Newborn Transition to Extrauterine Life

Fetal Preparation for Extrauterine Life

• Fetal lungs mature
• Surfactant is produced
• Surfactant is a mixture of phospholipids and lipoproteins
• Brown fat is deposited
• Brown fat helps infants regulate their body temperature
• Glucose is stored in the liver as glycogen
• This provides an energy source at birth
• The adrenal glands produce catecholamines, including dopamine, norepinephrine, and epinephrine

Thermoregulation

• Infants are at a greater risk of hypothermia
• Hypothermia means the body temperature is below normal
• Evaporation is a mechanism of heat loss; amniotic fluid on the infant evaporates
• Conduction is a mechanism of heat loss; heat transfers from the infant's body to cooler surfaces
• Convection is a mechanism of heat loss; the infant's body heat transfers to surrounding cool air
• Radiation is a mechanism of heat loss; the infant's body heat transfers to a cooler object not in contact with the infant.

Problems with Heat Regulation

• Lack of subcutaneous fat causes insulation issues
• Blood vessels are close to the surface

Brown Fat

• Infants rely on it to provide additional heat
• Metabolism of brown fat causes nonshivering thermogenesis

Cold Stress

• Brown fat is rapidly metabolized
• Metabolic acidosis can be the result

Increased Metabolic Rate in a Cold Newborn

• There is an increased need for oxygen
• Surfactant production decreases
• Stored glycogen is used more, causing hypoglycemia
• Rapid metabolism of brown fat leads to metabolic acidosis

Nursing Interventions for Thermoregulation

• Dry the baby immediately after birth
• Place skin-to-skin with the mother
• Cover the head
• Monitor temperature every 15 minutes for the first hour
• Avoid uncovering or exposing the entire body
• Bathe after the temperature is stable for at least 2 hours
• Avoid placing the crib near a draft or window
• Place under a preheated radiant warmer for procedures

Respiratory System

• A sequence of events including internal and external stimuli help the baby breathe
• Internal stimuli are chemically focused
• External stimuli are mechanical, sensory, and thermal changes in the newborn’s body
• Chest pressure squeezes out secretions and amniotic fluid at birth
• The chest recoils, which causes air to fill the lungs
• Surfactant increases to keep alveoli open after initial breaths
• Cutting the umbilical cord causes respiratory centers in the brain to begin working in response to dropping blood pH

Nursing interventions for the Respiratory System

• Count respirations per minute
• Suction mouth and nose
• Monitor respiratory effort
• Observe the abdomen

Cardiovascular System

• Circulation changes during newborn transition
• After the newborn starts breathing, blood flow changes
• Breakdown of RBC increases, which releases bilirubin
• Bilirubin is a waste product from the breakdown of RBCs
• Newborns have elevated WBCs
• There is an absence of vitamin K

Nursing Interventions for the Cardiovascular System

• Monitor heart rate
• Use positive pressure ventilation to increase heart rate
• Begin chest compressions if the heart rate falls below 60 bpm
• Monitor color of the trunk, mucous membranes, and the capillary refill time

Renal System

• Kidneys are immature
• Urine isn't concentrated until 6 weeks of age
• Urine is odorless and a light color or clear
• A newborn voids within 24 hours of birth with a volume of about 15 mL
• Total daily output for the first 2 days is 30-60mL
• Volume rises to 300 mL per day

Nursing Interventions for the Renal System

• Monitor first void
• Weigh diapers
• Encourage frequent breastfeeding

Gastrointestinal System

• The GI system is sterile at birth
• Bacteria enters the body and becomes probiotics
• Intestinal bacteria aids in digestion and synthesizes Vitamin K
• Capacity of newborn stomach is 60-90 mL
• Pancreas is immature
• The cardiac sphincter between esophagus and stomach is weak
• Meconium stool is expelled within 24-48 hours of birth

Nursing Interventions for the Gastrointestinal System

• Monitor for meconium stool; report if not expelled within 24 hours
• Teach parents not to overfeed
• Teach about the immature cardiac sphincter and regurgitation

Hepatic System

• The liver is immature at birth
• Newborns have a high number of unneeded RBCs
• If not removed efficiently, normal physiological jaundice occurs by day 2-4
• The liver removes indirect (unconjugated) bilirubin and convert/conjugate it to be excreted
• Indirect bilirubin causes jaundice, causing a yellow discoloration of the skin
• Once conjugated, direct (conjugated) bilirubin is excreted into the common duct, duodenum, and small amount in urine

Nursing Interventions for the Hepatic System

• Monitor for yellow sclera and skin
• Teach about normal physiological jaundice

Immune System

• Newborns are born with passive antibodies from immunoglobulin G
• These passive antibodies protect for 2-4 months
• Antibodies are not actively produced until about 2 months of age

Nursing Interventions for the Immune System

• Strict hand washing
• Protect from infection
• Screen health-care personnel and visitors for illness
• Teach hand hygiene
• Encourage immunizations to begin at 2 months of age

Behavioral Adjustment to Extrauterine Life

• Newborns initiate interaction by crying, quieting when soothed, and engaging in mutual gazing
• Newborns show they like something when focusing their eyes and tracking objects or people
• Newborns show they dislike something when turning away, crying, or yawning
• Newborns self-soothe with thumb or hand sucking
• Every baby is different

Periods of Reactivity

• First period: 30-60 minutes after birth; the infant is alert, active, and cooperative with a vigorous suck reflex
• Period of inactivity: deep sleep for 2-4 hours or longer and is unresponsive to external stimuli
• Second period: waking up from a long sleep and is alert, active, and hungry

Newborn Behavior

• Deep sleep
• Light sleep
• Drowsy
• Alert
• Active alert
• Crying