Assessment of Newborn Transition and Normal Newborn

Newborn Thermoregulation

• Newborns are at risk of heat loss due to their small amount of heat-producing tissue (muscle and adipose tissue) compared to their exposed skin.
• Newborns cannot produce heat by muscle movement and shivering, which requires oxygen.
• Cold stress can lead to respiratory distress.

Hepatic Adaptation

• After birth, the newborn's liver breaks down excess red blood cells, releasing bilirubin.
• Bilirubin is normally conjugated and excreted in the feces, but the newborn's immature liver may be overwhelmed, leading to jaundice.
• The liver produces clotting factors, requiring vitamin K, which is normally produced by gut bacteria.
• Newborns are given vitamin K to prevent bleeding problems.

Newborn Care

• Key components of newborn care include:
  • Drying and warming the neonate
  • Assessment (AGPAR scoring and physical examination)
  • Feeding
  • Hygiene (drying and first bath)
  • Promoting bonding (skin-to-skin contact, Kangaroo care)
  • Vitamin K administration
  • Eye care
  • BCG and Hepatitis B vaccination

Breastfeeding

• Breastfeeding is the optimal source of nutrition.
• Breast milk types:
  • Colostrum (rich in antibodies, produced in late pregnancy to 3 days after delivery)
  • Transitional milk (lower protein, produced 3-6 days after delivery)
  • Mature milk (produced 7 days after delivery until termination of breastfeeding)

Newborn Transition

• Physiologic adaptation:
  • Respiratory adaptation
  • Cardiovascular adaptation
  • Thermoregulatory adaptation
  • Metabolic adaptation
  • Hepatic adaptation
  • Behavioral and social adaptation
• Nursing assessment of the normal newborn includes:
  • General body proportions and posture
  • Vital signs
  • Physical measurements
  • Head-to-toe assessment
  • Neurologic assessment
  • Behavioral assessment
  • Gestational age assessment

Metabolic Adaptation

• A steady supply of blood glucose is necessary for metabolic processes and energy production.
• Neonatal hypoglycemia (blood glucose < 40 mg/dL) can occur due to excessive stress during labor or transition.
• Risk factors for hypoglycemia: respiratory distress, cold stress.
• Early signs of hypoglycemia: jitteriness, poor feeding, listlessness, irritability, low temperature, weak or high-pitched cry, hypotonia.
• Late signs of hypoglycemia: respiratory distress, apnea, seizures, coma.

Thermoregulatory Adaptation

• Thermoregulation is the balance between heat production and heat loss.
• Newborns are susceptible to heat loss due to their small amount of heat-producing tissue.