Transition and Stabilization of the Newborn Letha Nix RNC
Dec 17, 2015
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
D.) 6-12 hours
A newborn can take up to 12 hours to
transition from placental support to
extrauterine support.
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.
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.
Transition begins before delivery
Depending on….
• Gestational age
• placenta health/condition
• maternal health
• Any limitations to major organs
• physical defects/anomalies
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
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
PCO2=38 mmHg
PO2=40-50 mmHg
pH=7.36
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
Fetal Circulation
Systemic Vascular Resistance Pulmonary Vascular Resistance Pulmonary Arterioles Resistant
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.
Newborn Circulation
Umbilical cord is clamped Placenta is separated systemic blood pressure Three major shunts close
Newborn Circulation
Circulatory Changes Fetus separation mother/placenta Lungs begin to function First breath
Newborn Circulation
Lung fluid cleared Lungs fill with O2
Systemic vascular resistance increases Initiation of respiration Pulmonary arterioles Pulmonary Vascular Resistance Pulmonary Blood flow
Newborn Circulation
Blood flow resistance Blood flows through pulmonary
arteries Foramen ovale closes Blood pressure increases
Newborn Circulation
Left atrial pressure Right atrial pressure Foramen functional closure Ductus arteriosus
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
Physiologic Changes During Transition
• Cardiovascular
• Respiratory
• Hematologic
• Gastrointestinal
• Renal
• Immunologic
Considerations For Newborns in Transition Period
History…
• Maternal…Medications
Illness
• Labor and Delivery…
Fetal Distress
Delivery Complications
Types Delivery
• Resuscitation Measures
Assessment-continued
Normal head to toe assessment findings for infant in transition Skin Head Respirations/Breath Sounds Heart Sounds Intestines Urine Extremities
Thermoregulation
normal ranges 97.7F - 98.6F results of cold stress: O2
consumption & use of glucose stores radiant warmer/isolette bathing
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
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
> 40 ml/dl on first day
>40-50 ml/dl thereafter
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
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
Recognition of the Sick Newborn• Perinatal History
• Physical Assessment Skin Respiratory Cardiovascular Central Nervous System Morphologic Features GI Tract
Common Problems Seen In Transition
• Birth Trauma
• Birth Asphyxia
• Pulmonary
• Cardiovascular
• Hemodynamics
• Metabolic Problems
• Infection
• Congenital Anomalies
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
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