Newborn adaptation

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<ul><li> 1. Newborn AdaptataionPrepared By : HamzeH HarayzeHAl-AbbadiPresent for : Dr Gounan Samhan} : 12{ } 13{ }14{. </li> <li> 2. Outlines-Objectives-Introduction-Cold stress-Jaundice-Periodic breathing-Neutral thermal-Meconium-Thermoregulation-Neoatal period-Reflex-Fetal stuctures-Fetal circulation-NTE-kernicterus-Natural and acquired immunity-Fetal Immunoglobulins-Behavioral patterns </li> <li> 3. Objectives-Define outlines and key term used in outline-Identify the major changes in body,systems thatoccur as the newborns adapt to extrauterine life.-List the primary challenges faced by the newbornsduring the adaptation to extrauterine life.-Explain the three behavioral patterns of newbornbehavioral adaptaion.-Discuss the five typical behavioral responses of thenewborn-Discuse and have to understand fetal circulation-Know blood component for newborns.-Know about surfactant hormone and wat it functionin the body. </li> <li> 4. IntroductionThe neonatal period:Is defined as the first 28 days of life.-After Birth the newborn is exposed to awhole newSoundColorsSmellsSensation**the newborn previously confined to thewarm,dark,wet intra-uterineenvironment.Now is thrust into environment that muchbrighter and color. </li> <li> 5. In this presentation we have to descripe thephysiologic changes of the newbornsmajor body systems.it also discusses thebehavioral adaptaions.Includingbehavioral patterns and the newbornsbehaviroal respones &lt; that occur duringthis transition period. </li> <li> 6. Physiologic adaptationsThe mechanics of birth require a change in the newborn forsurvival outside the uterus.Immediately,respiratory,gasexchange,along with circulatory modification, must beoccur to sustain extrauterine life.during this time,asnewborns strive to attain homeostasis.The also experience complex changes in major organsystem.Although the transition usually takes place within the first 6-10 hours of life ..many adaptation take weeks to attainfull maturity </li> <li> 7. Respiratory systemfetus :fluid-filled,high-pressure system cause blood to be shuntedfrom the lungs through the ducts arterious to the rest of thebody.Newborn :Air-filled,low-pressure system encourge blood flow throughthe lungs for gas exchange;increase o2 content of blood inthe lungs contributes to the closing of the ductsarteriosus(becomes a ligament(. </li> <li> 8. Site of gas exchangeFetus:PlacentaNewborn:Lungs </li> <li> 9. Hepatic portal circulationFetus:Ductus venosus bypasses;maternal liverperforms filtering fuction.Newborn:Ductus venosus closes(becomes aligment(;hepatic portal circulation begin. </li> <li> 10. Circulation through the heartFetus:Pressure in the right atrium are greater than in theleft,encourging blood flow through the foremanovaleNewborn:Pressure in the left atrium are greater than in theright, causing circulation begins. </li> <li> 11. ThermoregulationFetus:Body temperature is maintained by maternal bodytemperature and the warmth of the intrauterineenvironment.Newborn:Body temperature is maintained through a flexedposture and brown fat </li> <li> 12. Cardiovasular system adaptations </li> <li> 13. Cardiovasular systemadaptations-The umbilical vein carries oxygenated bld from placentato the fetus.-The ductus venosus allows the majority of the umbilicalvein bld to bypass the liver and merge with bld movingthrough the vena cava, bringing it to the heart sooner.-The foramen ovale allows more than half the bld enteringthe right atrium to cross immedediatly to the leftartium,thereby passing the pulmory cicrulation-The ducuts arterious connects the pulmonary artery to theaorta, which allow bypassing of pulmonary circuit.. </li> <li> 14. At birth : placental (fetal) circ~~~&gt; pulmonary (newborn) gasexchangeThe physical forces of the contractions of labor andbirth,mild asphyxia, increased intracranial pressure as aresult of cord compression and uterine contraction,aswell as cold stress immediately experienced after birthlead to an increased release in catecholamines that iscritical for the changes involved in the transition toextrauterine life.The increased level epinephrine and norepinephrinestimulate increase cardiac output and contractility.surfactant release and promotion of pulmonary fluidclearance. </li> <li> 15. Fetal StructuresWhen umbilical cord is clamped---the first breath is taken and the lungsbegin to function as a Result-systemic vascular resistance increase and bldreturn to the heart via the inferior vena cava decrease.-With this change there is rapid decrease in pulmonary vascularresistance and increase in pulmonary bld flowThe foramen ovale functionally closes with a decrease in pulmonaryvascular resistance-Ductus arteriosus,ductus venosus,umbilical vessels that were vital duringfetal life are no longer needed.-the increase left atrail pressure causes the foramen ovale to close ..(Why..??) </li> <li> 16. -Foramen ovale closes with decrease pulmonary vascular resistanceIncreases pressure to left side of heart-4chambers-Ductus arteriosis closes due to increase of O2 to lungs.. ..( closewithin few hours after birth(-Ductus venosus close bcoz liver is activated..(close within few daysafter birth( ~~~&gt; convert to ligament in extrauterine life. </li> <li> 17. Heart rate-During the first few minutes after birth,HR=120-180 bpm.Thereafter begin decrease to average 120-130 pbm.THE newborn is highly dependent on heart rate formaintenance of cardiac output and BP.-Transient functional cardiac murmurs may be heardduring the neonatal period as a result of changingdynamics of the cardiovascular system at birth.So Its Normal during first 12 hours at nb age..But after 12 hours we have to do evolution for nb </li> <li> 18. Heart rate- 120-180 fluctuations due to activityAn increase in activity, such aswakefulness,movement,or crying, corresponds to anincrease in HR and bld pressure.Tachycardia :&gt; volume depletion,cardiorespiratorydss,drug withdrawal and hyperthyroidismBradycardia :&gt; associated with apnea and hypoxia </li> <li> 19. Blood Volume-The blood volume of the nb depend on the amount ofbld transferred from the placenta at birth.Its usuallyestimated to be 80-85 mlkg of body with the term infant.The volume may vary as much as 25%-40%,depending onwhere clamping of umbilical cord occurs.-Recent studies show the benefits of delayed cordclamping as improving the nb cardiopulmonaryadaptation ,preventing childhood anemia withoutincrease hypervolemia-related risks, increasing bldpressure, improving o2 transport.abd increase RBC flow. </li> <li> 20. Blood Components-Rbcs newborn life span= 80-10 days/120 in adult-Hb initially declines as a result of decrese in neonatal redcell mass(physiolgic anemia of infancy(.-Leukocytosis (elevated white bld cell( is present as aresult of birth trauma soon after birth.-The newborn platelet count and aggregation ability arethe same as adult. </li> <li> 21. HB 17-20G-DLHematocrit 52%-63%platelets 100.000-300.000-UlRed blood cells 5.1-5.8White blood cells 10-30/mm3 </li> <li> 22. The nb hematologic values are affected by:-the site of the bld sample (capillary bld hashigher levels of hb and hematocrit comparedwith venous bld.-placental transfusion (delayed cord clampingand normal shift of plasma of extravascularspaces,which cause higher levels of hb andhemoatocrit).-Increse GA _ Increase RBS and Hb </li> <li> 23. One of the most crucial adaptations that the nbmakes at birth is adjusting from a fluid-filledintrauterine environment to a gaseousextrauterine environment.during fetal life,thelungs are expanded with an ultrafiltrate of theamniotic fluid.during and after birth,this fluidmust be removed and replaced with air.passagethrough the birth canal allows intermittentcompression of the thorax,which helps eliminatethe fluid in the lungs.Respiratory System Adap.. </li> <li> 24. Respiratory System ContThe first breath of life is a gasp that generates an increase intranspulmonary pressure and result in diaphragmaticdescent.hypercapnia,hypoxia,and acidocis resulting from normallabor become stimuli for initiating respirations.= Tidal VolumeSurfactant is a surface tension-reducing lipoprotien found in the nblungs that prevents alveolar colapse at the end of expiration andloss of lung volumeQ : wat G-age surfactant Hormone is Formed and wats it function fornewborn body ??. and if surfactant dost complete form in newbornbaby..the baby maybe birth with..???-,-Normal lung function is dependent upon surfactant,which permits adecrease in surface tension at end-expiration( to preventatelectasis( and an increase in surface tension during lungexpansion( to facilitate elastic recoil on inspiration(. </li> <li> 25. Note:-Baby born by cesarean delivery does nothave the same benefit of the birth canalsqueeze as does the nb born by vaginaldelivery.Closely observe the respirations of the nbafter cesarean delivery. </li> <li> 26. Before the nb lungs can maintainrespiratory function,the followingevents must occur:*-Initiation of respiratory movement*-expansion of the lungs*-establishment of functional residualcapacity) ability to retain some air in thelungs on expiration).*-increased pulmonary bld flow*-redistribution of cardiac output. </li> <li> 27. RespirationsAfter respiration are established in the nb,they are shallow andirregular,ranging from 30 to 60 breaths per minute,with short periodsof apnea(less than 15 second).Signs of respiratory distress to observe for includecyanosis,tackypnea,expiratory grunting,sternal retractions and nasalflaring.In some cases, periodic breathing may occur,which is the cessationof breathing that lasts 5 to 10 seconds without changes in color orHR.Apneic periods lasting more than 15 seconds with cyanosis and HRchanges require further ecaluation. </li> <li> 28. Body Temperature RegulationOne of the most important elements in a nbsurvival is obtaining a stable bodytemperature to promote an optimaltransition to extrauterine life.Nb T= 36.5 to 37.5c*Thermoregulation.. ?? </li> <li> 29. Heat lossNewborn have several ch-ch that predispose them to heat loss:*-thin skin with bld vessels close to the surface.*-lack of shivering ability to produce heat involuntarily*-limited use of voluntary muscles activity or movement to produce heat.*-large body surface area relative to body weight.*-lack subcutaneous fat, which provide insulation.*-no ability to adjust their own clothing or blankets to achieve warmth.*-Inability to communicate that they are too cold or too warm.*-little ability to conserve heat by changing posture (fetal postions(. </li> <li> 30. Types of Heat Loss-Conduction- heat loss by contact with cooler surface.-Convection- warm body to cool air currents.-Evaporation- water converts to vapor.-Radiation-heated body to cooler object (no directcontact(. </li> <li> 31. ThermoregulationThermoregulation, the balance between heat loss and heat production,is related to the newborns rate of metabolism and...</li></ul>