the neonatal period (n2)

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THE NEONATAL PERIOD

HUMAN DEVELOPMENTVanessa M. Manila, RN

UP Manila College of Nursing

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1. Describe the newborn’s transition to extrauterine life.a. Intrauterine Life

b. Physiologic Adaptations

2. Describe the neonatal physical characteristics

3. Describe the neonate’s behavioral responses and developmental tasks

4. Discuss appropriate nursing care of the newborn

OBJECTIVESOBJECTIVES

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Transition from intrauterine Transition from intrauterine to to

extrauterine lifeextrauterine life

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I. Intrauterine Life

Placental Function:Placental Function:- transfer of gases (lungs)

- transport of nutrients (gastrointestinal tract)

- excretion of wastes (kidneys)- transfer of heat (skin)

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I. Intrauterine LifePlacental Function:Placental Function:

- conjugation of drugs and hormones (liver)

- production of various protein and steroid hormones (endocrine

gland)

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II. Physiologic Adaptations

“ The most profound physiologic change

required of the neonate is

transition from fetal or placental

circulation to independent

respiration…” (Whaley and Wong,

1989)

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A. Respiratory adaptationsB. Cardiovascular adaptationsC. Temperature regulationD. Urinary AdaptationsE. Gastrointestinal AdaptationF. Hepatic AdaptationG. Immunologic SystemH. Neurologic and Sensory/ Perceptual

Functioning

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most critical: first 24 hoursthe most critical and immediate physiologic change required of the newborn is the onset of breathing

slapping the infant’s feet/ buttocks has no beneficial

effect

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- shallow and irregular depth and rhythm- Primarily abdominal and synchronus with

the chest mov’t- Short periods of apnea are to be expected- Pauses lasting 5- 15 secs, called periodic

breathing, may occur

Characteristics:- Normal rate: 30- 60

breaths per minute


A. Respiratory adaptations

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Characteristics:Heart rate: 100 bpm when asleep; 120- 150 when awake

- Rates as high as 180 while crying may be normal

- Apical pulse rates should be obtained by auscultation for a full minute

BP: resting: 74/47 mmHg- Crying may cause elevation


B. Circulatory adaptations

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Neonatal Characteristics affecting thermal adaptation:- decreased subcutaneous fat and thin epidermis- blood vessels are closer to the skin- large body surface area- flexed posture - presence of Brown Adipose Tissue


C. Thermogenic Adaptations

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Thermogenesis in newborn:- increased muscular activity and positional changes- chemical thermogenesis (non-shivering thermogenesis); increased basal metabolic rate- vasomotor control


C. Thermogenic Adaptations

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First voiding should occur within 24 hoursUnable to concentrate urineUsually straw- colored and almost odorlessPseudo- menstruation in female infant


D. Renal System

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Loss of fluid, through urine, feces, lungs, increased metabolic rate and limited fluid

intake results in 5- 10% loss of body weight. This usually occurs during the

first 3-5 days. The infant usually regains the birth weight within 14 days after birth

At birth the total weight of the infant is 73% fluid as compared to 58% in

the adult

The infant has a proportionately higher ratio of

extracellular fluid than the adult

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E. Gastrointestinal System

The ability to digest, absorb, and metabolize food stuff is adequate but limited in certain functions.

(Whaley and Wong, 1989)

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E. Gastrointestinal System

A special mechanism coordinates breathing, sucking, and swallowing reflexes necessary for oral feedingSucking in newborn takes place in small bursts of 3- 8 sucks at a timeUnable to move food

from the lips to the pharynx

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III. Physiologic Adaptations

F. Hepatic Regulation

Liver is immature

Plays an important role:1. conjugation of bilirubin2. blood coagulation

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G. Immunologic System

Cells that provide the infant with immunity are developed early in fetal lifeNot activated for several monthsFirst 3 months: passive immunity from the mother

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III. Physiologic Adaptations

G. Immunologic System

Breast- fed infants receives passive immunity through colostrums and breast milkSepsis: respiratory distressBest protection: hand hygiene

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II. Physiologic AdaptationsH. Neurologic and Sensory/

Perceptual Functioning

Neither anatomically nor physiologically developedAll neurons are presentUncoordinated in movementLabile in temperature regulationHave poor control over their musculature

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Vision- the least

mature at term- development

continues for the first 6 months

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Hearing- as soon as amniotic fluid is drained

from the ear, hearing is similar as to that of an adult

- react to high frequency sound with a startle

- reacts to low- frequency sound by decreasing motor activity or stopping crying

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Smell- highly developed- by the 5th day, can recognize

mother’s smell- breastfed infants are able to smell

breastmilk and can differentiate their mother from other lactating women

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Taste- tasteless solution: no response- sweet: eager sucking- sour: puckering of lips- bitter: grimace- newborns prefer glucose water to plain water

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Touch- responsive to all

parts of the body- face, hands, and soles

of the feet appear to be the most sensitive

- touch and motion are essential to normal

growth and development

the neonatal period (n2)

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