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Physiologic Adaptations at Birth. Ma. Luisa de Villa- Manlapaz , MD, MHPEd February 8, 2011 ASMPH. Learning Objectives. To review the fetal circulation To learn the changes in the pulmonary and cardiovascular system that occur during birth

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physiologic adaptations at birth

Physiologic Adaptations at Birth

Ma. Luisa de Villa-Manlapaz, MD, MHPEd

February 8, 2011

ASMPH

learning objectives
Learning Objectives
  • To review the fetal circulation
  • To learn the changes in the pulmonary and cardiovascular system that occur during birth
  • To learn the hepatic adaptations in glucose metabolism, bilirubin metabolism, and vitamin K production
  • To learn how a newborn achieves thermoregulation
fetal circulation
Fetal Circulation
  • Placenta is responsible for exchange of gases, nutrients and metabolic waste products
  • Fetus receives blood from the placenta and returns it to the placenta
fetal circulation1
Fetal Circulation
  • Blood flows from the placenta into the umbilical vein
  • The blood which contains a PO2 of approx 35 mmHg passes through the liver and ductusvenosus
fetal circulation2
Fetal Circulation
  • Blood from ductusvenosus drains into the inferior vena cava  foramen ovale  left atrium
fetal circulation3
Fetal Circulation
  • Superior vena cava drains de-oxygenated blood from the brain into the right atrium.
  •  right ventricle.
  • 90% of blood from RA shunted through the ductusarteriosus
  • 10% ejected to pulmonary artery  lungs
fetal lungs and circulation
Fetal Lungs and Circulation
  • Alveoli filled with lung fluid
  • Pulmonary arterioles constricted
  • Pulmonary blood flow diminished

Click on the image to play video

neonatal circulation
Neonatal Circulation
  • After birth, umbilical cord is cut
    • Systemic vascular resistance increases

(BP in aorta increases)

    • Pulmonary vascular resistance decreases ((BP in lungs decreases)
lungs and circulation after delivery
Lungs and CirculationAfter Delivery
  • Lungs expand with air
  • Fetal lung fluid leaves alveoli

Click on the image to play video

lungs and circulation
Lungs and Circulation
  • Pulmonary arterioles dilate
  • Pulmonary blood flow increases
lungs and circulation1
Lungs and Circulation
  • Blood oxygen levels rise
  • Ductusarteriosus constricts
  • Blood flows through lungs to pick up oxygen
normal transition
Normal Transition

The following major changes take

place within seconds after birth:

  • Fluid in alveoli absorbed and replaced by air
  • Umbilical arteries and vein constrict thus increasing blood pressure
  • Blood vessels in lungs relax, increasing pulmonary blood flow
slide13

Baby cries and take first breath which help open alveoli

  • Surfactant keeps the alveoli from collapsing after they expand
metabolic adaptation
Metabolic Adaptation
  • In utero, fetus relies primarily on placental transfer of glucose and nutrients from mother to meet energy demands
metabolic adaptation1
Metabolic Adaptation
  • Fetus stores glucose in the form of glycogen in last trimester – especially in last month of trimester
after birth
After Birth

Enzymes activate breakdown of glycogen back into glucose molecules

Glucose released into bloodstream to maintain blood sugar

Normal glucose utilization

rate in fasting healthy term

infant is 4-6 mg/kg/min

slide17

Factors which influence glucose levels

    • Glycogen stores
    • Insulin levels
    • Glucose utilization
  • Premature baby
  • Infant of diabetic mother
  • Sick infant
thermoregulation
Thermoregulation
  • In utero, the fetus is in a warm and dark environment
  • Temperature is controlled
normal response to cold stress
Normal Response to Cold Stress
  • Vasoconstriction in arms and legs
  • Increased movement and flexion of extremities
  • Brown fat metabolism
heat loss
Heat loss
  • Occurs on a gradient from warmer to cooler

Baby’s warm body to cooler air or surface

    • Heat loss accentuated by:
      • Wet skin
      • Cool air temperature
      • Drafts
kangaroo mother care
Kangaroo mother care
  • Mother provides warmth to the baby by skin to skin contact.
  • Provides easy access to the breasts, promoting breastfeeding
hepatic adaptation
Hepatic adaptation
  • Minor role of fetal liver – portal circulation shunted through the ductusvenosus
  • Majority of bilirubin pigment transferred unaltered across the placenta to the maternal circulation
  • Fetus has a high percentage of circulating red blood cells to utilize all available oxygen in a low oxygen environment
physiologic jaudice
PHYSIOLOGIC JAUDICE

Increased bilirubin load on liver cell

Increased erythrocyte volume

Decreased erythrocyte survival

Increased enterohepatic circulation of bilirubin

Immature liver function

hepatic adaptation1
Hepatic Adaptation
  • Liver manufactures clotting factors needed for blood coagulation
  • Several factors need Vitamin K for their production
  • Bacteria that produce Vitamin K are normally found in the gastrointestinal tract
slide38

However, the gastrointestinal tract of the newborn is sterile

  • Therefore newborn cannot manufacture vitamin K which is needed to produce some clotting factors
  • Newborns are given Vitamin K either intramuscularly or orally at birth to prevent bleeding disorders
learning objectives1
Learning Objectives
  • To review the fetal circulation
  • To learn the changes in the pulmonary and cardiovascular system that occur during birth
  • To learn the hepatic adaptations in glucose metabolism, bilirubin metabolism, and vitamin K production
  • To learn how a newborn achieves thermoregulation
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