Chapter 12 Adjustments After Birth PDF

CHAPTER 12 Adjustments After Birth Newborn Assessment As soon as the neonate is born, several assessments are made to determine their health. One such assessment is the Apgar score. Human Reproductive Biology, 4th Ed. (2014) pg. 228 Looks at five different parameters and a child is score from 0-...

CHAPTER 12 Adjustments After Birth Newborn Assessment As soon as the neonate is born, several assessments are made to determine their health. One such assessment is the Apgar score. Human Reproductive Biology, 4th Ed. (2014) pg. 228 Looks at five different parameters and a child is score from 0-2 for each parameter. Will sometimes be assessed twice. Right after birth, and a few minutes later when the neonate as settled. Leboyer Method Popularized by Férérick Leboyer, is a method of controlling stress and sensory stimulation during and after birth. Key characteristics: • Warmer room temperature • Noise dampening • Dimmed lighting • Warm baths for newborn • Skin-to-skin contact https://www.amazon.com/Birth-without-ViolenceFr%C3%A9d%C3%A9rick-Leboyer/dp/1594772975 Circumcision A religious and cultural custom practiced around the world. Involved the surgical removal of the prepuce of the penis. Generally performed within the first few days or two weeks of life, but can be done at any point. Circumcision is also practiced in people with a clitoris. ~1/3 of neonates with a penis are circumcised in Canada. https://gmurology.com.au/other-urological-procedures/circumcision/ Newborn Adaptations Birth is a shock to the system of a neonate. Rapid transition from a dark, warm, stable, and aquatic environment to a bright, colder, dynamic, and land environment. Adaptations occur in neonates across many body systems: • Respiratory • Circulatory • Digestive • Thermoregulation • Nervous system Respiratory System A newborns lungs are coated with surfactant to help the lungs inflate. Surfactant production is triggered by cortisol. https://en.wikipedia.org/wiki/Adrenaline Passing through the birth canal is stressful. This causes the fetus to produce a large quantity of epinephrine. This helps to clear fluid from the lungs after birth. Coughing, sneezing, and hiccupping are all common behaviours after birth and help to clear the lungs. Crying can also be used as an assessment tool for respiratory function. Circulatory System The three fetal pathways for blood diversion do not anatomically close until a few days post delivery. However, increases in blood pressure cause these shunts to functionally close directly following birth. Improper closing can lead to patent ductus arteriosus. When this happens, the body’s tissues do not get enough oxygen and cyanosis may occur. https://www.healthgrades.com/rightcare/symptoms-and-conditions/cyanosis Digestive System The nutrients provided to the newborn come from storage within the body. Glucose from the heart and liver, and the break down of lipids supply the newborn with nutrients until it receives milk. https://pubchem.ncbi.nlm.nih.gov/compound/6140 The first bowel movement generally happens within the first 4 days of life. Phenylketonuria (PKU) can occur when newborn cannot metabolism proteins properly. Thermoregulation The adjustment to a cooler overall environment is a startling one for the newborn, especially because their thermoregulation is not fully functioning. Heat production mainly comes from brown fat being broken down through stimulation from epinephrine. https://medium.com/purple-green-lemons/you-need-morebrown-fat-than-white-fat-6fb892705858 Nervous System and Behaviour Fetal assessment often involves reflex testing to see how a newborn reacts to various stimuli. Newborns are able to hear, smell, and see light/dark differences and movement. Behaviours are also monitored. Five major behaviours are measured: clinging, crying, smiling (week 5), eye movement, and suckling. https://www.medicalnewstoday.com/articles/babinski-reflex Crying is a natural behaviour to communicate with care-givers. Morphological Features of Newborns • Oval shaped heads (will round-out within a few days) • Soft swelling on skull where it rested against the cervix (caput) • Blood clot between the skull and meninges • • • • • (cephalohematoma) Flat nose – from moving through the birth canal Sclera of the eyes appear grey-blue/green, sometimes brown, and pus-esque secretions come from the eyes Skin is thin and often warmer in tone than what it will be throughout life Jaundice is common – too much bilirubin – treated with UV incubation Swelling in breast tissue (in all babies) can occur. XX babies may have a bloody vaginal discharge Human Reproductive Biology, 4th Ed. (2014) pg. 230 Disorders of Newborns Premature birth can cause difficulties, especially if weight is low. Difficult births can also lead to problems, including lack of oxygen to the newborn. Stillborn births occur in 1/200 deliveries. Newborn blood is often drawn to run a series of metabolic screening tests, which can highlight diseases which are not obvious. Congenital hearing loss if fairly common – 1/1000, and an assessment is performed prior to the newborn leaving the hospital. Sudden infant death syndrome (SIDS) occurs most frequently between 1 month to 1 year. Very little is understood about why this happens, but some linkage to certain genetic, physiological, and environmental factors play a role. Birth Weight and Adult Disease Average birth weight in Canada is 3.5 kg (7.5 lbs). Normal range is 2.5 kg – 4.5 kg (5.5-10 lbs). Determination of birth weight is both affected by genetic and environmental factors. Lower weights can increase risk for the development of some illnesses (type 2 diabetes, heart disease), but can also be protective against others (certain cancers). May not be low birth weight, but the need to “catch-up” during early development for low weight births that increases some risks for illness. Physical Changes in Carrier Immediately following birth a carrier’s stroke volume/cardio output is up by 60-80%. Drops down to normal by week 6-12 postpartum. Frequent urination in the first weeks helps to remove the extra few litres of fluid still in the carrier’s body. The respiratory system bounces back to full volumes. The uterus returns to normal size within 6 weeks. Cervix dilation back to normal in 4 weeks. Vaginal tissues regulated by 6 weeks. Discharge called lochia is common in the first month. https://www.verywellfamily.com/things-you-needafter-having-a-baby-5092145 Psychological Changes in Carrier During pregnancy, a carrier must come to terms with the reality of their situation in order to accept the neonate after birth. Failure to do so can lead to negative feelings towards the neonate and failure/difficulty to bond. Baby blues often affects individuals immediately following birth. When these feelings emerge a bit later/persist and worsen, it is termed post-partum depression. Sperm donor behaviour is also affected. Some research shows decreased levels of testosterone in these new parents. Lactation High levels of progesterone and increased estrogen late in pregnancy prevent prolactin release. This leads to a delay in lactation, and instead colostrum is the first substance emitted from the breast post-birth. When the placenta is expelled, progeterone/estrogen drop and prolactin increases. This triggers lactation. Suckling causes physical nervous stimulation which triggers oxytocin release which causes contraction of myoepithelial cells leading to milk ejection. This is the milk-ejection reflex. Suckling also increases prolactin and milk synthesis. However, if the breast is not drained, a inhibitory molecule is released which prevents further prolactin release. Breastfeeding also sends impulses to the hypothalamus and inhibit GnRH release, therefore preventing menstruation for the first 6-9 months in routine breastfeeders. Human Reproductive Biology, 4th Ed. (2014) pg. 236 Pros and Cons of Breastfeeding Pros • Complete nutrient requirements for infant • Antibody transfer, linked to less disease/autoimmune symptoms later on • Growth factors may help regulate development • Sleep encouraging peptides • Oxytocin release can be calming/help with bonding for carrier Cons • Substances can pass between supplier and infant • Nutritional drain on mother • Other parents may not be as involved Human Reproductive Biology, 4th Ed. (2014) pg. 239