TransitionandStabilizationoftheNewborn

,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Transition and Stabilization of the Newborn,Letha Nix RNC,1,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,2,D.) 6-12 hours,A newborn can take up to 12 hours to,transition from placental support to,extrauterine support.,3,Definition,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 self-maintenance.,4,Objectives,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.,5,Transition begins before delivery,Depending on.,Gestational age,placenta health/condition,maternal health,Any limitations to major organs,physical defects/anomalies,6,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,7,Transition begins before delivery,During Labor,placenta,stress hormones,8,Review: Placental Circulation,Exchanges O,2,and CO,2,by simple diffusion,Eliminates waste products,Does the work of the lungs in utero,Uterine venous blood has,PCO,2,=38 mmHg,PO,2,=40-50 mmHg,pH=7.36,9,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,10,Fetal Circulation,Foramen Ovale,Shunt,Right atrium,Left atrium,Right Ventricle,11,Fetal Circulation,Ductus Arteriosus,Shunt,Unsaturated blood,Pulmonary Artery,Aorta,12,Fetal Circulation,Fetal Lungs,Fluid filled,Resistant,Nourishment,13,Fetal Circulation,Systemic Vascular Resistance,Pulmonary Vascular Resistance,Pulmonary Arterioles Resistant,14,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.,15,Newborn Circulation,Umbilical cord is clamped,Placenta is separated,systemic blood pressure,Three major shunts close,16,Newborn Circulation,Circulatory Changes,Fetus separation mother/placenta,Lungs begin to function,First breath,17,Newborn Circulation,Lung fluid cleared,Lungs fill with O2,Systemic vascular resistance increases,Initiation of respiration,Pulmonary arterioles,Pulmonary Vascular Resistance,Pulmonary Blood flow,18,Newborn Circulation,Blood flow resistance,Blood flows through pulmonary arteries,Foramen ovale closes,Blood pressure increases,19,20,Newborn Circulation,Left atrial pressure,Right atrial pressure,Foramen functional closure,Ductus arteriosus,21,22,Newborn Circulation,Postnatal,Right Atrium, SVC, IVC,Poorly oxygenated blood,Right ventricle, pulmonary artery, pulmonary circulation,Oxygenated blood,Left atrium, pulmonary veins,Left ventricle, aorta, systemic circulation,23,Physiologic Changes During Transition,Cardiovascular,Respiratory,Hematologic,Gastrointestinal,Renal,Immunologic,24,Considerations For Newborns in Transition Period,History,MaternalMedications,Illness,Labor and Delivery,Fetal Distress,Delivery Complications,Types Delivery,Resuscitation Measures,25,Assessment,Vital Signs,Measurements,Gestational Age Assessment,Head to Toe Exam,Glucose/Feeding,26,Assessment-continued,Normal head to toe assessment findings for infant in transition,Skin,Head,Respirations/Breath Sounds,Heart Sounds,Intestines,Urine,Extremities,27,Thermoregulation,normal ranges 97.7F - 98.6F,results of cold stress:,O,2,consumption & use of glucose stores,radiant warmer/isolette,bathing,28,Medications,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,29,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,30,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,31,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,32,Recognition of the Sick Newborn,Perinatal History,Physical Assessment,Skin,Respiratory,Cardiovascular,Central Nervous System,Morphologic Features,GI Tract,33,Tools Used to Diagnosis?,With MD order of course!,34,Common Problems Seen In Transition,Birth Trauma,Birth Asphyxia,Pulmonary,Cardiovascular,Hemodynamics,Metabolic Problems,Infection,Congenital Anomalies,35,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,36,Parental Support,Before Delivery,At Delivery,During Transition,Transfers,37,Review,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,38,Any Questions ?,39,