Title: THE NEWBORN
1THE NEWBORN
I had heard about the negatives---the fatigue,
the loneliness, loss of self. But nobody
told me about the wonderful parts holding
my baby close to me, seeing his first smile,
watching him grow and become more
responsive day by day.....For the first time I
cared about somebody else more than
myself, and I would do anything to
nurture and protect him.
2Respiratory Changes
- Extrauterine
- Within a few minutes after birth the vital
capacity is established - Surfactant reduces surface tension in alveoli and
keeps lungs from collapsing
- Intrauterine
- Lungs serve no respiratory function
- Oxygen supply secured through the placenta
- Lungs are filled with lung fluid which keeps them
partially expanded -
3Respiratory Changes
Mechanical
Initiation of Breathing
Chemical
Sensory
4Chemical Events
- 1. With cutting of the cord, remove oxygen
supply -
- 2. Asphyxia occurs
- 3. CO2 and O2 and pH
ACIDOSIS - 4. Acidotic state-- stimulates
the - respiratory center in the
medulla and - the chemoreceptors in
carotid artery to - initiate breathing
5Mechanical Events
- As the chest passes
- through the birth canal
- the lungs are compressed
- Subsequent recoil of the chest wall produces
passive inspiration of air into the lungs
Fluid expelled
Air Enters
6Mechanical Events
- About 60-110 ml. of fluid is squeezed out of the
lungs as the chest is compressed - The remaining fluid evaporates or is reabsorbed
by the blood vessels and lymphatics surrounding
the lungs. - When a baby is delivered in a presentation
other than vertex, it takes longer for the lungs
to rid themselves of the fluid
7Sensory Events
- Thermal--the decrease in
- environmental temperature
after - delivery is a major stimulus
of breathing
- Tactile--nerve endings in the skin
- are stimulated
- Visual--change from a dark world to
- one of light
- Auditory--sound in the extrauterine
- environment
stimulates the infant
8Answer this !
Answer This!
- When a baby is born by cesarean delivery, which
of the mechanisms to initiate breathing does it
lack?
9Cardiovascular Changes
10Fetal Circulation
- Placenta Umbilical Vein Liver
- Ductus venosus Inferior Vena Cava
- Right Atrium Foramen Ovale
- Left Atrium Left Ventricle Aorta
11Fetal Circulation
Enters Rt. Atrium Foramen Ovale Lf. Atrium Lf.
Ventricle Aorta To the Body
To the body
LA
RA
LV
RV
12Fetal Circulation
Right Atrium Right Ventricle
Pulmonary Artery Ductus
Arteriosus Aorta Body
(Small amount goes to the lungs)
13Fetal Circulation
Aorta
- OR
- Right Atrium
- Right Ventricle
- Pulmonary Artery
- Ductus Arteriosus
- Aorta
Ductus Arteriosus
LA
RA
LV
RV
14Cardiovascular Changes
- 1. Oxygen enters the lungs, and pulmonary alveoli
expand - 2. Oxygen lowers resistence in the pulmonary
vessels allowing blood to flow more freely to and
from the lungs - 3. Pressure in the right atrium decreases because
of flow of blood to the lungs - 4. Pressure in the left atrium increases because
of flow of blood from the lungs - 5. With oxygenation, the ductus arteriosus begins
to constrict, becoming functionally closed - 6. As pressure in the left side fo the heart
begins to exceed that in the right side, the
foramen ovale becomes closed.
15Cardiovascular Changes
3. Ductus Arteriosus begins to constrict
2. Blood flows to the lungs
4. Pressure in the LA increases RT Flow
of blood from the lungs
1. Pressure in RA decreases
5. Increase pressure in the LA forces the foramen
ovale to close
16True / False
- An infants first breath results in reduced
pulmonary vascular resistance, decreased left
atrium pressure, and increased right atrium
pressure - Increase CO2 , decreased O2, and increased pH
help trigger initial breathing
17Renal / Kidney Changes
- Intrauterine
- Urine if formed in utero and some excreted into
the amniotic fluid - Excretion of wastes is the function of the
placenta
- Extrauterine
- GFR is low --decrease ability to excrete drugs
- Limited ability to reabsorb Sodium
- Decreased ability to concentrate urine
- Bladder capacity is
- 6 - 44 ml
- Void within the first 24 hrs. and should void 6 -
10 times per day
18Hepatic and Liver Changes
- The newborns liver plays a role in
- Iron storage--for new RBC production. If the
mothers iron intake has been adequate, enough
iron will be stored to last 5 months. After
about 6 months of age, food containing iron or
iron supplements must be given - Carbohydrate metabolism--Glucose is the main
source of energy in the first 4 - 6 hrs. of life.
If the fetus experiences hypoxia or stress, the
glycogen stores are used ( and may be depleted)
to meet metabolic needs.
19Hepatic and Liver
- Iron Storage
- Carbohydrate metabolism
20- Coagulation--coagulation factors are under the
influence of vit. K. The absence of normal flora
needed to synthesize vit. K results in low levels
of vitamin K and creates a transient blood
coagulation alteration between the second and
fifth day after birth. - Vitamin K is given prophylactically to
combat
potential clinical bleeding problems
21Conjugation of Bilirubin
- Unconjugated bilirubin is a breakdown product
derived from hemoglobin that is released from
destroyed RBCs. - Unconjugated bilirubin is not in an excretable
form and is a potential toxin, so it must be
conjugated, made water-soluble, in order to be
excreted from the body.
22Conjugation of Bilirubin is a conversion of
Fat Soluble
Water Soluble
to
Unconjugated
Conjugated
by the enzyme Glucuronyl transferase in
the newborns liver
23Physiological Jaundice
- About 50 of all infants exhibit signs in 2 - 3
days after birth - Bilirubin levels at birth are about 3 mg./dl
and should not exceed 12 mg. - Nursing Care
- Keep well hydrated
- Promote elimination
- early feedings tend to keep bilirubin levels down
by stimulating intestinal activity thus removing
the contents and not allowing reabsorption
24Blood Changes
- By the 6th month the bone marrow has become chief
site of blood formation - The infant is born with a large number of RBCs
25Temperature Regulation
- A newborn is at a DISADVANTAGE in maintaining a
normal temperature because - Larger body surface in relation to body mass
- Small amount of insulating subcutaneous fat
26 Minimizing Heat Loss in the Newborn
is IMPERATIVE
27Four Avenues of Heat Loss
- Conduction --Loss of heat to a cooler surface by
direct skin contact - Convection--Loss of heat to cooler air currents
- Radiation--loss of heat to cooler surfaces and
objects not directly in contact with the skin - Evaporation-- loss of heat when water is
converted to a vapor.
28Heat Production
- 1. Increase in Muscular activity--shown by crying
and restlessness increases BMR - 2. Non-Shivering Thermogenesis - unique to
newborns. Uses the infants stores of brown fat. - Brown fat is found in the midscapular area,
around the neck, in the axillas, and around the
trachea, kidneys, and adrenal glands
29Non Shivering Thermogenesis
- 1. Skin receptors perceive a drop in
environmental temperataure - 2. Transmit impulses to the central nervous
system - 3. Which stimulates the sympathetic nervous
system - 4. Norepinephrine is released at local nerve
endings in the brown - 5. Metabolism of brown fat
- 6. Release of fatty acids
- 7. Release of HEAT!
30Peripheral Vasoconstriction
Subcutaneous Fat
Heat Maintenance
Curl up in fetal position
31Gastrointestinal Changes
- By 36-38 weeks of fetal life, the GI system is
fully mature and ready to digest simple
carbohydrates, fats, and protein. - The newborns stomach holds about 50 - 60 cc.
- Pass meconium in 24 - 48 hours after birth. This
shows the GI tract is patent.
32Immediate Care of the Newborn
- Ensure a Patent Airway
- Position on side
- Suction mouth then nares
- supply warmed oxygen is necessary
- Always have bulb suction in view !
33Clamping of the Cord
- Cord should be clamped off about 1 from base of
cord. - Inspect the cord for 2 arteries and 1 vein.
- Dont milk the cord
34Maintain Body Temperature
- Dry off
- Place in warmer
- Skin to skin contact
35Apgar Score
- Scoring system to appraise the newborn
- Done at 1, 5, and 10 minutes after birth
36Apgar Score
0 1 2
Heart Rate is the most important !
37Apgar Score
- Score of 7 - 10 Good Condition
- Score of 4 - 6 Fair Condition
- Score of 0 - 3 Poor Condition
38Score This !
- Baby girl Doe has a heart rate of 102, with slow,
irregular respirations. She grimaces when
stimulated. She has some flexion in her
extremities and her skin color is pale. - What is her Apgar Score?
39Identification of the Newborn
- Mother and infant should have matching
identibands. - Bands should be placed on infant prior to leaving
the delivery room - Footprint of infant and fingerprint of the mother
40Eye Care
- Legal requirement that all newborns have
treatment to prevent Ophthalmia neonatorium which
can lead to newborn blindness. - Treated with antibiotic eye medication either
ointment or drops - (Tetracycline or Erythromycin )
41Hemorrhage Prophylaxis
- Administration of Vitamin K (AquaMEPHYTON)
- This promotes liver formation of clotting factors
- The newborn does not have bacteria in the GI
tract to synthesize vit. K. - By 5 - 8 days after birth, it is formed.
42Transfer to the Nursery
- Identification checks
- Full report must be given to the nursery nurse by
the L D nurse - Condition of the neonate
- Labor and Birth record
- Antepartal history
- Parent-newborn interaction
43Nursing Assessments of the
Newborn
44Physical Assessment
- Temperature - 97.6 - 98.6
- Heart Rate - 120 - 160 BPM. Regular rate. PMI
- on the left side
of the chest - Respirations- 30 - 60 breaths / min.
Diaphragmatic with a shallow, irregular rate and
rhythm. Chest and abdominal movements should
synchronize. Periodic Breathing is normal. They
are nose breathers. Tachypnea is abnormal - Blood Pressure - 80-60 / 45-35.
45Measurements and Weights
- Length 18 - 22 inches
- Head and Chest Circumference Head is 13
Chest is 12. Head is larger than the chest by
one inch or 2 cm. - Weight - 6 - 9 lbs average. Newborns lose 5 -
10 of birth weight the first few days after
birth.
46Reflexes
- Moro
- Tonic Neck
- Palmar and Plantar grasp
- Babinski
- Feeding--Rooting, Sucking, Swallowing, Gag
- Protective -- Sneezing, Blinking, Gag
47Senses
- Touch-- most significant in first few weeks
- Vision -- can see objects 8 - 12 inches from
their eyes. They like faces the most,
particularily the eyes. Follow objects. Like
yellow and red. - Hearing -- they will turn toward the sound of a
voice. Alert more to a high pitched voice - Taste -- can discriminate tastes. Sweet /
non-sweet. - Smell -- ability to smell increases over first
few days of life. Smell moms breast milk.
48Skin
- Pink with acrocyanosis
- Desquamation
- Vernix caseosa
- Lanugo
- Erythema toxicum
- Mongolian spots
- Birth marks
49Head
- Large. 1/4 size of body
- Fontanels and sutures
- Fontanels should be soft and flat
- bulging increased intracranial pressure
- depressed dehydration
- Molding
- Cephalhematoma- bleeding between bone and
periosteum that does not cross sutures - Caput succadenum - edema (fluid) under the skin
of the scalp that crosses sutures
50Face
- Rounded
- Fat pads in the cheeks for sucking
51Eyes
- Slate blue
- Spaced 1/3 across face
- Assess for subconjunctival hemorrhage
- Check pupils
- May have strabismus or nystagmus
52Ears
- Assess placement
- should align with canthus of eye and where ear
attaches to the head - low set ears renal or chromosomal problems
- Assess Appearance
- Pinna of ear should have incurving
- No skin tags
- Note Gestation
- Rapid recoil
53Nose
- Check patency
- Note drainage
54Mouth
- Firm Palate
- Tongue
- short frenulum
- Should not protrude
- Extrusion reflex
- No Teeth
- Epstein pearls
55- Nose -- patency
- Mouth
- Neck
- Chest
- Abdomen
- Genitals -- never retract foreskin on male
- Anus -- patency
- Cry -- loud and lusty
56Behavorial / Sleep - Awake States
- Deep sleep
- Light Sleep
- Drowsy
- Quiet alert
- Active alert
- Crying
57Daily Nursing Care
- Need for warmth and dry
- Need for protection from infection
- Need for food
- Need for attachment and loving
- Need for bathing and cord care
58Nutritional Needs
- The newborns diet must supply nutrients to meet
the rapid rate of physical growth and development - Daily caloric intake should be 110 - 120 calories
/ kg. / day
59Circumcision
- It is not medically necessary. It is a personal
decision of the parents. - Nursing Care
- Assess for bleeding and voiding
- Apply vaseline
- Position on side not abdomen