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Transition and Stabilization of the Newborn. Letha Nix RNC. 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

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Transition and Stabilization of the Newborn

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Transition and Stabilization of the Newborn

Letha Nix RNC


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


Transition begins before delivery

During Labor…

  • placenta

  • stress hormones


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

Foramen Ovale

  • Shunt

  • Right atrium

  • Left atrium

  • Right Ventricle


Fetal Circulation

Ductus Arteriosus

  • Shunt

  • Unsaturated blood

  • Pulmonary Artery

  • Aorta


Fetal Circulation

Fetal Lungs

  • Fluid filled

  • Resistant

  • Nourishment


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

  • Vital Signs

  • Measurements

  • Gestational Age Assessment

  • Head to Toe Exam

  • Glucose/Feeding


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


Tools Used to Diagnosis?

With MD order of course!!!


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


Parental Support

  • Before Delivery

  • At Delivery

  • During Transition

  • Transfers


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


Any Questions ?


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