Newborn Adaptation to

Extrauterine Life
 Introduction
 The immediate postpartum period is a time of
significant physiological adaptation for both
the mother and baby.
 The newborn must adapt from being
completely dependent on another for life
sustaining oxygen and nutrients to an
independent being, a task accomplished over
a period of hours to days.
 Cont.,.,
 Successful transition from fetal to
neonatal life requires a complex
interaction between the following
systems:
 • Respiratory.
 • Cardiovascular.
 • Thermoregulatory.
 • Immunologic.
 Respiratory
 Establishing respirations is critical to
the newborn’s transition, as lungs
become the organ of gas exchange after
separation from maternal
uteroplacental circulation.
 Over 90% of newborns make the
transition from intrauterine life to extra
uterine life without difficulty, requiring
little to no assistance (NRP, 2010).
 Cont.,.,
 However, for the 10% of newborns who
do require assistance, about 1% require
extensive resuscitative measures to
survive.
 All personnel who care for newborns
immediately after birth should have
skills in neonatal resuscitation and
maintain their Neonatal Resuscitation
Program (NRP) status.
 Respiratory Adaptation
 The initiation of breathing is a complex
process that involves the interaction of
biochemical, neural and mechanical
factors (Alvaro & Rigatto, 2005).
Pulmonary blood flow, surfactant
production, and respiratory
musculature also influence respiratory
adaptation to extrauterine life.
 Cont.,.,
 Umbilical cord clamping decreases
oxygen concentration, increases carbon
dioxide concentration, and decreases
the blood pH. This stimulates the fetal
aortic and carotid chemoreceptors,
activating the respiratory centre in the
medulla to initiate respiration.
 Cont.,.,.
 Mechanical compression of the chest
during the vaginal birth forces
approximately 1/3 of the fluid out of
the fetal lungs.
 As the chest is delivered, it re-expands,
generating a negative pressure and
drawing air into the lungs.
 Cont.,.,
 Passiveinspiration of air replaces fluid.
As the infant cries, a positive
intrathoracic pressure is established
which keeps the alveoli open, forcing
the remaining fetal lung fluid into the
lymphatic circulation.
 In order for the respiratory system to
function effectively, the infant must
have:
- adequate pulmonary blood flow
- adequate amount of surfactant
- respiratory musculature strong
enough to support respiration
Cardio vascular
Cont.,.,
Normal Term Cord Blood
Values:
 Thermoregulation
 Large body surface area compared to
mass
 Types of heat loss:
 Conduction - direct skin contact.
 Convection - body to cooler air.
 Radiation - body to cold object.
 Evaporation - water to vapor.
Conduction:
Convection:
Radiation:
Evaporation:
GOAL: Keep baby in a neutral thermal
environment: where the baby's metabolic
rate, and therefore O2 consumption, is
minimal, but the body temperature remains
within the normal range.
 The Liver: Hepatic Functions
 Conjugates bilirubin.
 Stores fetal iron.
 Stores liver glycogen for energy.
 Coagulation.
 Liver Adaptations:
 Iron content stored in liver.
 Low carbohydrate reserves.
 Main source of energy is glucose.
 Liver begins to conjugate bilirubin.
 Lack of intestinal flora results in low
levels of vitamin K.
 Coagulation & Vitamin K
 The absence of normal flora in newborn
gut needed to synthesize Vitamin K
results in low Vitamin K levels until 5th
day of life
 every newborn gets injected with Vit. K
(AQUA MEPHYTON or PHYTONADIONE)
to prevent bleeding problems.
Cont.,.,

 Dose:
1mg (0.5ml) IM >1500 gm

0.5mg(0.25ml)IM<1500 gm
GI Adaptation - COOL facts...
 BEFORE BIRTH, baby has already swallowed
and peristalsis begins
 stomach holds 50-60 ml (2 ounces)

 GI tract mature 36-38 wks gestation

 By 24 hours, the intestines are air filled

 Saliva is hardly produced until 3 months

 Babies regurgitate due to immature sphincter

 Newborns lose 5-10% body wt. in 5-10 day

 insensible water loss & low caloric intake
 POOP!
Meconium
Transitional
Fecal
Breastfed
 Immunologic Adaptation:
 IgG- Active acquired immunity (35 wks)
 Provides bacterial and viral protection for 4-8
months
 IgM- produced by fetus starting 10-15 wks
 Elevated levels indicate infection in uter.o
 IgA- passive immunity from colostrum.
 Protects respiratory, GI and eyes.
 Reactivity States in the Newborn
First period of reactivity - first 40 min.
Baby is alert,responsive, eager to explore the
world
 Sleep period - 1-3 hours after birth. May
continue for 3-6 hrs. Baby is in a deep sleep,
difficult to arouse. Resp. rate & heart rate decrease.
 Second period of reactivity – 3-6 hours after
birth. Baby is awake, respirations are rapid,
irregular, and may have periods of apnea. May
cough and regurg mucus, etc. Keep bulb syringe
handy. Heart rate again increases.
 That’s it!!

Aren’t babies a miracle??