1. 2.

3. 4.

a. b. Decreased pulmonary vascular resistance c. Increased pulmonary blood flow d. Decreased alveolar surface tension from adequate surfactant e. Recoil of chest, causing replacement of fluids f. Change from weightlessness to gravity controlled environment Q Respiration may be irregular, with short periods of apnea; respiration is at times shallow, abdominal, nasal, quiet and rapid: 30 -60 per minute. Surfactant is a requisite for mature lung functioning. Respiratory secretions may be abundant.

5. Difficult to palpate pulses: radial, temporal C. HEMATOLOGY IN THE NEWBORN: Blood values (venous samples) 1. Red blood cells: 5 7.5 million/m3 2. Hemoglobin: 14 20 gm/100 mL; 17 18 gm/100 mL, average 3. Hematocrit: 42% - 52% (61% upper limit) 4. WBC: 20,000/mm3, average; with normal leucocytosis because of trauma of childbirth 5. Platelets: Platelet counts at birth are in the same range of adults, but newborns may manifest mild transient platelet aggregation functioning defect which is accentuated by phototherapy (Hatch & Summer, 1981). 6. Blood Volume: 78-98 mL/kg, depending on cord clamping. 7. Newborn coagulation: a. The initial sterility of the newborns GIT [absent normal bacterial flora] results in low levels of vitamin K transient blood coagulation deficiency between the second and fifth day of life [lowest point about 2 to 3 days] after birth slow rise adult level at 9 months of age or later (Olds, London & Ladewig 1988). b. Prophylactic vitamin K (Aquamephyton) is given at birth to combat potential bleeding problems. c. If there is a bleeding problem, intake of cows milk restores prothrombin time faster than breastmilk because breastmilk contains only a quarter the amount of vitamin K per deciliter of cows milk (Korones, 1986).

B. CARDIOVASCULAR SYSTEM 1. Circulatory changes occurring after birth: a. Umbilical vein and arteries and ductus venosus close with clamping of the cord. b. Foramen ovale and ductus arteriosus close functionally with the establishment of respiration caused by increased pressure in the left side of the heart as a result of increased pulmonary blood flow; it only becomes permanently anatomically closed after several months (3-4mo). This explains why murmurs could be heard and are common in the first month of life. 2. Apical beat: at the level of the 3rd or 4th interspace to the left of the midclavicular line; 110-160/minute (Littleton & Engebretson, 2006) 3. Pulses: reflect systemic circulation 4. Easily palpable pulses: femoral and brachial

d. Coagulation factors synthesized in the liver and activated under the influence of vitamin K (and therefore are vitamin Kdependent) are factors II, VII, IX, X. These vitamin Kdependent factors increase in response to y Dietary intake, and y Bacterial colonization of the intestines. Safety alert: Anticoagulant Coumadin (warfarin) is not given to pregnant women because it crosses the placenta barrier and accentuate existing vitamin K-dependent factor deficiencies. If there is a need for anticoagulant therapy in pregnancy, the safe drug to use is Heparin, as it does not cross the placental barrier. e. Fibrinogen and factors V and VII are near adult level ranges (Oski & Naiman 1982) D. NEUROMASCULAR SYSTEM