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Transition and Stabilization of the Newborn

Letha Nix RNC

How long should it take to transition from intrauterine life to extrauterine life?
A.) 1-2 hours B.) 2-3 hours C.) 3-6 hours D.) 6-12 hours

D.) 6-12 hours

A newborn can take up to 12 hours to transition from placental support to extrauterine support.

Transition is a process of physiologic change in the newborn infant that begins in utero as the child prepares for transition from intrauterine placental support to extrauterine selfmaintenance.

Identify primary features of fetal and newborn circulation. Identify physiologic changes during transition to extrauterine life. Identify routine care considerations for a newborn during the transition period. Identify signs and symptoms of common problems during transition period. Discuss methods for parental support.

Transition begins before delivery

Depending on. Gestational age placenta health/condition maternal health Any limitations to major organs physical defects/anomalies

Transitional begins before delivery

The infant prepares by Fetal breathing (producing surfactant at 34 weeks) storing glycogen in the liver producing catecholamines depositing brown fat

Transition begins before delivery

During Labor placenta stress hormones

Review: Placental Circulation

Exchanges O2 and CO2 by simple diffusion Eliminates waste products Does the work of the lungs in utero Uterine venous blood has
PCO2=38 mmHg PO2=40-50 mmHg pH=7.36

Review: Fetal Circulation

One Umbilical Vein-oxygenated blood Two Umbilical Arteries-deoxygenated blood Three Fetal Shunts
Ductus Venosus- hepatic system Foramen Ovale- between right & left atrium Ductus Arteriosus- vein connects pulmonary artery to descending aorta

Fetal Circulation
Foramen Ovale Shunt Right atrium Left atrium Right Ventricle

Fetal Circulation
Ductus Arteriosus Shunt Unsaturated blood Pulmonary Artery Aorta

Fetal Circulation
Fetal Lungs Fluid filled Resistant Nourishment

Fetal Circulation
Systemic Vascular Resistance Pulmonary Vascular Resistance Pulmonary Arterioles Resistant

Transition to Extrauterine Life begins when the cord is CUT.

Placenta no longer works as lungs Lungs begin to exchange gases First breath inflates lungs and causes circulatory changes Lungs inflate - resistance to blood flow through lungs & blood flow from pulmonary arteries This results in Newborn Circulation.

Newborn Circulation
Umbilical cord is clamped Placenta is separated systemic blood pressure Three major shunts close

Newborn Circulation
Circulatory Changes Fetus separation mother/placenta Lungs begin to function First breath

Newborn Circulation
Lung fluid cleared Lungs fill with O2
Systemic vascular resistance increases Initiation of respiration Pulmonary arterioles Pulmonary Vascular Resistance Pulmonary Blood flow

Newborn Circulation
Blood flow resistance Blood flows through pulmonary arteries Foramen ovale closes Blood pressure increases

Newborn Circulation
Left atrial pressure Right atrial pressure Foramen functional closure Ductus arteriosus

Newborn Circulation
Right Atrium, SVC, IVC

Poorly oxygenated blood

Right ventricle, pulmonary artery, pulmonary circulation

Oxygenated blood
Left atrium, pulmonary veins Left ventricle, aorta, systemic circulation

Physiologic Changes During Transition

Cardiovascular Respiratory Hematologic Gastrointestinal Renal Immunologic

Considerations For Newborns in Transition Period

History MaternalMedications Illness Labor and Delivery Fetal Distress Delivery Complications Types Delivery Resuscitation Measures

Vital Signs Measurements Gestational Age Assessment Head to Toe Exam Glucose/Feeding

Normal head to toe assessment findings for infant in transition Skin Head Respirations/Breath Sounds Heart Sounds Intestines Urine Extremities

normal ranges 97.7F - 98.6F results of cold stress: O2 consumption & use of glucose stores radiant warmer/isolette bathing

0.5% Erythromycin eye ointment
give within 1 hr of birth!

Vitamin K (phytonadione)
give within 1 hr of birth!

Hepatitis B vaccine & Hepatitis B immunoglobulin (HBIG)

give within 12 hrs if mom + or unknown vaccine only at d/c if negative

Glucose Needs & Feeding

Delivery stress conversion of fats and glycogen to glucose for energy At 1-2 hours of age glucose level falls Baseline glucose 30 mins-1 hr of age Goal-Glucose level
> 40 ml/dl on first day >40-50 ml/dl thereafter

Glucose Needs & Feeding-continued

Risk Factors for Hypoglycemia

Asphyxia Cold stress work of breathing Sepsis Premature or SGA Infants of mother with diabetes or gestational diabetics LGA babies

Glucose Needs & Feeding-continued

S/S of Hypoglycemia Treatment of Hypoglycemia
Feed early on demand in first hour

Evaluation before feeding Contraindication before nipple/breast feeding Contraindications to gavage feeding Guidelines for feeding Indication for IV glucose infusion

Recognition of the Sick Newborn

Perinatal History

Physical Assessment

Skin Respiratory Cardiovascular Central Nervous System Morphologic Features GI Tract

Tools Used to Diagnosis? With MD order of course!!!

Common Problems Seen In Transition

Birth Trauma Birth Asphyxia Pulmonary Cardiovascular Hemodynamics Metabolic Problems Infection Congenital Anomalies

Stabilization of the Transitioning Newborn

Use Mnemonics!
S = Sugar T = Temperature A = Artificial Breathing B = Blood Pressure L = Labs E = Emotional Support for the Family

Parental Support
Before Delivery
At Delivery

During Transition

Transition period can last 6-12 hours Three phases of transition
Phase One- Period of Reactivity

1-2 Hours Phase Two- Sleep Period 1-4 Hours Phase Three- Second Period of Reactivity 2-8 Hours

Any Questions ?