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Newborn Adaptataion
Prepared By : HamzeH HarayzeH
Al-Abbadi
Present for : Dr Gounan Samhan
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} ‫ن‬ٍ ‫كي‬ِ ‫م‬ّ ‫ر‬ٍ ‫را‬َ ‫ق‬َ13{‫ة‬َ ‫غ‬َ ‫ض‬ْ ‫م‬ُ ‫ل‬ْ ‫ا‬ ‫نا‬َ ‫ق‬ْ ‫ل‬َ ‫خ‬َ ‫ف‬َ ‫ة‬ً ‫غ‬َ ‫ض‬ْ ‫م‬ُ ‫ة‬َ ‫ق‬َ ‫ل‬َ ‫ع‬َ ‫ل‬ْ ‫ا‬ ‫نا‬َ ‫ق‬ْ ‫ل‬َ ‫خ‬َ ‫ف‬َ ‫ة‬ً ‫ق‬َ ‫ل‬َ ‫ع‬َ ‫ة‬َ ‫ف‬َ ‫ط‬ْ ‫ن‬ّ ‫ال‬ ‫نا‬َ ‫ق‬ْ ‫ل‬َ ‫خ‬َ ‫م‬ّ ‫ث‬ُ
‫ن‬َ ‫قي‬ِ ‫ل‬ِ ‫خا‬َ ‫ل‬ْ ‫ا‬ ‫ن‬ُ ‫س‬َ ‫ح‬ْ ‫أ‬َ ‫ه‬ُ ‫ل‬ّ ‫ال‬ ‫ك‬َ ‫ر‬َ ‫با‬َ ‫ت‬َ ‫ف‬َ ‫ر‬َ ‫خ‬َ ‫آ‬ ‫قا‬ً ‫ل‬ْ ‫خ‬َ ‫ه‬ُ ‫نا‬َ ‫أ‬ْ ‫ش‬َ ‫أن‬َ ‫م‬ّ ‫ث‬ُ ‫ما‬ً ‫ح‬ْ ‫ل‬َ ‫م‬َ ‫ظا‬َ ‫ع‬ِ ‫ل‬ْ ‫ا‬ ‫نا‬َ ‫و‬ْ ‫س‬َ ‫ك‬َ ‫ف‬َ ‫ما‬ً ‫ظا‬َ ‫ع‬ِ
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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

Objectives
-Define outlines and key term used in outline
-Identify the major changes in body,systems that
occur as the newborns adapt to extrauterine life.
-List the primary challenges faced by the newborns
during the adaptation to extrauterine life.
-Explain the three behavioral patterns of newborn
behavioral adaptaion.
-Discuss the five typical behavioral responses of the
newborn
-Discuse and have to understand fetal circulation
-Know blood component for newborns.
-Know about surfactant hormone and wat it function
in the body.

Introduction
The neonatal period:
Is defined as the first 28 days of life.
-After Birth the newborn is exposed to a
whole new
Sound
Colors
Smells
Sensation
**the newborn previously confined to the
warm,dark,wet intra-uterine
environment.
Now is thrust into environment that much
brighter and color.

In this presentation we have to descripe the
physiologic changes of the newborn’s
major body systems.it also discusses the
behavioral adaptaions.Including
behavioral patterns and the newborn’s
behaviroal respones < that occur during
this transition period.

Physiologic adaptations
The mechanics of birth require a change in the newborn for
survival outside the uterus.Immediately,respiratory,gas
exchange,along with circulatory modification, must be
occur to sustain extrauterine life.during this time,as
newborns strive to attain homeostasis.
The also experience complex changes in major organ
system.
Although the transition usually takes place within the first 6-
10 hours of life ..many adaptation take weeks to attain
full maturity

Respiratory system
fetus :
fluid-filled,high-pressure system cause blood to be shunted
from the lungs through the ducts arterious to the rest of the
body.
Newborn :
Air-filled,low-pressure system encourge blood flow through
the lungs for gas exchange;increase o2 content of blood in
the lungs contributes to the closing of the ducts
arteriosus(becomes a ligament(.

Site of gas exchange
Fetus:
Placenta
Newborn:
Lungs

Hepatic portal circulation
Fetus:
Ductus venosus bypasses;maternal liver
performs filtering fuction.
Newborn:
Ductus venosus closes(becomes a
ligment(;hepatic portal circulation begin.

Circulation through the heart
Fetus:
Pressure in the right atrium are greater than in the
left,encourging blood flow through the foreman
ovale
Newborn:
Pressure in the left atrium are greater than in the
right, causing circulation begins.

Thermoregulation
Fetus:
Body temperature is maintained by maternal body
temperature and the warmth of the intrauterine
environment.
Newborn:
Body temperature is maintained through a flexed
posture and brown fat

Cardiovasular system adaptations

Cardiovasular system
adaptations
-The umbilical vein carries oxygenated bld from placenta
to the fetus.
-The ductus venosus allows the majority of the umbilical
vein bld to bypass the liver and merge with bld moving
through the vena cava, bringing it to the heart sooner.
-The foramen ovale allows more than half the bld entering
the right atrium to cross immedediatly to the left
artium,thereby passing the pulmory cicrulation
-The ducuts arterious connects the pulmonary artery to the
aorta, which allow bypassing of pulmonary circuit..

At birth : placental (fetal) circ~~~> pulmonary (newborn) gas
exchange
The physical forces of the contractions of labor and
birth,mild asphyxia, increased intracranial pressure as a
result of cord compression and uterine contraction,as
well as cold stress immediately experienced after birth
lead to an increased release in catecholamines that is
critical for the changes involved in the transition to
extrauterine life.
The increased level epinephrine and norepinephrine
stimulate increase cardiac output and contractility.
surfactant release and promotion of pulmonary fluid
clearance.

Fetal Structures
When umbilical cord is clamped---the first breath is taken and the lungs
begin to function as a Result
-systemic vascular resistance increase and bld
return to the heart via the inferior vena cava decrease.
-With this change there is rapid decrease in pulmonary vascular
resistance and increase in pulmonary bld flow
The foramen ovale functionally closes with a decrease in pulmonary
vascular resistance
-Ductus arteriosus,ductus venosus,umbilical vessels that were vital during
fetal life are no longer needed.
-the increase left atrail pressure causes the foramen ovale to close ..
(Why..??)

-Foramen ovale closes with decrease pulmonary vascular resistance
Increases pressure to left side of heart
-4chambers
-Ductus arteriosis closes due to increase of O2 to lungs.. ..( close
within few hours after birth(
-Ductus venosus close bcoz liver is activated..(close within few days
after birth( ~~~> convert to ligament in extrauterine life.

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 for
maintenance of cardiac output and BP.
-Transient functional cardiac murmurs may be heard
during the neonatal period as a result of changing
dynamics of the cardiovascular system at birth.
So It’s Normal during first 12 hours at nb age..
But after 12 hours we have to do evolution for nb

Heart rate- 120-180 fluctuations due to activity
An increase in activity, such as
wakefulness,movement,or crying, corresponds to an
increase in HR and bld pressure.
Tachycardia :> volume depletion,cardiorespiratory
dss,drug withdrawal and hyperthyroidism
Bradycardia :> associated with apnea and hypoxia

Blood Volume
-The blood volume of the nb depend on the amount of
bld transferred from the placenta at birth.It’s usually
estimated to be 80-85 mlkg of body with the term infant.
The volume may vary as much as 25%-40%,depending on
where clamping of umbilical cord occurs.
-Recent studies show the benefits of delayed cord
clamping as improving the nb cardiopulmonary
adaptation ,preventing childhood anemia without
increase hypervolemia-related risks, increasing bld
pressure, improving o2 transport.abd increase RBC flow.

Blood Components
-Rbcs newborn life span= 80-10 days/120 in adult
-Hb initially declines as a result of decrese in neonatal red
cell mass(physiolgic anemia of infancy(.
-Leukocytosis (elevated white bld cell( is present as a
result of birth trauma soon after birth.
-The newborn platelet count and aggregation ability are
the same as adult.

HB …17-20G-DL
Hematocrit …52%-63%
platelets … 100.000-300.000-Ul
Red blood cells … 5.1-5.8
White blood cells … 10-30/mm3

The nb hematologic values are affected by:
-the site of the bld sample (capillary bld has
higher levels of hb and hematocrit compared
with venous bld.
-placental transfusion (delayed cord clamping
and normal shift of plasma of extravascular
spaces,which cause higher levels of hb and
hemoatocrit).
-Increse GA _ Increase RBS and Hb

One of the most crucial adaptations that the nb
makes at birth is adjusting from a fluid-filled
intrauterine environment to a gaseous
extrauterine environment.during fetal life,the
lungs are expanded with an ultrafiltrate of the
amniotic fluid.during and after birth,this fluid
must be removed and replaced with air.passage
through the birth canal allows intermittent
compression of the thorax,which helps eliminate
the fluid in the lungs.
Respiratory System Adap..

Respiratory System Cont
The first breath of life is a gasp that generates an increase in
transpulmonary pressure and result in diaphragmatic
descent.hypercapnia,hypoxia,and acidocis resulting from normal
labor become stimuli for initiating respirations.=↑ Tidal Volume
Surfactant is a surface tension-reducing lipoprotien found in the nb
lungs that prevents alveolar colapse at the end of expiration and
loss of lung volume
Q : wat G-age surfactant Hormone is Formed and wats it function for
newborn body ??. and if surfactant dos’t complete form in newborn
baby..the baby maybe birth with..???
-,
-Normal lung function is dependent upon surfactant,which permits a
decrease in surface tension at end-expiration( to prevent
atelectasis( and an increase in surface tension during lung
expansion( to facilitate elastic recoil on inspiration(.

Note:-
Baby born by cesarean delivery does not
have the same benefit of the birth canal
squeeze as does the nb born by vaginal
delivery.
Closely observe the respirations of the nb
after cesarean delivery.

Before the nb lungs can maintain
respiratory function,the following
events must occur:
*-Initiation of respiratory movement
*-expansion of the lungs
*-establishment of functional residual
capacity) ability to retain some air in the
lungs on expiration).
*-increased pulmonary bld flow
*-redistribution of cardiac output.

Respirations
After respiration are established in the nb,they are shallow and
irregular,ranging from 30 to 60 breaths per minute,with short periods
of apnea(less than 15 second).
Signs of respiratory distress to observe for include
cyanosis,tackypnea,expiratory grunting,sternal retractions and nasal
flaring.
In some cases, periodic breathing may occur,which is the cessation
of breathing that lasts 5 to 10 seconds without changes in color or
HR.
Apneic periods lasting more than 15 seconds with cyanosis and HR
changes require further ecaluation.

Body Temperature Regulation
One of the most important elements in a nb
survival is obtaining a stable body
temperature to promote an optimal
transition to extrauterine life.
Nb T= 36.5 to 37.5c
*Thermoregulation.. ??

Heat loss
Newborn 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(.

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 direct
contact(.

Thermoregulation
Thermoregulation, the balance between heat loss and heat production,
is related to the newborn’s rate of metabolism and oxygen
consumption.
-An environment in which body temperature is maintained without an
increase in metabolic rate or oxygen use is called neutral thermal
environment NTE
-Bcoze the nb have difficulty maintaining their body heat through
shivering or other mechanisms, they need higher environmental
Temperature to maintain NTE…If environmental decrease, the
newborn respond by~~~>increase in O2 consumping..the RR
increase(tackypnea) in response to increase o2.As a result , the
newborn’s metabolic rate increase.

The newborn’s primary method of heat production is through
nonshivering thermogenesis.a process in which brown fat (adipose
tissue) is oxidizes in response to cold exposure.
Brown fat is special kind of highly vascular fat found only in newborn.
-Nb can experience heat loss through all four mechansim,ultimately
resulting in cold strees,COLD STRESS is excessive heat loss that
requires newborn to use compensatory mechanism(such as
nonshivering thermogenesis and tackypnea).
---Body T decrease and Nb be less active,lethargic,hypotonic and
weaker.
Preterm baby have chance for cold stress great from term baby..
WHY..!!
-Cold stress can lead to problems in newborn if n’t reversed:
depleted brown fat stores,increase O2 need,Rd,increase glucoze
consumption (haypoglycemia,metabolic acidosis,jaundice, and
decrease in surfctant production

Hepatic system function
Placenta function in fetus = liver function in newborn:
-Iron storge
-Carbohydrate metabolism
-Blood coagulation
-Conjuction of bilirubin.

Bilirubin Conjugating
-It’s a yellow to orange bile pigment
produced by breakdown of Rbcs.
Bilirubin normally circulates in plasma,is
taken up by liver cells,and is changed to a
water-soluble pigment that excreted in the
bile.This conjugated form of bilirubin is
excreted from the liver cells as a
constituent of bile.

Failure of the liver cells to breakdown and excrete bilirubin
can cause an increase amount of bilirubin in
bloodstream, leading to Jaundice.
-When bilirubin pigment is deposited in the skin and
mucous membranes,jaundice typically results.
-jaundice also known as icterus,refers to the yellowing of
the skin,sclera,and mucous membranes that result from
increase bilirubin blood levels.
-Extremely elevated blood levels of bilirubin during the first
week of life can cause Kernicterus…~~>(a permanent
and devastating form brain damage.(

The cause of newborn jaundice can be classified
into three groups based on the mechanism of
accumlation:
1-Bilirubin overproduction
(bld incompatibilty Rh or ABO,drugs,trauma)
2-Decrease bilirubin conjugation.
(hypothyridism,breastfeeding)
3-Impaired bilirubin excertion.
(biliary atresia,sepsis,steriods,alcohol)

Gastrointestinal system adaptations
The full-term newborn has the capacity to
swallow,digest,metabolize,and absorb
food taken in soon after birth.At birth, the
ph of stomach contents is mildly acidic,
reflecting the ph of the amniotic fluid.the
oncesterile gut changes rapidly,depending
on what feeding is received.

Stomach and Digestion
The stomach nb=30-90ml
Immaturity of the pharyngoesophageal sphincter and
absence of lower esophageal peristaltic waves also
contribute to the reflux of gastric content.
Avoiding overfeeding and stimulating frequent burping
may minimize regurgitation. most digestive enzymes are
available at birth, allowing nb to digest simple protein
and carbohdrate.they have limited ability to digest
complex carbohyrates and fats,because amylase and
lipase level are low at birth.

Bowel Elimination
The evolution of a stool pattern begins with newborns first stool,which
is Meconium.
Meconium is comosed of amniotic fluid, shed mucosal cells,intestinal
secretions and blood.
It’s a greenish black tarry consistency..and usually passes within 12-24
hours of birth….(It’s sterile(
The stools of the breast-fed nb are yellow-gold,loose and stringy to
pasty in consistency,and typically sour-smelling.
The stools of the formula-fed nb vary depending on the type of formula
ingested.
They may be yellow,yellow green.or greenish and loose,pasty,or
formed in consistency,and they have an unpleasant odor.

Renal System Changes
Although the nb kidneys can produce urine,they are limited
in their ability to concentrate it until about 3months of
age,when the kidney mature.
AT birth the glomerular filtration rate(GFR( is approximately
30% of normal adults values.reaching approximately
50% of normal adult values by the 10th
day of life and full
adult values by the first year of life.
The low GFR and limited excertion and conservation
capabilty of the kidney affect the nb abilty to excerte
salt,waterloads and drugs.

Immune System Adapt..
The newborn’s immune system begins working early in gestation,but many of
respones to not function adequtely during the early neonatal period.The
intrauterine environment usually protect the fetus from harmful
microorganisms and the need for defensive immunologic responses.
Responses of the immune system serve three purpose:
1-defence(protection from inavding organism(.
2-homeostasis(elimination of worn-out host cells(.
3-surveillance(recognition and removal of enemy cells.(.
the nb immune system response involves recognition of the pathogen or other
foreign material,followes by activation of mechanisms to react against and
eliminate it.
-The immune system’s responses can divided into two categories
1-natural
2-active

Natural Immunity
Natural immunity includes responses or mechanism that do not require
previous exposure to the microogansim or antigen to operate
efficiently.
-physical barriers
(such as intact skin and mucous membranes(
-chemical barriers
(such as gastric acids and digestive enzymes(
and resident nonpathologic organsims make up the nb natural
immune system.
Natural immunity involve the most basic host defense responses
ingestion and killing of micro organsims by phagocyric cells.

Acquired Immunity
It have 2 primary processes:
1-the development of circulating antibodies or
immunoglobulins capable of targeting specific
invading agents(intigens(for destrcution.
2-formation of activated lymphocytes desinged to
destroy foreign invaders.acquired immunity is
absent until after the first invasion by foreign
organism or toxin.

In adult Immunoglobulins are subdivided five classes: IgA,IgD,IgE,IgG,IgM.
The newborn depends largely on three immunoglobulins for defense
mechansim:IgG,IgA,IgM.
-IgG is the major immunoglobulin and the most abundant,making up about
80% of all circulating antibodies.(it’s found in serum&interstitial fluid(..It is the
only class able to cross the placenta,with active placental
transfer beginning at approximately 20 to 22 weeks’ gestation.IgG
PRODUCE antibodies against bacteria,bacterial,and viral agents.
-IgA is the second most abundant immunoglbulin in the serum.IgA does
not cross the placenta,and maximum levels are reaches during
childhood.IgA is predominantly found in the gastrointestinal and respiratory
tracts,tears,saliva,colostrum,and BREAST MILK.
-IgM is found in blood and lymph fluid and is the first immunoglobulin to
respond to infection..It’s don’t cross to the placenta.

Integumentary system Adap..
The most important function of skin is to provide protective barrier
between body and environment. its limit to loss water.prevent
absorption harmful agents.protects against physical truma.
The epidermal barrier begins to develop during mid-gestation and fully
develop in 32 weeks gestationl.although neonatal epidermis similer
to the adult in thickness and lipid compostion.Skin is nt complete at
birth.
It’s less mature the skin function
Also in newborn, the risk of injury producing break in the skin from
tape, monitors and handling is greater than for an adult.
Skin coloring varied, depending on the nb age;race;ethnic groub
At birth the nb skin is dark red ro purple.as the newborn begins to
breath air,the skin color changes to red.this redness normally begins
to fade the first day.

Neurologic system Adapt..
Myelin develops early on in sensory impulse transmitters.thus,the newborn has
an acute sense of hearing,smell,and taste.the newborn’s sensory
capabilities include:
-Hearing-well developed at birth,responds to noise by turing to sound.
-Taste-ability to distinguish between sweet and sour by 72 hours old.
-Smell-ability to distinguish between mother’s breast milk and breast milk from
others.
-Touch-sensitivity to pain;responds to tactile stimuli.
-Vision-ability to focus on objects only in close proximity(7-12 inches way(
Myopia…??
..(The presence and strength of a reflex is an important indication of
neurologic development and function.A Reflex is an involuntry muscular
response to a sensory stimulate.

Behavioral Adaptation
First period of Reactivity
THE first period of reactivity begins at birth and lasts for 30 minute.
The nb is alert and moving and may appear hungry(movement
eyes,sucking motions;chewing;rooting.respiration and HR are
elevated but gradually begin to slow as the next period(
This period of alertness allows parents to interact with their newborn
and to enjoy close contact with their new baby.
..(The appearance of sucking and rooting behaviors provides good
opportunity for initating breast feeding….(

Period of Decrease
Responsiveness
At 30-120 minute of age.the newborn enters the
second stage of transition__that of sleep or
decrease in activity.Movement are less jerky and
less frequent.HR&RR decline as the newborn
enters the sleep phase. muscle become
relaxed.no interst in sucking is shown. here can
mother and baby togther take rest after labor
and birthing experience.

Second Period of Reactivity
The second period of reactivity begins as the newborn
awakens and shows in interest in environmental
stimuli.this period lasts 2-8 hours in the normal
newborn.
HH&RR increase.motor activity and muscle tone increase.
Here interaction between mother and newborn during this
second period of reactivity is encouraged if the mother
has rested and desire it.
…(Teaching about feeding.postion for feedong and diaper-changing
techniques can be reinforced this period..((

HamzeH al-HarayzeH
Nursing School

�ݺ�ߣ

Newborn adaptation

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