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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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Presentation Transcript
slide2
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

slide3
D.) 6-12 hours

A newborn can take up to 12 hours to

transition from placental support to

extrauterine support.

definition
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
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
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
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 delivery8
Transition begins before delivery

During Labor…

  • placenta
  • stress hormones
review placental circulation
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
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
Fetal Circulation

Foramen Ovale

  • Shunt
  • Right atrium
  • Left atrium
  • Right Ventricle
fetal circulation13
Fetal Circulation

Ductus Arteriosus

  • Shunt
  • Unsaturated blood
  • Pulmonary Artery
  • Aorta
fetal circulation14
Fetal Circulation

Fetal Lungs

  • Fluid filled
  • Resistant
  • Nourishment
fetal circulation15
Fetal Circulation
  • Systemic Vascular Resistance
  • Pulmonary Vascular Resistance
  • Pulmonary Arterioles Resistant
transition to extrauterine life begins when the cord is cut
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
Newborn Circulation

Umbilical cord is clamped

  • Placenta is separated
  •  systemic blood pressure
  • Three major shunts close
newborn circulation19
Newborn Circulation
  • Circulatory Changes
  • Fetus separation mother/placenta
  • Lungs begin to function
  • First breath
newborn circulation20
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 circulation21
Newborn Circulation
  • Blood flow resistance
  • Blood flows through pulmonary arteries
  • Foramen ovale closes
  • Blood pressure increases
newborn circulation23
Newborn Circulation
  • Left atrial pressure 
  • Right atrial pressure 
  • Foramen functional closure
  • Ductus arteriosus
newborn circulation25
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
Physiologic Changes During Transition
  • Cardiovascular
  • Respiratory
  • Hematologic
  • Gastrointestinal
  • Renal
  • Immunologic
considerations for newborns in transition period
Considerations For Newborns in Transition Period

History…

  • Maternal…Medications

Illness

  • Labor and Delivery…

Fetal Distress

Delivery Complications

Types Delivery

  • Resuscitation Measures
assessment
Assessment
  • Vital Signs
  • Measurements
  • Gestational Age Assessment
  • Head to Toe Exam
  • Glucose/Feeding
assessment continued
Assessment-continued

Normal head to toe assessment findings for infant in transition

  • Skin
  • Head
  • Respirations/Breath Sounds
  • Heart Sounds
  • Intestines
  • Urine
  • Extremities
thermoregulation
Thermoregulation
  • normal ranges 97.7F - 98.6F
  • results of cold stress:  O2 consumption & use of glucose stores
  • radiant warmer/isolette
  • bathing
medications
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
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
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 continued34
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
Recognition of the Sick Newborn
  • Perinatal History
  • Physical Assessment
    • Skin
    • Respiratory
    • Cardiovascular
    • Central Nervous System
    • Morphologic Features
    • GI Tract
slide36
Tools Used to Diagnosis?

With MD order of course!!!

common problems seen in transition
Common Problems Seen In Transition
  • Birth Trauma
  • Birth Asphyxia
  • Pulmonary
  • Cardiovascular
  • Hemodynamics
  • Metabolic Problems
  • Infection
  • Congenital Anomalies
stabilization of the transitioning newborn
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
Parental Support
  • Before Delivery
  • At Delivery
  • During Transition
  • Transfers
review
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

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