L4: Newborn adaptations to extrauterine life Flashcards
Newborn adjustments to the respiratory system
- When born we stimulate the baby to cry. This helps open up the lungs
- An increase in RR can be a sign of infection
- Opioids can decrease fetal RR
- We are okay with acrocyanosis (blue extremities); not central cyanosis
Which ducts close in the circulation system after birth
- Ductus venosus
- ductus arteriosus: If it doesn’t close completely it is still benign and you can hear swooshing sound during auscultation.
- foreman ovale
Fetus circulation
TBC
- Mom to baby’s liver via UC
Cardiovascular adaptations
When baby takes first breath and the cord is clamped:
- pulmonary pressure decreases
- Increase blood flow to lungs
- Inc oxygen to periphery
- the high vascular pressure cause inc pressure in the left atrium, the ventricle, and the aorta which shuts the foramen ovale
Explain the cardiovascular assessment
- the normal HR ranges from 110-160bpm. Ranges with activity
- should auscultate apical pulse instead of umbillical cord pulse. More accurate
- Concerned for apnea, central cyanosis, pallor, poor feeding
Hematopoietic system changes
- RBC and hemoglobin level are high in fetus but they will dec 2w after birth
- They have high WBC (leukocytes)
- they have low platelet levels hence the reason to administer vit K.
Thermoregulation system adaptations
Prone to hypothermia
Thermoregulation methods:
- vasoconstriction
- acrocyanosis
- Inc metabolic activity of glucose and O2 by flexing
- metabolize brown fat
Babies cannot not shiver
What are cold stress symptoms
Blood sugar drops so baby develops resp distress, reopening of ductus arteriosus, hyperbilirubinemia, hypoglycemia
Renal changes
- Water loss in first few day causes 5-10% weight loss
-
GI changes
Babies don’t have amylase or lipase. Lipase in human milk helps babies digest fat
Stool changes
meconium to transitional stool, to milk stool within first week
Feeding behaviours in newborns
- it’s important to monitor force, frequency, amount, and time of regurgitation
- Babies can be fussy bc they are uncomfortable
Hepatic system changes
- There is a decrease in the baby’s glucose blood level after birth.
- There is a risk of hypoglycemia esp in babies with diabetic mothers (we want it to be between 2.5 to 3.0 mmol/L)
- After day 4, the glucose level stabilizes to 4.0 to 6.0 mmol/L
What Immunoglobins do we pay attention to after birth
- IgG: Crosses placenta for passive immunity
- IgM: elevated levels is a sign of infection
- IgA: is passed through breastmilk. It provides baby with a little bit of respiratory and GI infection resistance
