Newborn Transition to Extrauterine Life

NEWBORN TRANSITION TO EXTRAUTERINE LIFE Delivery Room ◦ Onset of labor stimulates reabsorption of fluid from alveolar spaces in lungs. ◦ Cold stimulates skin sensory receptors. ◦ Newborn responds with rhythmic respiration. ◦ Excessive cooling may lead to profound respiratory depression from cold stress. ◦ Tactile stimulation ◦ Enhances stimulation to the respiratory center of the brain. ◦ Skin-to-skin is beneficial/helps with cold stress. Neonatal Transition in Delivery Room ◦ Increased systemic vascular resistance & decreased pulmonary vascular resistance. ◦ Due to increased oxygenated pulmonary blood flow and loss of placenta resistance. ◦ Closure of the foramen ovale ◦ Pressure gradients in atria reversed- L atrial pressure greater. ◦ Closure of ductus arteriosus ◦ Increased serum PO2 causes constriction. ◦ Closure of the ductus venosus ◦ Cutting umbilical cord results in redistribution of blood & cardiac output. Neonatal Transition in Delivery Room ◦ 1st 6-8 hrs. of life. ◦ Stabilization of respiratory & circulatory functions. ◦ The “newborn period” ◦ Birth- 28th day of life. ◦ Adjustments from intrauterine to extrauterine life. ◦ Most complex physiologic adaptation that occurs in the human experience. ◦ Involves virtually every organ system. APGARS ◦ Used to evaluate the physical condition of the newborn. ◦ Scored at 1 minute & 5 minutes of life. ◦ If low scores obtained, will continue to be assessed in 5-minute intervals until 20 minutes of life. ◦ Scored on 0-10 point scale ◦ The lower the score= the worse your baby is doing. Scoring: 8-10: minimal or no difficulty adjusting to extrauterine life 4-7: moderate difficulty 0-3: severely distress Vital Signs ◦ HR ◦ 110-160 bpm ◦ RR ◦ 30-60 pm ◦ Temperature ◦ 97.7 F- 99.5 F ◦ Axillary preferred method ◦ BP ◦ Not a routine V.S in heathy term infant. Newborn Medications ◦ Vitamin K ◦ Hepatitis B Vaccine ◦ Erythromycin ointment Stages of Transition ◦ First period of reactivity ◦ Last up to first 30 minutes of life. ◦ Alert with spontaneous startles. ◦ Period of decreased responsiveness ◦ Marked decrease in activity lasting 60-100 minutes. ◦ Sleepy ◦ Second period of reactivity ◦ 2- 8 hours after birth. ◦ Lasts anywhere from 10 minutes to several hours. References ◦ Textbook: ◦ Table: 24.1: Initial Physical Assessment ◦ Page 487 ◦ Table 24.3: Physical Assessment of the Newborn ◦ Page 488-498 THERMOREGULATION & COLD STRESS Thermoregulation ◦ Newborns are homeothermic ◦ They attempt to stabilize their own core temperature. ◦ Neutral Thermal Environment (NTE) ◦ Specific environment temperature range. ◦ Newborn metabolism & o2 rates are minimal. ◦ Internal body temperature is maintained due to thermal balance. ◦ Thermoregulation ◦ Closely related to the rate of metabolism & o2 consumption. Thermoregulation ◦ How do they do this? ◦ Flexion- Decreases exposed surface area to environment, thereby reducing heat loss. ◦ Nonshivering thermogenesis- Heat production via metabolism of brown adipose tissue. ◦ Heat transfer- Decreased subcutaneous fat & large body surface to weight ratio. ◦ Allows for heat transfer from organs to skin surface. ◦ Blood vessels- Closer to newborn’s skin & circulating blood is influence by environmental temperature. Nonshivering Thermogenesis ◦ Mechanism of heat production by chemical thermogenesis. ◦ Skin receptors perceive drop in environmental temperature. ◦ This transmits a signal to sympathetic nervous system to use newborn’s brown fat cells to increase the speed with which triglycerides are metabolized to produce heat. Brown Fat ◦ AKA “Brown Adipose Tissue (BAT)” ◦ Begins to develop in late 2nd trimester & continues until 3-5 weeks of life in term infant. ◦ Unless depleted by cold stress! ◦ Dark color d/t enriched blood supply, dense cellular content, & abundant never endings. ◦ These characteristics allow for rapid metabolism, heat generation, & heat transfer to peripheral circulation. ◦ BAT breakdown causes increased o2 consumption & caloric output in the already compromised infant. Cold Stress ◦ Cold stress ◦ Excessive heat loss resulting in the use of compensatory mechanisms. ◦ Compensatory mechanisms ◦ Increased respirations. ◦ Nonshivering thermogenesis/ use of brown fat stores. ◦ Preterm & SGA ◦ At increased risk! ◦ Decreased adipose tissue, brown fat stores, & glycogen for metabolism. Cold Stress ◦ Nursing management ◦ Prevention of heat loss is key! ◦ Pre-warm blankets & surfaces. ◦ Neo-wrap/cellophane for extremely premature infants. ◦ Frequent temperature checks! ◦ Nursing Interventions ◦ Maintain neutral thermal environment. ◦ Isolette? Radiant warmer? ◦ Re-warm slowly as to prevent hypotension & apnea. ◦ Warm IV fluids; blankets; hats; clothing if allowed to be dressed. ◦ Monitor for hypoglycemia. Methods of Heat Loss ◦ Think of everything we do in the delivery room & postpartum to keep infants warm. Hyperthermia ◦ Vasodilation r/t hyperthermia can cause hypotension in the newborn. ◦ Increased metabolic rate & o2 consumption effect on the newborn. ◦ Infant will assume a flaccid, extended position to promote cooling. ◦ If exposed to prolonged periods of hyperthermia- gross brain damage or death can occur. BIRTHMARKS & RASHES Identification Activity (use chapter 23 for help) A B C D E F CONGENITAL ANOMALIES Identification Activity (use chapter 35 for help) B A C D E F Spina Bifida Male Abnormalities SIGNS OF DISTRESS & BIRTH TRAUMA Signs of Respiratory Distress ◦ https://www.youtube.com/watch?v=Blb9JribRRI ◦ https://www.youtube.com/watch?v=-7jiBSuJUSE ◦ https://www.youtube.com/watch?v=Ndp8-E3jYMk Most Common Birth Traumas ◦ Clavicle fracture ◦ Brachial Plexus Injury ◦ Facial Paralysis ◦ Intracranial hemorrhages Head Assessment NEWBORN REFLEXES Most common ◦ Sucking & Rooting ◦ Palmer ◦ Planter ◦ Moro ◦ Babinski Answers to Birthmarks & Rashes ◦ A: Infantile Hemangioma (Strawberry Hemangioma) ◦ B: Nevus Flammeus (Port Wine Stain) ◦ C: Nevus Simplex (Stork Bite) ◦ D: Slate Gray Nevi (Mongolian Spots) ◦ E: Milia ◦ F: Erythema Toxicum (Newborn Rash) Answers to Congenital Abnormalities ◦ A: Cleft Lip ◦ B: Cleft Palate ◦ C: Talipes Equinovarus (Club foot) ◦ D: Omphalocele ◦ E: Gastroschisis ◦ F: Congenital Diaphragmatic Hernia