NEONATAL ADAPTATION

Adaptation :
the process by which one adjusts and becomes more attuned to the environment.

Neonatal adaptation

Functional adjustment from intrauterine to extrauterine life Ability to adjust --- HOMEOSTASIS Maladaptation --- Morbidity

NEONATAL ADAPTATION
ADAPTATION depend on :

MATURATION NUTRITIONAL STATUS TOLARANCE ADAPTIVE CAPACITY

NEONATAL ADAPTATION
ADAPTATION depend on :

MATURATION
Related to gestational age

NUTRITIONAL STATUS TOLARANCE ADAPTATION

NEONATAL ADAPTATION
ADAPTATION depend on :

MATURATION NUTRITIONAL STATUS Related to birth weight TOLARANCE

ADAPTATION

NEONATAL ADAPTATION
ADAPTATION depend on :
MATURATION NUTRITIONAL STATUS TOLARANCE

The ability to overcome the new environment Tolerability to hypoxia, hypoglycemia, caloric intake, etc.

ADAPTATION

NEONATAL ADAPTATION
ADAPTATION depend on :
MATURATION NUTRITIONAL STATUS TOLARANCE ADAPTIVE CAPACITY

the potential or ability of a system to adapt to the effects of change

NEONATAL ADAPTATION
Adaptation involved multi-organ function, include :
Cardio-circulatory system Respiratory system Intestinal tract Metabolism Central nervous system

Circulatory ADAPTATION
Fetus from 8 weeks until birth organs mature to support external life

Fetal circulation
umbilical-placental circuit via umbilical cord circulatory shunts to bypass
Liver ductus venosus to inferior vena cava Lungs @ foramen ovale between right & left atria @ ductus arteriosus connects pulmonary artery to aorta

CIRCULATORY ADAPTATION
Umbilical vein
Ductus venosus Foramen Ovale

Ductus arteriosus
Pulmonary circ. Systemic circ. Umbilical artery

CIRCULATORY ADAPTATION
DUCTUS VENOSUS
BY PASS I

CIRCULATORY ADAPTATION

BY PASS II FORAMEN OVALE

CIRCULATORY ADAPTATION

BY PASS III

PATENT DUCTUS ARTERIOSUS

CIRCULATORY ADAPTATION
FETAL CIRCULATION
High pulmonary resistance Low resistance in systemic blood flow

RIGHT to LEFT shunt

Foramen Ovale
(Left arterial pressure low because returned lung blood is low and right atrial pressure high due to large volume of blood from placenta)

Ductus arteriosus
(High pulmonary resistance, Low fetal systemiv blood and prostaglandin function)

CIRCULATORY ADAPTATION
NEONATAL CIRCULATION

Profound changes of circulation at birth Increased pulmonary blood flow due to the drops of pulmonary resistance - lung expansions. Venous return from lung increase. Left arterial press. is raised; Right art.press.decrease foramen ovale closed. Systemic resistance higher than pulmonary resistance (24 hours) Prostaglandin function Ductus close Constrict umbilical arteries and placental blood stops.

NEONATAL ADAPTATION

NEONATAL FETAL CIRCULATION CIRCULATION

NEONATAL ADAPTATION
CIRCULATORY ADAPTATION
Fetus
Pulmonary circulation Foramen ovale Ductus arteriosus Botali Ductus Venosus Arantii Systemic circulation
Active, less develop.

Newborn
Active, increased development

Open

Close

Open
Open
Active with low resistance

Close
Close
Active with increase resistance

Circulatory ADAPTATION

NEONATAL ADAPTATION
FETAL PULMONARY DEVELOPMENT
Alveoli present : 25 weeks fill with lung fluids Breathing movements: Intermittently Lung developments Control of breathing Fetus : gas exchange placenta

NEONATAL ADAPTATION
Temperature Touch

Proprioceptive

Pain

FIRST BREATH

Mechanical

Diafragm
Neonatal Respiration Irregular Abdominal respiration

Chemoreceptor

NEONATAL ADAPTATION
PULMONARY ADAPTATION

CHAIN OF EVENTS AFTER FIRST BREATH :

Converts fetal to adult circulation

Empties the lung fluids.

Begin pulmonary function.

THE NEWBORN RESPIRATION BEGIN

PULMONARY ADAPTATION

FETUS
Alveolus Pulmonary vessels Pulmonary resistance Pulmonary blood Oxygen needs CO2 excretion Colaps Non active High Low Placenta Placenta

NEWBORN
Develops Active Decrease Increase Lung Lung

NEONATAL ADAPTATION
Progressive developments of the duodenum, liver, pancreas and biliary apparatus

Gest.Age 4 wk

Gest.Age 6 wk
Duodenum : occluded - reformation of lumen X atresia Liver & biliary : Begin at 6 and 12 weeks failure to canalization X biliary atresia Pancreas : Insulin secretion and glucagon - 10 and 15 weeks

ADAPTASI NEONATUS
GASTRO INTESTINAL ADAPTATION
FETUS :
Caloric and nutritional needs derived from mother placenta. Intestinal motility non active

No need for enzyme metabolism.

NEWBORN Intestinal motility begin in function. Increase needs of calori/nutritional and enzyme metabolism.

NEONATAL ADAPTATION
GASTROINTESTINAL ADAPTATION
Fetus
Nutritional absorption Bacterial colonization Feces Enzyme Non active

Newborn
Active

Negative
Meconium Non function

Positive
Meconium Feces Active

NEONATAL ADAPTATION
UROGENITAL ADAPTATION
Renal organogenesis a continuous process 6 till 36 weeks gestation
The developments of urogenital funtion continuous after birth Fetal urine production maintaining amniotic fluid volume More than 90% newborn void in the first 24 hours. Newborn urine production : 1-2 ml/kg BW/hour.

NEONATAL ADAPTATION
UROGENITAL ADAPTATION

ALLERTNESS
OLIGOHYDRAMNIOS
May suggest renal agenesis; hypoplasia; dysplasia; urinary tract obstruction.

POLYHYDRAMNIOS
Gastrointestinal anomalies; transplacental transfusion syndr.; congenital DM

DELAYED MICTURITION (>48 hours)

Inadequate renal perfusion (Hypovolemia/hypoxia); Failure urine production; urine flow obstruction.

NEONATAL ADAPTATION
IMMUNOLOGIC STATUS of the FETUS and NEWBORN
FETUS :
Phagocytic cells Granulocytes cells Monocytes cells Identified at 4 mo gestation.

NEWBORN : Immune system even in term - lower than adults. Between 3-12 mo transient immunodeficiency. The risk enhance by : Prematurity Traumatic delivery Neonatal stress, etc.

PREVENTION FROM INFECTIONS

37.5 C

Normal range
36.5 C Cold stress ---------- Cause for concern Moderate hypothermia --- WARM BABY 32.0 C Severe hypothermia / outlook grave Skilled care urgently needed

36.0 C

NEONATAL ADAPTATION
TEMPERATURE ADAPTATION
FETUS : Body temperature intrauterine environment NEWBORN : Expose to extra uterine condition homeothermy capabilities is limited due to : large surface area; poor thermal insulation; low ability to conserve heat. PREVENT OF HEAT LOSS

NEONATAL ADAPTATION
HEAT LOSS.
CONDUCTION CONVECTION EVAPORATION

Transfer of body heat to skin surface.

RADIATION

Dry and wrap the baby Place in a warm mattress

NEONATAL ADAPTATION
HEAT LOSS
CONDUCTION CONVECTION EVAPORATION Skin heat loss depends on air temperature/flow.

RADIATION

Wrap the baby and control room temperature

NEONATAL ADAPTATION
HEAT LOSS.
CONDUCTION CONVECTION EVAPORATION Depend upon air humidity

RADIATION

Control humidity and room temperature

NEONATAL ADAPTATION
HEAT LOSS
CONDUCTION CONVECTION EVAPORATION

RADIATION

The transfer of body heat to environmental temperature

Radiant heater and control room temperature

NEONATAL ADAPTATION
Normal newborn :
Term infants Birth weight : 37 42 weeks GA : 2500 4000 g

Birth Length Apgar Score

: 44 53 cm : 7 10

Head circumference : 31 -36 cm Congenital anomalies : negative