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Adaptation to EUA

Adaptation to EUA. Aims:. To provide an overview of a normal newborn’s adjustment to his/her new environment. To understand baby’s behavioural cues. Adaptation to EUA. Learning Outcomes:. 1. Appreciate the contrast in environment between in-utero and extra uterine

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Adaptation to EUA

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  1. Adaptation to EUA Aims: To provide an overview of a normal newborn’s adjustment to his/her new environment To understand baby’s behavioural cues

  2. Adaptation to EUA Learning Outcomes: 1. Appreciate the contrast in environment between in-utero and extra uterine 2. Consider the impact on the differences on the baby

  3. Learning Outcomes (cont): 3.Discuss how the midwife can minimise any adverse effects of birth 4. Identify ways in which the care giver can assist developmental progress in the newborn

  4. Comparison of In Utero & EU Environment Temperature Respiration  Circulation Nutrition  Infection Protection/Love  Movement

  5. Adaptation to EU Life Effects on Baby? How to minimise trauma?

  6. Comparison of In Utero & EU Environment   Temperature: 37.70C  26.00C Breathing: 1-2 per minute 30-50 pm Obligatory nasal breathers

  7. Comparison of In Utero & EU Environment Heart rate: 120-160 per minute  100-120 pm Nutrition: diffusion from mother  Breast feeding / AF

  8. Comparison of In Utero & EU Environment Infection & protection: bag of membranes, uterus, maternal abdominal tissue

  9. Comparison of In Utero & EU Environment Movements: from about 7/40 Kicking increases in response to mother’s stress/ sounds of high frequency Some light penetrates the uterine wall – stimulates activity when very bright

  10. Fetal Circulation & Adaptation to Extra Uterine Life Primitive heart: starts beating at about 4 weeks Circulatory System of fetus: established between 8-12 weeks gestation

  11. Fetal Circulation • Fetus develops its own blood • – fetal blood does not mix with maternal blood •   Separated by layers of: • synciotrophoblast • cytotrophoblast • walls of capillaries

  12. Fetal Circulation

  13. Fetal Circulation Lungs only receive a very tiny proportion of fetal blood Placenta is responsible for blood oxygenation and elimination of wasteproducts

  14. Fetal Circulation • Three shunts: • Ductus arteriosus • Ductus venosus • Foramen ovale

  15. Circulatory Adjustments at birth dramatic fall in pulmonary vascular resistance marked increase in pulmonary blood flow progressive thinning of the walls of the pulmonary arteries

  16. Fetal Circulation • Fetal StructureAdult Structure • Foramen Ovale Fossa Ovalis • Umbilical Vein Ligamentum teres • Umbilical Arteries Umbilical ligaments,Ductus Venosus Ligamentum venosum • Ductus Arteriosum Ligamentum arteriosum

  17. Fetal Circulation Consider MW’s Role in Maximising Health

  18. Temperature Control Difficult in the newborn due to: -large surface area -poor insulation -wet & exposed body -inability to shiver -immature temp. regulating centre

  19. Temperature Control • Heat loss through: • Conduction • Convection • Evaporation • Radiation

  20. Temperature Control Consider M/W’s Role in Maximising Health

  21. NEONATAL INFECTION All neonates are susceptible to infection WHY? Diminished immunity

  22. NEONATAL INFECTION • skin is a poor barrier • don’t sweat until 1 month • don’t have tears (lysozome is bactericidal) •  low gastric juice until 4 weeks

  23. NEONATAL INFECTION • low T lymphocyte function • low levels of fetal antibody levels at birth (unless been exposed to intrauterine infection) • invasive procedures (PKU)

  24. NEONATAL INFECTION ROUTES OF INFECTION (1)Transplacentally (2) Ascending Infection/ Intrapartum early SROM (3) Postnatally

  25. NEONATAL INFECTION Consider M/W’s Role in Maximising Health

  26. Emotional Development The development of the baby involves dynamic exchanges within the environment. In-utero environment Dark Muffled sounds Temp –37.50 C

  27. Emotional Development • Role of the midwife is therefore: • to facilitate • to enhance • a positive environment for optimum health, both physically as well as emotionally

  28. Emotional Development • Consider the in-utero environment: •  Dark • Muffled sounds • Constant contact with mother • Temp –37.50 C

  29. Emotional Development Attachment & Trust – they are the key developmental issues of infancy  The infant-carer dyad is pivotal in this

  30. Emotional Development The baby is interested in his surroundings for at least the 1st hour or so, before going to sleep  Time to CONNECT!!!

  31. Emotional Development • ‘LOVE & NURTURING’ • SKIN TO SKIN CONTACT •   PREFERENCE FOR FACE RATHER THAN OBJECTS

  32. Emotional Development • Baby’s control of his environment • THUMBSUCKING (don’t cover hands) • GAZING ( face distance –22cm/9 inch)

  33. Emotional Development • Baby’s control of his environment • Turning away • Positing • Hiccups • Colour change

  34. Emotional Development • Carer’s facilitation • Hand to Chest • Swaddling

  35. Emotional Development • Adjust light if too bright • Do not start a procedure abruptly • Hand over chest- stops startles 

  36. Adaptation to EU Life • Conclusion • Many adaptations • Midwife’s role: • minimise stress • maximise health

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