New Born Baby and Adjustment to

Extra Uterine Life

 Outlines
• Extra uterine Adjustment .

• Physiologic changes occur within new born

body related to respiratory system and
circulatory system .

• Physiologic status of other system after

birth .
 Adjustment To Extra uterine Life
• The most profound physiologic change required of
neonates is transition from fetal or placental
circulation to independent respiration.

• The loss of the placental connection means the loss

of complete metabolic Support, especially the supply
of oxygen and the removal of carbon dioxide.
 Adjustment To Extra uterine Life
• Factors that interfere with this normal
transition or that interfere with fetal
oxygenation and affect the fetus’s adjustment
to extra uterine life :

• Hypoxemia.
• Hypercapnia.
• Acidosis.
 Respiratory System
• The most critical and immediate physiologic change
required of newborns is the onset of breathing.

• The stimuli that help initiate the first breath are

primarily chemical and thermal.
 Respiratory System
• Chemical factors in the blood (low oxygen, high
carbon dioxide, and low pH) initiate impulses that
excite the respiratory center in the medulla.

• The primary thermal stimulus This abrupt change in

temperature excites sensory impulses in the skin
that are transmitted to the respiratory center.
 Respiratory System
• Tactile stimulation may assist in initiating respiration.

Acceptable methods of tactile stimulation include :

• Tapping or flicking the soles of the feet
• Gently rubbing the newborn’s back, trunk, or
extremities.
 Respiratory System
• As the chest emerges from the birth canal,
fluid is squeezed from the lungs through the
nose and mouth.

• After complete delivery of the chest air enters

the upper airway to replace the lost fluid.

• Remaining lung fluid is absorbed by the

pulmonary capillaries and lymphatic vessels.
Respiratory System
 Circulatory System
The transition from fetal to postnatal circulation
involves the functional closure of the fetal shunts:
• Foramen ovale
• Ductus arteriosus
• Ductus venosus
 Circulatory System
Increased blood flow
1. Dilates the pulmonary vessels.
2. Pulmonary vascular resistance decreases.
3. Systemic resistance increases.
4. Maintaining blood pressure (BP)
 Circulatory System
Ductus arteriosus
• is a blood vessel connecting the pulmonary
artery to the proximal descending aorta.

• It allows most of the blood from the right

ventricle to bypass the fetus's fluid-filled non-
functioning lungs.
 Circulatory System
• With the increase in pulmonary blood flow and
dramatic reduction of pulmonary vascular
resistance,the ductus arteriosus begins to
close.
 Circulatory System
foramen ovale
• is a hole in the wall between the left and right
atria of every human fetus.
• This hole allows blood to bypass the fetal
lungs, which cannot work until they are
exposed to air.
 Circulatory System
foramen ovale cont
• As the pulmonary vessels receive blood, the
pressure in the right atrium, right ventricle,
and pulmonary arteries decreases.

• Left atrial pressure increases above right atrial

pressure, with subsequent foramen ovale
closure.
 Circulatory System
Ductus venosus
• a vein passing through the liver and
connecting the left umbilical vein with the
inferior vena cava of the fetus, losing its
circulatory function after birth.
 Circulatory System

• Failure of the ductus arteriosus or foramen

ovale to close results in persistence of fetal
shunting of blood away from the lungs.
 Thermoregulation
• Next to establishing respiration, heat
regulation is most critical to the newborn’s
survival.
 Thermoregulation
factors predispose newborns to excessive heat loss:

• The newborn’s large surface area facilitates heat loss to

the environment.

• The newborn’s thin layer of subcutaneous fat provides

poor insulation for conservation of heat.

• The newborn’s mechanism for producing heat is different

from that of the adult, who can increase heat production
through shivering.
 Thermoregulation
The principal thermogenic sources are
• Heart.
• Liver.
• Brain.

• An additional source, once believed to be unique to

newborns is known as brown adipose tissue, or
brown fat.
 Thermoregulation
• Heat generated in brown fat is distributed to
other parts of the body by the blood, which is
warmed as it flows through the layers of this
tissue.
 Thermoregulation
Superficial deposits of brown fat are located :
• Between the scapulae.
• Around the neck.
• In the axillae.
• Behind the sternum.
• Deeper layers surround the kidneys.
• Trachea
• Esophagus.
• Some major arteries, and adrenals.
 Hematopoietic System
• The blood volume of the newborn depends
on the amount of placental transfer of blood.

• The blood volume of a full-term infant is

about 80 to 85 ml/kg of body weight
Immediately after birth.

• The total blood volume averages 300

ml.
 Fluid and Electrolyte Balance
• Changes occur in the total body water
volume, extracellular fluid volume, and
intracellular fluid volume during the
transition from fetal to postnatal life.
 Fluid and Electrolyte Balance
• At birth, the total weight of an infant is 73%
fluid compared with 58% in an adult.
• Infants have a proportionately higher ratio of
extracellular fluid than adults.
 Fluid and Electrolyte Balance
factors make infants more prone to dehydration
and acidosis:

• Infant’s rate of metabolism is twice that of an adult

in
relation to body weight.

• As a result, twice as much acid is formed, leading to

more rapid development of acidosis.

• Immature kidneys cannot sufficiently concentrate urine

to conserve body water.
 Gastrointestinal System
The ability of newborns to digest, absorb, and
metabolize foodstuff is adequate but limited
in certain functions.
• Enzymes are adequate to handle proteins and
simple carbohydrates.

• Deficient production of pancreatic amylase

impairs use of complex carbohydrates.
 Gastrointestinal System
• Deficiency of pancreatic lipase limits
absorption of fats, especially with ingestion of
foods with high saturated fatty acid content
such as cow’s milk.

• Human milk, despite its high fat content, is

easily digested because the milk itself contains
enzymes such as lipase, which assist in
digestion.
 Gastrointestinal System
The liver is the most immature of the
gastrointestinal organs.
• The activity of the enzyme glucuronyl
transferase is reduced
• Affects the conjugation of bilirubin with
glucuronic acid and contributes to physiologic
jaundice of newborns.
 Gastrointestinal System
The liver is also deficient in forming plasma
proteins.
The decreased plasma protein
concentration probably plays a role in
the edema usually seen at birth
 Gastrointestinal System
• The liver stores less glycogen at birth than
later in life.
• Consequently, newborns are prone to
hypoglycemia.
 Gastrointestinal System
• Some salivary glands are functioning at birth,
but the majority do not begin to secrete saliva
until about age 2 to 3 months, when drooling
is frequent.
 Gastrointestinal System
• Stomach capacity varies in the first few days of
life, from about 5 ml on day 1 to about 60 ml
on day 3.
• thus, infants require frequent small feedings
 Gastrointestinal System
• An infant’s intestine is longer in relation to
body size than that of the adult.

• Therefore, there are a larger number of

secretory glands and a larger surface area for
absorption compared with an adult’s
intestine.
 CHANGE IN STOOLING
PATTERNS OF NEWBORNS
Meconium
• Infant’s first stool; composed of amniotic fluid and its
constituents, intestinal secretions, shed mucosal
cells, and possibly blood (ingested maternal blood or
minor bleeding of alimentary tract vessels)

• Passage of meconium should occur within the first 24

to 48 hours, although it may be delayed up to 7 days
in very low–birth-weight infants.
 CHANGE IN STOOLING
PATTERNS OF NEWBORNS
Transitional Stools
• Usually appear by third day after initiation of
feeding; greenish brown to yellowish brown,
thin, and less sticky than meconium; may
contain some milk curds.
 CHANGE IN STOOLING
PATTERNS OF NEWBORNS
Milk Stool

• Usually appears by fourth day In breastfed infants

stools are yellow to golden, are pasty in
consistency,and have an odor similar to that of sour
milk.

• In formula-fed infants stools are pale yellow to light

brown, are firmer in consistency, and have a more
offensive odor.
 Renal System
• All structural components are present in the
renal system, but there is a functional
deficiency in the kidneys’ ability to
concentrate urine and to cope with
conditions of fluid and electrolyte stress such
as dehydration or a concentrated solute
load.
 Renal System
• Total volume of urine per 24 hours is about 200 to
300 ml by the end of the first week.
• the bladder voluntarily empties when stretched by a
volume of 15 ml, resulting in as many as 20 voidings
perday.
• The first voiding should occur within 24 hours.
• The urine is colorless and odorless and has a specific
gravity of about 1.020.
 Integumentary System
• At birth, all of the structures within the skin are
present, but many of the functions of the
integument are immature.

• The growth phases of hair follicles usually occur

simultaneously at birth.

• During the first few months, the synchrony

between hair loss and re growth is disrupted, and
there may be overgrowth of hair ortemporary
alopecia.
 Integumentary System
• The eccrine glands, which produce sweat in
response to heat or emotional stimuli, are functional
at birth, and palmer sweating on crying reaches
levels equivalent to those of anxious adults by 3
weeks of age.

• The eccrine glands produce sweat in response to

higher temperatures than those required in adults,
and the retention of sweat may result in miliaria.
 Musculoskeletal System
• At birth, the skeletal system contains more cartilage
than ossified bone, although the process of
ossification is fairly rapid during the first year.

• The six skull bones are relatively soft and are

separated only by membranous seams. The sinuses
are incompletely formed in newborns.
• muscular system is almost completely formed at
birth.
 Defenses Against Infection
Infants are born with several defenses against infection.

• The first line of defense is the skin and mucous membranes, which
protect the body from invading organisms.

• The second line of defense is the macrophage system, which

produces several types of cells capable of attacking a
pathogen.

• The neutrophils and monocytes are phagocytes, which means

they can engulf, ingest, and destroy foreign agents.

• The third line of defense is the formation of specific antibodies

to
an antigen.
 Endocrine System
Ordinarily, the endocrine system of newborns is adequately
developed,but its functions are immature.

• The effect of maternal sex hormones is particularly evident in

newborns.

• The labia are hypertrophied, and the breasts of both genders may
be engorged and secrete milk from the first few days of life to as
long as 2 months of age.

• Female newborns may have pseudomenstruation

(more often seen as a milky secretion than actual blood) from a
sudden drop in progesterone and estrogen levels.
 Neurologic System
• At birth, the nervous system is incompletely
integrated but sufficientlydeveloped to sustain
extrauterine life.

• Most neurologic functions are primitive

reflexes.

• The autonomic nervous system is crucial during

transition because it stimulates initial
respirations, helps maintainacid–base balance,
and partially regulates temperature control.
 Sensory function
• Sensory Functions Newborns’ sensory
functions are remarkably well developed and
have a significant effect on growth and
development, including the
attachmentprocess.
 Sensory function
Vision
• At birth, the eye is structurally incomplete.

• Tear glands usually do not begin to function

until 2 to 4 weeks of age.

• The pupils react to light, the blink reflex is

responsive to minimal stimulus, and the corneal
reflex is activated by a lighttouch.
 Sensory function
Hearing
• After the amniotic fluid has drained from the
ears, infants probably have auditory acuity
similar to that of adults
 Sensory function
Smell
• Newborns react to strong odors such as
alcohol and vinegar by turning their heads
away.
• Breastfed infants are able to smell breast milk
and will cry for their mothers when they smell
leaking milk
 Sensory function
Taste
• The newborn has the ability to distinguish
among tastes.
Touch
• At birth, infants are able to perceive tactile
sensation in any part of the body, although
the face (especially the mouth), hands, and
soles of the feet seem to be most
sensitive.
 References
• Marilyn J.Hockenberry,David Wilson
,2009,Essentials of Pediatric
Nursing,(8)Edition.PP186-189.