Chapter 14

Physiological & Behavioral Adaptations of the

Newborn
PHYSOLOGICAL ADAPTATIONS
 The transition to extrauterine life begins before birth. The fetus is prepared for life in the following
ways:
o Fetal lungs develop & mature during last trimester of pregnancy to support gas exchange at birth.
 Surfactant- mixture of phospholipids & lipoproteins, is produced in fetal lungs
 Production of surfactant begins around 24 wks. w/ distribution throughout lungs at 28-32
wks.
 Sufficient concentration to prevent respiratory complications occur at 34-35 wks.
 Important for newborn b/c it prevents alveoli from sticking together when baby takes the
first few breathes & makes it easier for gas exchange to occur in lungs
o Brown fat- body fat that is used by infants to regulate body temperature
 Infant does not shiver to raise body temp; he/she burns brown fat instead
 Main function of brown fat is to protect the infant from hypothermia
 Located in scapular area, thorax, and behind kidneys
o Glucose is stored in the liver as glycogen to provide an energy source for the newborn at birth
o During labor, fetal adrenal glands are stimulated to produce catecholamines
 Catecholamines: hormone dopamine, norepinephrine, & epinephrine
 All increase blood flow to the heart, lungs, & brain; increase energy, & stimulate WBC
production in the immune system
 Immediately after birth is the important time for these physiological adaptions to occur
o Must transition from being dependent on the placenta for oxygen & nutrients to independent functioning
o Most significant body system changes for baby: respiratory, cardiovascular, & thermoregulation
 Accomplished in first 4-6 hrs. following delivery
o Infants who need assistance with transition include : premature, nonreassuring FHR pattern in labor,
shoulder dystocia, infants who went through assistive deliveries, & those w/ presence of meconium

THERMOREGULATION SYSTEM
 Temperature of a newborn is about 37.2°C (98.9°F) at birth b/c of warm environment of the uterus.
o Infant begins to lose heat after birth through 4 mechanisms :
 Evaporation: loss of heat as the amniotic fluid on the infant evaporates
 Conduction: transfer of heat from the infant’s body to cooler surfaces, such as towels or cool base
of a warming unit
 Convection: transfer of body heat to the surrounding cool air
 Radiation: transfer of infants body heat to a cooler object that the infant is not in contact with,
such as a window
o Abt. 4 hours for temp to stabilize
o Do not have sub-Q fat to provide insulation, & their blood vessels are close to the surface
 Nonshivering thermogenesis: “brown fat” that newborn relies on
 Infants body constricts blood vessels in the skin, & the deeper vessels pick up heat from brown fat to
warm body
o Brown fat nerves can be quickly depleted if prolonged cold stress occurs
 When this happens → brown fat breaks down into fatty acids, leading to metabolic acidosis
 Newborn can attempt to raise temp. by crying & kicking; but also will become quickly fatigue from this
effort
 Prevention of cold stress is a priority
 o As infant tries to increase body temp, an increase in the metabolic rate occurs; & consequences of that can
be serious:
 Increase need for 02
 Decrease in surfactant production
 Increase in use of stored glycogen (hypoglycemia)
 Rapid metabolism of brown fat, leading to metabolic acidosis
o Nursing interventions
 Drying infant immediately after birth & removing wet towels
 Skin-to-skin with mother asap covering w/ warmed blanket
 If unable: place under a preheated radiant warmer
o Do not overheat surfaces or place on surface hotter than baby skin temp
 Covering head asap
 Monitor temp every 15 min.
 Avoid uncovering or exposing entire body for procedures
 No bathing until temp stable for 2 hrs.
 Do not place crib near a draft or window
 Prewarming objects: mattress, towel, stethoscope, blankets (prevent conductive heat loss)

RESPIRATORY SYSTEM
 While in uterus fetal lungs are full of fluid, & fetus receives 02 through umbilical cord.
o Fetal circulation picks up 02 from placenta & umbilical vein transports oxygenated blood to the fetal
heart
 Most blood bypass lungs b/c placenta is supplying 02 to the fetus
 The clamping of umbilical cord ends flow of 02 from placenta
o When this is done a sequence of events occurs for infant to breath
 Internal stimuli- chemically focused
 External stimuli- r/t mechanical, sensory, & thermal changes in body
 External stimuli begins as fetus moves through birth canal; pressure on chest causes lung secretions &
amniotic fluid inside lungs to be squeezed out through airway
o When chest fully emerges chest reexpands or recoils, causing an intake of air to fill lungs
 First few breathes critical: lungs adjusting to pressure changes from inside of mother to outside
environment
o Blood flow to lungs increase, & alveoli are forced open
 Surfactant secretions increases to keep the alveoli open after initial breathe
 Breathing becomes easier: as infant is dried, sensors in skin are stimulated = encourage respiratory
center to begin the 1st sequences of breathing
 Internally, chemical factors influence the newborn to breathe, after the umbilical cord is cut:
o A decrease in 02 concentration
o Increase in C02
o Drop in pH in blood
 These factors stimulate respiratory center in brain to begin functioning
 Nursing interventions:
o count respirations/min
o suction mouth & nose w/ bulb syringe to clear mucus
o monitor respiratory effort
 abdomen included b/c newborn breathing involves diaphragm & abdominal muscles
 Allowing newborn short burst of crying will increase the depth of respirations & aid in opening the
alveoli at birth
o Prolonged crying is not safe d/t tiring infant & infant’s body to use up stored glycogen for energy

CARDIOVASCULAR SYSTEM
  After newborn starts breathing the umbilical cord is cut, changes occur in:
o Blood flow
o Pressure
o Volume within the heart
 Fetal circulation is no longer effective & blood flows in new route
 Newborns blood volume is 80-110 ML & has more RBC’s than average adult
o The RBC’s provide extra oxygenation for the stress of labor
 Hgb is 17-18 g/mL & HCT 45-50%
 After oxygenation through lungs is established, the lg number of RBCs is unneeded in baby
o Extra RBCs begin to breakdown within days
o As they are broken down, Bilirubin (waste product of RBCs) is released & bilirubin levels rise
 Also has elevated WBCs from 15,000-30,000
o Elevated WBC count does not reflect infection but reflects how stressful birth was
 Diminished ability to clot blood vessels b/c absence of Vit. K
o Vit. K is essential for formation of factors II (prothrombin), VII (proconvertin), IX (plasma
thromboplastin component), & X (Stuart-Power Factor) in clotting sequence
 It is synthesized by bacteria in the intestines
 Newborn has sterile intestines at birth & not enough of these bacteria/intestinal flora to
synthesize Vit. K until about 24 hours after birth
 Nursing interventions for cardiovascular
o Monitor HR
 If less than 100 BMP stimulate baby to breathe
 If ineffective increasing HR use positive pressure ventilation in RM at low pressure to increase
O2 = will increase HR
o Begin chest compressions in HR below 60 BPM.
 When beginning compressions, monitor baby color of trunk and MM & cap refill time of the
trunk
 Keep in mind, normal newborn may have decrease peripheral circulation & bluish
hands/feet

GI SYSTEM
 GI tract sterile at birth but bacteria enter the mouth during birth through vaginal secretions & after
birth through hospital linens & contact at the breast
o These bacteria become probiotics
 Intestinal bacteria that aid in digestion & synthesize Vit. K
 Capacity of newborn stomach is 60-90 mL.
o Pancreas is immature
 The enzymes lipase & amylase (help to digest fat & starch) are deficient for 1st few months
o Cardia sphincter between esophagus & stomach is weak, which allows the infant to regurgitate easily
 Meconium stool composed of sticky, blackish/green material made from mucus, vernix, lanugo,
hormones, & carbohydrates
o Accumulate in bowel during fetal development, should be expelled within 24-48 hrs. of birth
 Nursing interventions
o Monitor meconium stool & report if not expelled within 24 hrs.
o Teach parents not to overfeed newborn & about the immature cardiac sphincter & regurgitation

HEPATIC SYSTEM
 At birth liver serves to store glycogen & iron
o Immature liver does not detoxify medication or breakdown bilirubin from RBCs efficiently
o The extra blood cells that were necessary for O2 begin to breakdown, releasing bilirubin
  Liver job =. Remove indirect (unconjugated) bilirubin from circulation and convert/conjugate, it to a
form that can be excreted
o Indirect bilirubin in circulation causes jaundice
 During conjugated process liver changes yellow pigment from breakdown of RBC into a water-soluble
pigment that can be excreted by the body
o Direct (conjugated) bilirubin is excreted into the common duct & duodenum
o Once direct bilirubin is in intestines, the normal intestinal flora reduce it further, & is excreted as
yellowish/brown stool
 Small amt can be excreted through urine
 b/c liver is immature & # of unneeded RBCs is large, the job of breaking down & removing bilirubin is
not accomplished efficiently
o causing lg number of babies to develop jaundice by days 2-4
 appearance of jaundice before 24. Hrs. of life indicates abnormal rapid destruction of RBCs &
could indicate ill newborn
 Nursing interventions
o Monitor for yellow sclera & skin
o Teach parents abt normal physiological jaundice
 Expected range for bilirubin is less than 5.8mg
o Bilirubin levels will rise & should peak by day 5 & should be bellow 11.7 mg
 Elevated levels need to be reported to HCP

IMMUNE SYSTEM
 Born with passive antibodies (immunoglobulin G) passed to him/her from mother through placenta
o If mother fully vaccinated or has had these illnesses, the newborn is protected from:
 Polio
 Measles
 Diphtheria
 Pertussis
 Chicken pox
 Rubella
 Tetanus
o This passive immunity from mother protects infant for 1st 2-4 months of age
 Nursing interventions
o Maintain strict handwashing for everyone in contact w/ newborn
o Protecting newborn from infection
o Screening health care & visitors for illnesses
o Encourage parents to begin immunizations at 2 months of age
 Newborn has no immunity against herpes simplex
o Any family member or health care personnel w/ outbreak should not care for infant until lesions are
crusted over
 If newborn contracts virus it can progress to a systemic form of the dx, which can be fatal

BEHAVIORAL ADJUSTMENT TO EXTRAUTERINE LIFE

 Initiate interaction by crying, quiet when soothed & engage in mutual gazing
o Newborn will demonstrate they like something by focusing eyes & tracking an object/person
o Demonstrate behaviors that indicate dislikes, turning away, crying, & yawning
 Self-soothe by thumb or hand sucking
 PERIODS OF REACTIVITY
o First period occurs in first 30-60 min. after birth; during this time newborn is:
 Alert, active, & cooperative
  A vigorous suck reflex is present, which is good time to introduce lack-on for breastfeeding
 After period of alertness; baby falls into deep sleep that can last 2-4 hrs. or longer
 This is called the period of relative inactivity
o During this time, baby is unresponsive to external stimuli
o HR & RR decrease but stay WNL
o Parents may have trouble waking baby for feedings
o Second period of reactivity begins when baby wakes up from long sleep & is alert, active, &
hungry.
 HR will depend upon external stimuli
 Periods of rapid respirations may be noted
 During this time educate parents about hunger cues
 SLEEP & AWAKE STATES
o Deep sleep- baby lies very still w/ occasional twitch.
 No eye movement, & breathing is reg.
 Difficult to awaken baby
o Light sleep- known as “rapid eye movement sleep”
 Eye movements may be visible beneath eyelids
 May occasionally fuss or make sucking movements
 State typically right before baby wakes
o Drowsy- baby’s eyes may open
 Baby not fully asleep & may go back to sleep or wake more
o Alert- baby’s eyes open.
 Breathing regular
 Attentive to what is going on
 Most interested in eating
o Active alert- more active & may begin to chew on hands/feet
 May try to get in position for feeding
 Sensitive to hunger, discomfort, & fatigue
 May require comforting in this state
o Crying- baby conveys that something is bothering him/her
 May need to be fed/burped
 May need diaper changed
 May be bored, overstimulated, or need close physical contact