NEONATAL ADAPTATION

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 depends on :
p MATURATION
p NUTRITIONAL STATUS
p TOLERANCE
p ADAPTIVE CAPACITY
NEONATAL ADAPTATION

ADAPTATION depend on :
p MATURATION
Related to gestational age
p NUTRITIONAL STATUS
p TOLERANCE
p ADAPTATION
NEONATAL ADAPTATION

ADAPTATION depend on :
p MATURATION
p NUTRITIONAL STATUS
Related to birth weight
p TOLERANCE
p ADAPTATION
NEONATAL ADAPTATION

ADAPTATION depends on :
p MATURATION
p NUTRITIONAL STATUS
p TOLERANCE

The ability to overcome the

new environment
Tolerability to hypoxia, hypoglycemia, caloric
intake, etc.
p ADAPTATION
 NEONATAL
ADAPTATION
ADAPTATION depends on :
p MATURATION
p NUTRITIONAL STATUS
p TOLERANCE
p ADAPTIVE CAPACITY
the potential or ability of a
system to adapt to the
effects of change
NEONATAL ADAPTATION

Adaptation involve multi-

organ function, include :

 Cardio-circulatory system
 Respiratory system
 Intestinal tract
 Metabolism
 Central nervous system
Physiological changes at birth

Changes Time
 Breathing Seconds
 Blood flow Seconds
 Glucose homeostasis Minutes
 Temperature control Minutes
 Renal Hours – days
 GI tract Hours - days
 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 systemic blood
and prostaglandin function)
 CIRCULATORY ADAPTATION

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

NEONATAL
FETAL CIRCULATION
CIRCULATION
 NEONATAL ADAPTATION

CIRCULATORY ADAPTATION
Fetus Newborn
Active,
Pulmonary Active, less
increased
circulation development.
development

Foramen ovale Open Close

Ductus arteriosus
Open Close
Botali
Ductus Venosus
Open Close
Arantii
Active with Active with
Systemic
low increased
circulation resistance resistance
Circulatory Adaptation
NEONATAL ADAPTATION
FETAL
PULMONARY
DEVELOPMENT
Alveoli present : 25
weeks filled with lung
fluids
Breathing movements:
• Intermittently
• Lung development
• Control of
breathing

Fetus : gas exchange via

placenta
 NEONATAL ADAPTATION

Temperature

Touch Proprioceptive

FIRST Mechanical
Pain BREATH

Diafragm Chemoreceptor
Neonatal Respiration
Irregular
Abdominal respiration
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
BEGINS
 PULMONARY ADAPTATION

FETUS NEWBORN
Alveolus Collaps Develops

Pulmonary vessels Non active Active

Pulmonary
High Decrease
resistance
Pulmonary blood Low Increase

Oxygen needs Placenta Lung

CO2 excretion Placenta Lung
NEONATAL ADAPTATION
Progressive developments of the duodenum,
liver, pancreas and billiary apparatus
Gest.Age 4 wk

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

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 to function.
 Increase needs of calories/nutritional and
enzyme metabolism.
 NEONATAL ADAPTATION

GASTROINTESTINAL
ADAPTATION
Fetus Newborn
Nutritional
Non active Active
absorption
Bacterial
Negative Positive
colonization
Meconium
Feces Meconium
Feces
Non
Enzyme Active
function
 Neonatal Adaptation

UROGENITAL ADAPTATION

 Renal organogenesis – a continuous process –

6 till 36 weeks gestation
 The development of urogenital function
continued 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

OLIGOHYDRAMNIOS
May suggest renal agenesis; hypoplasia; dysplasia;
urinary tract obstruction.
POLYHYDRAMNIOS
Gastrointestinal anomalies; transplacental transfusion
syndrome; 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 Identified at 4
Monocytes cells mo gestation.

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

PREVENTION FROM INFECTIONS

 Body
Body Temperature
Temperature in
in the
the NB
NB

37.5 C
Normal range
36.5 C
Cold stress ---------- Cause for concern
36.0 C

Moderate hypothermia --- WARM BABY

32.0 C

Severe hypothermia / outlook grave

Skilled care urgently needed
 Neonatal Adaptaion
TEMPERATURE ADAPTATION

FETUS :
Body temperature  intrauterine
environment (0.7 o Celcius above mothers
temperature)
NEWBORN :
Expose to extra uterine condition 
homeothermy capabilities are limited
due to : large surface area; poor
thermal insulation; low ability to conserve
heat.

PREVENT OF HEAT LOSS

 Neonatal Adaptation

HEAT LOSS.
 CONDUCTION Transfer of body heat
to skin surface.
 CONVECTION
 EVAPORATION
 RADIATION

Dry and wrap the baby

Place on a warm mattress
 NEONATAL
ADAPTATION
HEAT LOSS
Skin heat loss depends
 CONDUCTION
on air
 CONVECTION temperature/flow.
 EVAPORATION
 RADIATION

Wrap the baby and control

room temperature
NEONATAL ADAPTATION

HEAT LOSS.
 CONDUCTION
 CONVECTION
 EVAPORATION Depend upon air
humidity and dryness
 RADIATION
of skin

Dry the baby and

Control humidity and
room temperature
 Neonatal Adaptation

HEAT LOSS
 CONDUCTION
 CONVECTION
 EVAPORATION The transfer of body heat
 RADIATION to environmental
temperature

Radiant heater and control

room temperature
 Neonatal Adaptation

Normal newborn :
 Term infants : 37 – 42 weeks GA
 Birth weight : 2500 – 4000 g
 Birth Length : 44 – 53 cm
 Head circumference : 31 -36 cm
 Apgar Score : 7 – 10
 Congenital anomalies : negative