PHYSIOLOGIC FUNCTION

1. CARDIOVASCULAR SYSTEM
 Changes in the cardiovascular systems are necessary at
birth because the lungs now must be oxygenate the blood
that was formerly oxygenated by the placenta.
 Cord is clamped →lungs inflate for the first time
↓
Pressure decreases in the chest and in the
pulmonary artery
( artery leading to the lungs)

Promote closure of the ductus arteriosus

As pressure increases in the left side of the heart

Closure of the foramen ovale( because of the pressure against the lip of the
structure .

Umbilical vein, 2 umbilical arteries and ductus venosus closes, and no

longer receive blood, blood within them clots, vessels atrophy
 Circulatiom remains sluggish for the 1st 24 hrs.
 ACROCYANOSIS – feet to feel cold to touch.
a. Blood values
 Bld volume = 80 – 110- ml/kg body wt or 300 ml
 Erythrocyte ct = 6 M/cubic ml
 Hgb – bet. 45 and 50%
 Capillaty heel stick may reveal a false high hematocrit or
hgb bec of sluggish peripheral circulation
 WBC – 15,000- 30,000cells/mm3
 High as 40,000 cells/mm3 may be seen if the birth is
stressful.
 LEUKOCYTOSIS is the response to the trauma of birth and
is nonpathogenic= an increased in WBC should not be taken
as evidence of infection.
b. BLOOD COAGULATION
 Most newborns are born with a prolonged coagulation or
prothrombin time because their blood levels of Vitamin K are lower
than normal.
 Vit K synthesized through the action of intestinal flora= necessary
for the formation of factor II ( prothrombin), factor VII( proconvertin),
factor IX (plasma thromboplastin) and factor X( Stuart prower factor)
 Takes 24 hour for the flora to accumulate and for vitamin K to be
synthesized.
 Newborns have diminished blood coagulation ability so VIT K is
administered IM at the lateral anterior thigh.
2. RESPIRATORY SYSTEM
 THE FIRST BREATH OF A NEWBORN is initiated by a combination
of cold receptors, a lowered PO2 ( PO2 falls from 80 mmHg to as
low as 15 mmHg) and an increased PCO2 ( PCO2 rises as high as
70mmHg)
 First breath requires a tremendous amount of pressure ( about 40-
70 cm H2o)

 The presence of fluid in the lungs :

a. eases the surface tension on alveolar walls and makes a first
breath easier
b. allows the alveoli to inflate more easily than if the lung walls were
dry

Breathing becomes much easier for the baby

requiring only about 6-8 cm H2O pressure.

 abt 1/3 of the fluid is forced out of the lungs by the pressure of
vaginal birth.
 A baby born by CS does not have as much lung fluid expelled at
birth

Many have more difficulty establishing effective respiration

Because of excessive fluid blocks the air exchange space
 Should be examined closely in the pot partal period for a
cardiac murmur or indication of patent cardiac structure
= patent ductus arteriosus.

Additional fluid is quickly absorbed by the lung blood vessels and

lymphatic’s after the first breath.
 Within 10 minutes = newborn has established a good residual
volume.
 By 10 t0 12 hours of age = vital capacity is established at newborns
proportion
 Immature newborn and whose alveoli collapse each time they
exhale because of lack of pulmonary surfactant have trouble
establishing effective residual capacity and respirations.
 If the alveoli do not open well = cardiac system is compromised
because closure of the foramen ovale and ductus arteriosus
depends on free blood flow through the pulmonary artery and good
oxygenation of blood.
3. GASTROINTESTINAL SYSTEM
 Usually sterile at birth
 Bacteria may be cultured from the intestinal tract in most babies and
within 5 hours after birth and from all babies at 24 hours of life.
 Bacteria enters the tract through
 the newborn’s mouth
 airborne sources.
 Vaginal secretions at birth
 Hospital bedding
 Contact at the breast
 Accumulation of bacteria in the gastrointestinal tract is necessary for
the digestion and synthesis of vit K.
 Milk= the infant’s main diet is low in Vit. K
 Newborn’s stomach holds 60 -90 ml
 Has limited ability to digest fat and starch because pancreatic
enzymes (lipase and amylase) are deficient for the first few months
of life.
  Newborn regurgitates easily because of an immature cardiac
sphincter between the stomach and esophagus.
 Immature liver functions may lead to lowered glucose and protein
serum levels.
a. STOOLS
 The first stool within 24 hours consists of MECONIUM a sticky
tarlike, blackish-green, odorless form from mucus, vernix,
lanugo, hormones and carbohydrates that accumulated during
intrauterine life.
 A newborn who did not pass a stool within 24-48 hours should
be examined, for the possibility of meconeum ileus, imperforate
anus or bowel obstruction.
 2nd or third day of life, TRANSITIONAL STOOL= green and
loose, may resemble diarrhea
 4th day = breastfed babies pass 3-4x light yellow stools per
day. They are sweet smelling because breast milk is high in
lactic acid which reduces the amount of putrefactive organisms
in the stool.
 Fed with formula =passes 2 – 3x with bright yellow stools a
day. Have a slight noticeable odor than breastfed babies.
 Placed under phototherapy = bright green stools because of
increased bilirubin ecretion.
 With bile duct obstruction = clay colored stool ( gray) because
the bile pigment do not enter the intestinal tract.
 Blood flecked stools indicate anal fissure.
 Occasionally, a newborn swallows some maternal blood
during birth and will either vomit fresh blood immediately
after birth or pass tarry stool in 2 or more days.
 Maternal blood may be differentiated from the fetal blood
by a dipstick Apt test = if the stools remain black or tarry=
intestinal bleeding should be suspected.

4. URINARY SYTEM
 THE average newborn voids within 24 hours after birth.
 Didn’t void within 24 hour = possibility of urethral stenosis or
absent of kidneys or ureters.
 Possibility of obstruction in the urinary tract can be assessed
by observing the force of the urinary stream :
 a. Male – void with enough force to produce a small
projected arc
b. Females – should produce a steady stream
 Kioneys do not concentrate urine well thus the urine is light
colored and odorless
 15 ml= single voiding of a newborn
 Spec gravity = 1.008-1.010
 Daily urine output for thew 1st 1 or 2 days is 30-60 ml
 By week 1= total daily volume is 300 ml
 The first voiding may be pink or dusky because of uric acid
crystals that were formed in the bladder in utero.
 Small amount of protein is normally present for the first few
days life until kidney glomeruli are more fully mature.
5. IMMUNE SYSTEM
 Have difficulty forming antibodies against invading antigens until
they are about 2 months of age. = prone to infection.

The reason that most immunization against childhood diseases are

not given to infants younger than 2 months and since they have
that passive antibodies (IgG) from the mother that have crossed the
placenta.
6. NEUROMUSCULAR SYSTEM
 MATURE NEWBORNS demonstrate general neuromuscular
function by moving their estremities, attempting to control head
movement, exhibiting strong cry.
 LIMPNESS or total absence of muscular response to manipulation
is never normal and suggest NARCOSIS, shock or cerebral injury.
 Occasionally makes twitching or flailing movements of the
extremities in the absence of stimulus because of immaturity of the
nervous system.
 Newborn at term Demonstrates SEVERAL REFLEXES:
a. Blink Reflex-
 to protect the eye from any object coming near it by rapid
eyelid closure.
b. Rooting reflex
 Serves to help the baby find food.
 Newborn’s cheek is brushed or stroked near the corner
of the mouth, the child will turn the head in that direction.
  Disappears abt the 6th week of life. = at this time, the eyes
can already focus can already see.
c. Sucking Reflex
 When a newborn’s lips re touched, the baby makes a
sucking motion.
 Diminish at 6 months of age
 Disappears immediately if not stimulated.
d. Swallowing reflex
 Food that reaches the posterior portion of the tongue is
automatically swallowed.
 Gag,cough and sneeze reflex are also present to maintain
a clear airway in the event that normal swallowing does
not keep the pharynx free of obstructing mucus.

e. Extrusion Reflex
 Extrude any substance that is placed on the anterior
portion of the tongue.
 This protective reflex prevents the swallowing of inedible
substances.
 Disappears about 4 months of age= until then, an infant
may seem to be spitting out or refusing solid food placed
in the mouth.
f. Palmar Grasp Reflex
 Grasp an object placed in their palm by closing their
fingers on it.
 Mature newborns grasp so strongly they can be raised
from a supine position and be suspended from the
examiner’s fingers.
 Disappears at 6 weeks to 3 months
 A baby begins to grasp meaningfully at about 3 months of
age.
g. Step (Walk) in place Reflex
 Newborns who are held in A vertical position with their
feet touching a hard surface will take a few quick
alternating steps.
 Disappears by 3 months of age
 At 4 months, babies can bear a good portion of their
weight unhindered by this reflex.
h. Placing Reflex
 Similar to the step-in-place reflex, except it is elicited by
touching the anterior surface of a newborn’s leg against
the edge of a bassinet or table.
 A newborn will make a few quick lifting motions as if to
step onto the table.
i. Plantar Grasp Reflex
 When an object touches the sole of a newborn’s foot at
the base of the toes, the toes grasp in the same manner
as the fingers do.
 Disappears at about 8-9 months of age in preparation for
walking.
 May be present during sleep for a longer period.
j. Tonic neck Reflex
 When newborn’s lie on heir backs, their head usually turn
to one side of the other.
 The arm and the leg on the side to which the head turns
extend, and the opposite arm and leg contract
 Movement is evident in the arms
 Also called the Boxer or fencing reflex
 Disappears between the 2nd and 3rd month of life.

k. Moro / Startle Reflex

 Can be initiated by startling the newborn with a loud noise
or by jarring the bassinet
 The most accurate method to elicit reflex is to hold
newborns in a supine position and allow their heads to
drop backward an inch .
They abduct and extend their arms and legs.
 Fingers assume a typical “C” position
 The reflex stimulates the action of someone trying to
ward off an attacker, then covering up to protect himself.
 Strong for the 1st 8 weeks
 Disappears at the end of 4th or 5th month when the infant
can roll from danger.
l. Babinski Reflex
 When the side of the sole of the foot is stroked in an
inverted “J” curve from the heel upward.
 This reaction occurs because nervous system
development is immature.
  Remains positive until 3 months of age
m. Magnet Reflex
 If pressure is applied to the soles of the feet of a newborn
lying in a supine position, he or she pushes back against the
pressure.
 Test of spinal cord integrity ( Moro, babinski and magnet
reflex)
n. Crossed Extension Reflex
 One leg of a newborn lying supine is extended and the
sole of that foot is irritated by being rubbed with a sharp
object. Causes the newborn to raise the other leg and
extend it as trying to push away the hand irritating the first
leg.
o. Trunk Incurvation Reflex
 When the newborn lie in a prone position and are touched
along the paravertebral area by a probing finger, they will
flex their their trunk and swing their pelvis toward the
touch.
p. Landau Reflex
 A newborn who is held in a prone position with a hand
underneath supporting the trunk should demonstrate
some muscle tone.
 Babies may not ne able to lift their head or arch their back
( at 3 months), but they sag into an inverted “U”
position.
q. Deep tendon Reflex
 Tapping the patellar tendon with the tip of the finger.
 Biceps reflex is a test for spinal nerves C4 and C6
 Patellar reflex is a test for spinal; nerves L2 through L4
 THE SENSES
1. Hearing
 Able to hear in the utero
 Hearing is acute – when the amniotic fluid drains or absorbed from the
middle ear thru the Eustachian tube within hours after birth
 Appear to have difficulty in hearing sound
 They respond with generalized activity to a sound such as bell ringing a
short distance from inner ear.
 If actively crying when the bell is rung, they will stop crying and seem to
attend
 Recognize the mother’s voice immediately.
2. Vision
 Newborns demonstrate sight at birth by blinking at a strong light or
following the bright light or toy a short distance with their eyes
 They focus best on black and white objects at a distance of 9 -12 inhes.
 A papillary reflex is present from birth.
 They cannot follow past the midline vision
 They lose track of objects easily
 Sometimes reported that they can’t see
3. Touch
 Well developed at birth
 Demonstrate it by quieting at a soothing touch and by positive sucking and
rooting reflexes
 React to painful stimuli
4. Taste
 Has the ability to discriminate taste because taste buds are developed and
functioning before birth.
 In the utero= it swallow amniotic fluid more rapidly if glucose is added to
sweeten its taste.
 The swallowing decreases if a bitter flavor is added.
5. Smell
 Present as soon as the nose is clear of mucus and amniotic fluid.
 Turns toward their mother’s breast partly out of recognition of the smell of
breast milk and partly as a manifestation of the rooting reflex.
 Their ability to respond to odors can be used to document alertness.