The Neonatal

Period
Adapt

Integrate

Coordinate

APGAR
acronym for
A
-ppearanc
e
P -ulse

G -rimace
A -ctivity

Scoring

Ben was born one

minute ago

Color - completely blue

Heart rate 101

Cries when you insert a

suction catheter to remove
oral secretions

He quickly recoils his arms

and legs after you extend
them

Slight respiratory grunt,

weak cry as you rub him
with warm towels

Total 1 min
7
APGAR =
Total 5 min APGAR = ?

Response to
APGAR
7-10

Minimal

3-6

Moderately distress
Oxygen, Narcan, vigorous
stimulation

0-2

Severely distress
CPR, drug tx, intubate

Extrauterine
Adaptation
Respiratory
Cardiovascu
lar
Thermoregulat
ion
Neurologica
l

Renal
Hepatic
Gastrointesti
nal
Musculoskele
tal

Integument

Respiratory
MOST critical adaptation

Initiated by triggers
Chemical
Mechanical
compression intrathoracic pressure
release of chest compression negative
pressure drawing air in lungs
Thermal
Sensory
Pulmonary vasculature
Clamping cord
blood pressure circulation, lung perfusion

Major Difference in
Cardio?
Foramen ovale- formation of a valve
opening that allows blood to flow directly to
left atrium (shunting blood from right to left
atrium)
Ductus arteriosus- shunt of blood from
pulmonary artery to descending aorta
Ductus venosus- connection of umbilical
vein to inferior vena cava.

Fetal vs. Newborn

Circulation

Circulatory Transition

Cardiovascular
Normal Heart Rate- 100 to 160/min over a full minute

First breaths combined with alveolar capillary distention inflate

the lungs and pulmonary vascular resistance to blood flow
from pulmonary arteries.

Pulmonary pressure drops in pressure of right atrium.

pulmonary blood flow from the left side of heart pressure in
the left atrium closure of Foramen Ovale (for a few days,
crying can reverse closure mild cyanosis).

Cardio (cont)
Fetal Po2 from 27 mmHg (in utero) to 50 mmHg (extrauterine),
O2 and prostaglandin E2 [PGE2] closes the ductus arteriosus.
Can reopen in response to hypoxia, asphyxia, or prematurity.
By clamping and cutting the cord, the arteries, vein, and ductus
venosus close.

Pulmonary pressure drops in pressure of right atrium.

pulmonary blood flow from the left side of heart pressure in
the left atriumcausing the foramen ovale to close. (for a few
days, crying can reverse closure mild cyanosis.

Thermoregulation
Normal temp- 97.7 to 98.9 F
Anatomic and physiologic characteristics place newborns at risk
for hypothermia and hyperthermia

Newborns have larger body surface-to-body weight (mass)

Blood vessels are closer to the skin. Changes in room temp
temp of the blood influencing temp regulation centers in the
hypothalamus

Therm (cont)
To conserve heat energy,
newborns assume a position of
flexion.
Constrict peripheral blood vessels
Brown fat is used for non-shivering
thermogenesis (located in
superficial deposits in
interscapular region, axillae,
thoracic inlet, vertebral column,
and kidneys.

Cold Stress

Neurological

Neurological

Renal

Renal

Hepatic

Hepatic

Formation and
Excretion of Bili

Gastrointestinal

Gastrointestinal

Musculoskeletal

Musculoskeletal

Integument

Integument

Caput,
Cephalhematoma, &
Subgaleal

Extrauterine
Adaptation
Physical

Characteristics

Vital
Signs

Weigh
t

Head

Length

Chest

Baby J. was a SVD,

2 hours ago. The
nurse obtained the
following
assessment
findings:

Initial Assessment
findings
Head
Circumference: 33 cm
sutures over-riding
caput & molding
noted fontanels palpable nonbulging

Assessment continued...

Chest

33cm

Length

48cm

Weight

3600 g

Vital Signs

HR = 124
R = 48
T = 97.0 ax

Estimating Gestational Age

Physical Examination

Neuromuscular Examination

The nurse notes the

following physical
characteristics for Baby
J.

Skin is leathery,
cracked and
wrinkled
No lanugo is
present
Deep plantar
creases

Infant States
Immediately following birth
I

12

After first 6 hours

12

II

II

II

II

II

II

II

II

Feeding Methods

Breastfeeding

Bottle feeding

Breast vs. Bottle

Advanta
ges

Disadvantag
es

Newborn Nutrition
Steady Weight gain
Regular Sleep pattern
Normal Elimination
pattern
Active with happy
disposition
Firm muscles and
appropriate fat

Assessment of
Newborn Nutrition
Infant weight_________(lbs or kg)
Calculate recommended intake
________________calories recommended
Calculate calories in ounces consumed
________________calories consumed
Compare the reported total to the
recommended
& give appropriate instruction

A new mother
asks the following
questions about
her newborn...

What is the white sticky stuff

under my babys arms? Why is
it there?

How much will my baby eat?

Why does he spit up after
eating?

What are the red freckles on

his neck?

I received a nice baby bathtub with

baby oil, lotion and powder from
my mothershe said give him a
bath everyday and put a bellybinder on him.

How do I care for the

circumcision?

I am breast-feeding and my
mother is coming to stay with
us for 2 weeks to do all of the
night-time feedings with a
bottle. Can I pump enough
milk to do this?

I take Prozac 20mg for mild

depression, should I take it
before or after I breastfeed
each morning?

Should I wake my baby up

to feed him on a schedule?

I notice that he jumps a lot

when we make noise or touch
himis something wrong?

The night nurse told me that

my baby had to have a
genetic test done on his foot.
My family doesnt have any
retarded children. Please
dont stick him!

 We do not have a baby bed

yet, so he will sleep in bed
with us for a few weeks.
What kind of bed do I need?

My grandmother said feed him a

little bit of cereal in the bottle at
night and he will sleep better.

She also said to let him sleep on

his stomach because he might get
a stomach ache if he sleeps on his

Questions?