Newborn Transition PDF

Newborn Transition DR. GINA WILDING  “Transition always starts with an ending. To become something else, you have to stop being what you are now; to start doing things a new way, you have to end the way you are doing...

Newborn Transition DR. GINA WILDING  “Transition always starts with an ending. To become something else, you have to stop being what you are now; to start doing things a new way, you have to end the way you are doing them now…” William Bridges Newborn Transitioning CHAPTER 17 Newborn adaptations HAVE YOU NOTICED A THEME ABOUT ADAPTATIONS IN MATERNAL/NEWBORN CARE?  Immediate transition at birth Four Areas: Our job: Early identification of transition deviations require quick 1. Circulatory intervention 2. Respiratory The first hour is the “golden hour” 3. Thermoregulation Transition is difficult and complex, without making these changes, the 4. Glycemic control newborn will not survive Transition occurs in the first 6 to 10 hours of life, but some adaptations occur to completion over weeks. Prenatal and Postnatal Circulation Fetus vs Newborn Circulation Body Fetal Function Newborn Function Umbilical Vein Carries O2 from placenta Becomes a ligament to fetus Ductus Venosus Bypass liver to allow blood Becomes a ligament to join vena cava to the heart Foramen Ovale Bypass the pulmonary Becomes Fossa ovalis? circulation from the right atrium directly to the left atrium Ductus Arteriosus Bypass the pulmonary Becomes a ligament circuit by connecting the pulmonary artery to the aorta Delayed cord clamping Blood volume varies 25 to 40% dependent on timing of cord clamping Timi Now recommended to delay 30 – 60 sec by AAP, ACOG, WHO ng Improve cardiopulmonary adaptation Prevent iron deficient anemia Ben Increase iron stores – Higher serum iron levels at 4 to 6 months efits 60 % increase in RBCs 30% (term) to 50% (preterm) increase in blood volume - Without increasing hypervolemia Phy Improved systemic blood pressure siolo Increased cerebral oxygen index gic Higher hemoglobin levels – at 24 to 48 hours Ben efits Cord blood banking and lotus birth Respirations Periodic Breathing No color or 30 to 60 bpm Cessation of heart rate Shallow breathing changes Lasting 5 to First few 10 seconds days Monitor Irregular Closely Temperature regulation Normal range 97.9-99.7F (36.6 – 4 Mechanisms of heat loss 37.6C) Skin to skin contact should be 1. Conduction initiated immediately. 2. Convection Can become overheated or 3. Evaporation underheated 4. Radiation Predisposed for heat loss Can drop 3 to 5 degrees within minutes of birth Mechanisms of Heat Exchange Thermoregulation: The balance between heat loss and heat production ◦ Overheating Increases: ◦ Cold Stress: ◦ Fluid loss ◦ Less activity ◦ Respiratory rate ◦ Lethargic ◦ Metabolic rate ◦ Hypotonic ◦ Thermoregulation by increasing: ◦ Weaker ◦ Metabolic rate ◦ Worsening ◦ Oxidative glucose ◦ Depleted brown fat stores ◦ Fat and protein metabolism ◦ Increased O2 and glucose consumption ◦ Non-shivering thermogenesis of brown fat ◦ Respiratory distress ◦ Muscular activity through movement ◦ Depletion of glucose causing hypoglycemia ◦ Peripheral Vasoconstriction ◦ Pulmonary vasoconstriction ◦ Assume fetal position ◦ Metabolic acidosis ◦ Jaundice ◦ Hypoxia ◦ Decreased surfactant production Sites for Brown Fat – Used for Thermoregulation Nursing interventions ◦ Prewarm blankets, hats, and surfaces (Conduction) ◦ Dry the infant immediately and thoroughly at birth and with baths (Evaporation) ◦ Encourage skin to skin with mom immediately ◦ Promote early breastfeeding ◦ Use heated O2 ◦ Always use radiant warmers (Radiation) ◦ Defer bathing until stable and use radiant warmer ◦ Place temperature probe from radiant warmer on appropriate area (liver when supine) ◦ If hypothermic, think check blood sugar. If hypoglycemic, think check temperature Hepatic function ◦ Liver takes over for placenta ◦ Some enzymatic pathways are not functional until 3 months of age ◦ Blood coagulation, iron stores, carbohydrate metabolism, conjugation of bilirubin ◦ Liver stores the iron of destroyed RBCs ◦ Shorter life cycle – 80 days ◦ Affected by mother’s iron intake ◦ Carbohydrate Metabolism ◦ No longer has mother’s glucose which is essential for brain metabolism. Adjusts to intermittent source (meals) ◦ Initially glucose declines, then regulates using glycogen stores from liver to release glucose for use ◦ Hypoglycemia occurs frequently in the first 24 hours  Hepatic function - bilirubin Bilirubin Yellow to orange bile pigment Hemolysis of RBCs (Heme) Unconjugated Bilirubin Reticuloendothelial system/liver Indirect Bilirubin – fat soluble process Conjugated Bilirubin Excreted in GI via bile Direct Bilirubin – water soluble (feces)/kidneys (urine) Bilirubin -jaundice ◦ Produced in newborn: 8 to 10 mg/kg/dy 3 Classifications of Jaundice ◦ Twice the production of adults ◦ Bilirubin over production ◦ At adult levels by 10 to 14 days ◦ Blood incompatibility – hemolysis ◦ Drugs, bruising, polycythemia, delayed cord ◦ Immature ability to conjugate bilirubin clamping, bf ◦ Jaundice occurs from too much ◦ Decreased bilirubin conjugation bilirubin in blood stream ◦ Physiologic jaundice, hypothyroidism, ◦ Inability to conjugate and excrete bilirubin breastfeeding ◦ Impaired bilirubin excretion ◦ Biliary obstruction, sepsis, hepatitis, chromosomal ◦ Drugs – asa, Tylenol, sulfa, etoh, steroids, abx Bilirubin graph Adaptations This Photo by Unknown GI Adaptation Renal Adaptations Author is licensed under CC BY-NC-ND ◦ Mucosa immature for 4 – 6 months ◦ Susceptible to dehydration and ◦ Develops mucosal barrier for protection overload ◦ Colonization of bacteria/previously ◦ Limited urine concentration ability – low SG sterile ◦ Reduced glomerular filtration ◦ Food source plays a role ◦ Kidneys can handle acid/base balance ◦ Usually starts within 24 hours of excretion unless other process ◦ Necessary for Vitamin K production occurring ◦ Transmission from mom via birth, suckling, ◦ Voids right after birth kissing, touching ◦ Pathologic substance cause inflammation and Immune Adaptation allergies ◦ Starts as fetus: collects maternal ◦ Rapid capacity gain of stomach ~4 antibodies, keeps until ~6 months days newborn ◦ Not the first day, does not stretch ◦ Breastfeeding provides protection ◦ Overfeeding causes linked to later obesity issues ◦ Immature system- At risk for acquiring ◦ Meconium – greenish black, tarry infection ◦ First 12 – 24 hours, then transitional stool – greenish to yellow stool ◦ Produce own antibodies 2-3 months newborn Behavioral patterns First Period of Reactivity ◦ Lasts 30 min – 2 hours ◦ Alert, active, appear hungry ◦ Parents interact with newborn ◦ Latch well Period of Decreased Responsiveness ◦ Starts when the first period ends, lasts minutes to hours ◦ Sleep period – activity, pulse, resp decrease ◦ Difficult to arouse ◦ Parents can rest Second Period of Reactivity ◦ Lasts 2 to 8 hours ◦ Peristalsis, activity, hr, resp increase ◦ Parents engage