Transition%20and%20Stabilization%20of%20the%20Newborn

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Transition and Stabilization of the Newborn

• Letha Nix RNC

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• 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

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• D.) 6-12 hours
• A newborn can take up to 12 hours to
• transition from placental support to
• extrauterine support.

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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.

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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.

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Transition begins before delivery

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

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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

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Transition begins before delivery

• During Labor
• placenta
• stress hormones

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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
• PCO238 mmHg
• PO240-50 mmHg
• pH7.36

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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

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Fetal Circulation

• Foramen Ovale
• Shunt
• Right atrium
• Left atrium
• Right Ventricle

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Fetal Circulation

• Ductus Arteriosus
• Shunt
• Unsaturated blood
• Pulmonary Artery
• Aorta

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Fetal Circulation

• Fetal Lungs
• Fluid filled
• Resistant
• Nourishment

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Fetal Circulation

• Systemic Vascular Resistance
• Pulmonary Vascular Resistance
• Pulmonary Arterioles Resistant

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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.

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Newborn Circulation

• Umbilical cord is clamped
• Placenta is separated
• ? systemic blood pressure
• Three major shunts close

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Newborn Circulation

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

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Newborn Circulation

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

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Newborn Circulation

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

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Newborn Circulation

• Left atrial pressure ?
• Right atrial pressure ?
• Foramen functional closure
• Ductus arteriosus

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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

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Physiologic Changes During Transition

• Cardiovascular
• Respiratory
• Hematologic
• Gastrointestinal
• Renal
• Immunologic

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Considerations For Newborns in Transition Period

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

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Assessment

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

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Assessment-continued

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

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Thermoregulation

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

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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

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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
• gt 40 ml/dl on first day
• gt40-50 ml/dl thereafter

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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

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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

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Recognition of the Sick Newborn

• Perinatal History
• Physical Assessment
• Skin
• Respiratory
• Cardiovascular
• Central Nervous System
• Morphologic Features
• GI Tract

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

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Common Problems Seen In Transition

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

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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

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Parental Support

• Before Delivery
• At Delivery
• During Transition
• Transfers

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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
  

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Any Questions ?