1. Physiologic and Behavioral Adaptation of the Newborn

2. Physiologic and Behavioral Adaptation of the Newborn
Neonatal period-includes the time of birth through day 28 day of life
Transition to Extrauterine Life
Transition Period-Infants undergo phases of instability during the first 6 to 8 hours after birth
First phase of the transition period last up to 30 minutes after birth and is called the first period of reactivity
Newborn’s heart rate increases rapidly to 160 to 180 beats/min or so to a baseline range of between 100 to 120 beats/min

3. Physiologic and Behavioral Adaptation of the Newborn
First Period of Reactivity
Respirations are irregular, with a rate between 60 and 80 beats/min
Crackles may be present
Audible grunting, nasal flaring, and retractions of the chest
Brief periods of apnea
Infant is alert
Infant’s behavior is marked by spontaneous startle reactions, tremors, crying, and movement of the head from side to side
Decrease in body temperature
Generalized increase in motor activity
Increase in muscle tone
Onset of bowel sounds
Passage of meconium
Production of saliva

4. Physiologic and Behavioral Adaptation of the Newborn
Second Period of Reactivity
Occurs roughly between the second and eighth hours after birth
Last from 10 minutes to several hours
Periods of tachypnea and tachycardia occur
Increase muscle tone, skin color, and mucus production
Meconium is commonly passed at this time

5. Physiologic and Behavioral Adaptation of the Newborn
Physiologic Adaptations
Respiratory System
Signs of Respiratory Distress
May include
Nasal flaring
Retractions
Grunting with expirations
Increase use of the intercostals muscles
Seesaw respirations instead of abdominal respirations
Respiratory rate that is less than 30 or greater than 60 beats/min with the infant at rest must be reported to the pediatrician

6. Physiologic and Behavioral Adaptation of the Newborn
Cardiovascular System
Change in the pressure causes a functional closure of the foramen ovale
Ductus arteriosus functionally closes within 24 hours; permanent closure may take several weeks
Umbilical arteries, Umbilical vein, and ductus venosus are functionally closed and are converted into ligaments within 2 to 3 months

7. Physiologic and Behavior Adaptations of the Newborn
Heart Rate and Sounds
Newborn has a resting heart rate between 100 and 160 beats/min
Normal heart rate for a newborn is 110 to 160 beats/min
Heart murmurs heard during the first few weeks have no pathologic significance
Murmurs result from a patent ducutus arteriosus
Tricuspid regurgitation

8. 1.A heart rate of 100 beats per minute
A nurse is listening to the apical heart rate of a newborn infant. The nurse determines that the heart rate is normal if which of the following is noted?
1.A heart rate of 100 beats per minute 
2.A heart rate of 140 beats per minute 
3.A heart rate of 180 beats per minute 
4.A heart rate of 190 beats per minute 

9. Physiologic and Behavior Adaptation of the Newborn
Blood Volume
Total blood volume in the newborn is 300 ml
Hematopoietic System
Red blood cells and hemoglobin
Term newborn may have a hemoglobin concentration of 14 to 24 g/dl
Hematocrit ranges from 51 to 56 %
RBC count is 4.6 to 5.2 mm

10. Physiologic and Behavioral Adaptation of the Newborn
Thermogenic System
Thermoregulation-the maintenance of balance between heat loss and heat production
Hypothermia from excessive heat loss is common and dangerous problem in neonates
Nonshivering thermogenesis is accomplish primarily by metabolism of brown fat

11. Physiologic and Behavioral Adaptation of the Newborn
Heat Loss
Occurs by four modes
Convection
Radiation
Evaporation
Conduction
Temperature Regulation
Newborns have larger body surface-to-body weight (mass) ratio than do children and adults
Flexed position of the newborn helps guard against heat loss

12. Physiologic and Behavioral Adaptation of the Newborn
Temperature Regulation
Cold Stress
Imposes metabolic and physiologic demands in all infants, regardless of gestational age and condition
Effects of cold stress:
Infant is stressed by cold, oxygen consumption increases and pulmonary and peripheral vasoconstriction occurs
Thereby decreasing oxygen uptake by the lungs and oxygen to the tissues
Anaerobic glycolysis increases
There is a decrease in P02 and ph, leading to metabolic acidosis

13. Effects of Cold Stress
When an infant is stressed by cold, oxygen consumption increases and pulmonary and peripheral vasoconstriction occur, decreasing oxygen uptake; anaerobic glycolysis increases and a decrease in PO2 and pH, leading to metabolic acidosis

15. Physiologic and Behavioral Adaptation of the Newborn
Renal System
Small quantity (approximately 40 ml) of urine is usually present at birth in the bladder of a term infant
Newborns should void:
within 24 hours of life
2 to 6 times per day during the first and second day of life
6 to 8 voids per day after day 4
Formula-fed infants may void more frequently

16. Physiologic and Behavioral Adaptations of the Newborn
Gastrointestinal System
Bowel sounds can be heard shortly after birth
Capacity of the stomach varies from 30 to 90 ml on day one depending on the size of the infant
Meconium is greenish black and viscous and contains occult blood
First meconium passed is sterile

17. Physiologic and Behavioral Adaptation of the Newborn
Hepatic System
Infant’s iron store in the liver is proportional to the body weight, and for the term infant, should be sufficient for 4 to 6 months
Healthy term newborns, blood glucose levels stabilize at 50 to 60 mg/dl during the first several hours after birth
Within the first week they should be approximately 60 to 80
Bilirubin- a yellow pigment should be approximately 60 to derived from the hemoglobin with the breakdown of RBCs and the myoglobin in muscle cells

18. Physiologic and Behavioral Adaptation of the Newborn
Physiologic Jaundice
Neonatal jaundice is considered benign, bilirubin may accumulate to hazardous levels and lead to a pathologic condition
Results from characteristics of normal newborn physiology, such as increased bilirubin production due to increased RBC mass, shortened life span of the fetal RBCs,
and liver immaturity

19. Physiologic and Behavioral Adaptation of the Newborn
Physiologic Jaundice
Jaundice is considered pathologic if it appears within the first 24 hours of life, if serum bilirubin levels increase by more than 6 mg/dl in 24 hours, or if serum bilirubin exceeds 15 mg/dl at any time.
Some reflex behaviors are important for the newborn’s survival.

20. Physiologic and Behavioral Adaptation of the Newborn
Kernicterus
Bilirubin encephalopathy, is the most serious complication of neonatal hyperbilirubinemia
Occurs when bilirubin is deposited in the basal ganglia and brain stem, disrupting neuronal function and metabolism
Usually occurs when bilirubin levels are higher than 25 mg/dl
Acute stage of kernicterus, the infant is lethargic, hypotonic, and has a poor suck
Untreated, the infant becomes hypertonic (with backward arching of the neck and trunk), has a high –pitched cry, and may develop fever

21. 2.Stop the breast-feeding and switch to bottle-feeding permanently
A nurse is providing instructions to the mother of a newborn with hyperbilirubinemia who is being breast-fed. The nurse tells the mother to:
1.Switch to bottle-feeding during the period of high bilirubin levels and feed less frequently 
2.Stop the breast-feeding and switch to bottle-feeding permanently 
3.Provide water feedings between the breast-feeding periods 
4.Breast-feed the newborn every 2 to 3 hours 

22. Physiologic and Behavioral Adaptation of the Newborn
Coagulation
An injection of vitamin K soon after birth helps prevent clotting problems
Immune system
First 3 months of life, the infant is protected by passive immunity received from the mother
Infant who is breastfed receives passive immunity through the colostrum and breast milk
Protection provided varies with the age and maturity of the infant and the mother’s level of immunity

23. Physiologic and Behavioral Adaptation of the Newborn
Integumentary System
Vernix Caseosa (a cheeselike, whitish substance) is fused with a epidermis and serves as a protective covering
Acrocyanosis- Hands and feet appear slightly cyanotic.
Caused by vasomotor instability, capillary stasis, and a high hemoglobin level
Normal and appears intermittently over the first 7 to 10 days, especially with exposure to cold
Healthy newborn is plump.

24. Physiologic and Behavioral Adaptations of the Newborn
Caput Succedaneum
A generalized, easily identifiable edematous area of the scalp most commonly found on the occiput
Boggy edematous swelling, present at birth, extends across the suture lines of the fetal skull and disappears spontaneously within 3 to 4 days
Cephalhematoma
A collection of blood between a skull bone and its periosteum; therefore a cephalhematoma does not cross a cranial suture line

25. Skeletal system
Molding
Caput succedaneum
Cephalhematoma
Subgaleal hemorrhage
Spine
Extremities
Oligodactyly; polydactyly; syndactyly
Developmental dysplasia of the hips (DDH)
Signs of skeletal problems

27. Physiologic and Behavioral Adaptation of the Newborn
Mongolian Spots
Bluish-black areas of pigmentation, may appear over any part of the exterior surface of the body, including the extremities
More common on the back and buttocks
Most frequently noted in babies whose ethnic origins are in the Mediterranean area, Latin America, Asia, or Africa
Can be mistaken for bruises
Fade gradually over months or years

28. Physiologic and Behavioral Adaptation of the Newborn
Nevi
Stork bites or angel kisses, telangietaticn nevi are pink and easily blanched
Appear on the upper eyelids, nose, upper lip, lower occipital area, nape of the neck
Have no clinical significance and fade by the second year of life
Strawberry mark, or nevus vasculosus, is a common type of capillary hemangioma
Typical lesion is a raised, sharply demarcated, bright or dark red, rough-surfaced swelling that resembles a strawberry
Lesions usually are single but may be multiple with 75% occurring on the head

29. A. Telangiectatic nevus (stork bite) B. Erythema toxicum

30. Reproductive System Female Full complement of potential ova
Pseudomenstruation
External genitals are usually edematous
with increased pigmentation
Labia majora and minora cover the vestibule

31. Reproductive System Male Foreskin completely covers the glans
Hypospadias-urethral opening is located in an abnormal position
Epithelial pearls-small, white firm lesions and may be seen at the tip of the prepuce
Testes can be palpated in the scrotum, and rugae cover the scrotal sac

32. Physiologic and Behavioral Adaptation of the Newborn
Erythema Toxicum
Also called erythema neonatorum or newborn rash or flea bite
Lesion in different stages; erythematous macules, papules, and small vesicles
Lesions may appear suddenly anywhere on the body
Rash is thought to be an inflammatory response

33. Physiologic and Behavioral Adaptations of the Newborn
Skeletal System
Head is one fourth of the total body length
Legs are one third of the total body length
Molding-the shaping of the fetal head by the overlapping of cranial bones to facilitate movement through the birth canal during labor
Infant was in the breech position in utero, the legs may be extended and remain in that position for several weeks

34. Signs of Developmental Dysplasia of the Hip

35. Physiologic and Behavioral Adaptation of the Newborn
Behavioral Characteristics
Sleep-Wake States
Six states forms a continuum from sleep to extreme irritability
Two sleep states-deep sleep and light sleep
Four wake states-drowsy, quiet alert, active alert, and crying
Newborn sleep approximately 16 to 19 hours per day, with periods of wakefulness gradually increasing

36. Physiologic and Behavioral Adaptation of the Newborn
Sensory Behaviors
Vision
Development of the visual system continues for the first 6 months
Pupils react to light, the blink reflex is easily stimulated, and the corneal reflex is activated by light touch
The room is darkened, newborns will open their eyes wide and look about
Newborns have the ability to fixate and track a high-contrast object horizontally and vertically
Newborns will tract their parents’ eyes

37. Physiologic and Behavioral Adaptation of the Newborn
Hearing
Infant’s hearing is similar to that of an adult
Loud sounds of about 90 decibels cause the infant to respond with a startle reflex
Low-frequency sounds such as a heartbeat or lullaby will decrease motor activity or stop the newborn from crying
Infant responds readily to the mother’s voice
Smell
Newborns have a highly developed sense of smell and are responsive to odors that facilitate adaptation to the extrauterine environment

38. Physiologic and Behavioral Adaptation of the Newborn
Response to Environmental Stimuli
Temperament
Newborn posses individual characteristics that affect selective responses to various stimuli present in the internal and external environment
Habituation
A protective mechanism that allows the infant to become accustomed to environmental stimuli
Consolability
Newborns vary in their ability to console themselves or to be consoled

39. Newborn Sleep-Wake States A. Deep sleep B. Light sleep C. Drowsy D
Newborn Sleep-Wake States A. Deep sleep B. Light sleep C. Drowsy D. Quiet alert E. Active alert F. Crying D B C F E A

40. Question
The nurse is assessing a newborn at 5 hours of age and finds a soft mass over the infant’s occiput. The soft mass crosses the suture line. The nurse documents this finding as which of the following?
Subgaleal hemorrhage
Caput succedaneum
Cephalhematoma
Hydrocephalus

41. Key Points
By full term, the newborn’s various anatomic and physiologic systems have reached a level of development and functioning that permits a physical existence apart from the mother.
The neonate’s most critical adaptation to extrauterine life is to establish effective respirations.

42. Key Points (Cont.)
Heat loss in the healthy term newborn can exceed the capacity to produce heat; this can lead to cold stress and metabolic and respiratory complications that threaten the newborn’s well-being.
Physiologic jaundice occurs in 60% of term infants and 80% of preterm infants.

43. Key Points (Cont.)
Jaundice is considered pathologic if it appears within the first 24 hours of life, if serum bilirubin levels increase by more than 6 mg/dl in 24 hours, or if serum bilirubin exceeds 15 mg/dl at any time.
Some reflex behaviors are important for the newborn’s survival.