antibodies against bacteria,bacterial,and viral agents.

-IgA is the second most abundant immunoglbulin in the serum.IgA does not cross the placenta,and maximum levels are reaches during childhood.IgA is predominantly found in the gastrointestinal and respiratory tracts,tears,saliva,colostrum,and BREAST MILK.

-IgM is found in blood and lymph fluid and is the first immunoglobulin to respond to infection..It’s don’t cross to the placenta.

Page 50: Newborn adaptation

Integumentary system Adap..The most important function of skin is to provide protective barrier between body and environment. its limit to loss water.prevent absorption harmful agents.protects against physical truma.

The epidermal barrier begins to develop during mid-gestation and fully develop in 32 weeks gestationl.although neonatal epidermis similer to the adult in thickness and lipid compostion.Skin is nt complete at birth.It’s less mature the skin functionAlso in newborn, the risk of injury producing break in the skin from tape, monitors and handling is greater than for an adult.

Skin coloring varied, depending on the nb age;race;ethnic groubAt birth the nb skin is dark red ro purple.as the newborn begins to breath air,the skin color changes to red.this redness normally begins to fade the first day.

Page 51: Newborn adaptation

Neurologic system Adapt..Myelin develops early on in sensory impulse transmitters.thus,the newborn has an acute sense of hearing,smell,and taste.the newborn’s sensory

capabilities include:

-Hearing-well developed at birth,responds to noise by turing to sound. -Taste-ability to distinguish between sweet and sour by 72 hours old.

-Smell-ability to distinguish between mother’s breast milk and breast milk from others.

-Touch-sensitivity to pain;responds to tactile stimuli. -Vision-ability to focus on objects only in close proximity(7-12 inches way)

Myopia??…

)..The presence and strength of a reflex is an important indication of neurologic development and function.A Reflex is an involuntry muscular response to a sensory stimulate.

Page 52: Newborn adaptation

Behavioral Adaptation

First period of Reactivity

THE first period of reactivity begins at birth and lasts for 30 minute.The nb is alert and moving and may appear hungry(movement eyes,sucking motions;chewing;rooting.respiration and HR are elevated but gradually begin to slow as the next period)This period of alertness allows parents to interact with their newborn and to enjoy close contact with their new baby.

)..The appearance of sucking and rooting behaviors provides good opportunity for initating breast feeding(.…

Page 53: Newborn adaptation

Period of Decrease Responsiveness

At 30-120 minute of age.the newborn enters the second stage of transition__that of sleep or decrease in activity.Movement are less jerky and less frequent.HR&RR decline as the newborn enters the sleep phase. muscle become relaxed.no interst in sucking is shown. here can mother and baby togther take rest after labor and birthing experience.

Page 54: Newborn adaptation

Second Period of Reactivity

The second period of reactivity begins as the newborn awakens and shows in interest in environmental stimuli.this period lasts 2-8 hours in the normal newborn.HH&RR increase.motor activity and muscle tone increase.

Here interaction between mother and newborn during this second period of reactivity is encouraged if the mother has rested and desire it.

)…Teaching about feeding.postion for feedong and diaper-changing techniques can be reinforced this period((..

Page 55: Newborn adaptation

HamzeH al-HarayzeH

Nursing School