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THE NEONATAL PERIOD

HUMAN DEVELOPMENT Vanessa M. Manila, RN UP Manila College of Nursing 1

OBJECTIVES
1. Describe the newborn’s transition to extrauterine life.
a. Intrauterine Life b. Physiologic Adaptations

2. Describe the neonatal physical characteristics 3. Describe the neonate’s behavioral responses and developmental tasks 4. Discuss appropriate nursing care of the newborn
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Transition from intrauterine to extrauterine life
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I.

Intrauterine Life

Placental Function:
- transfer of gases (lungs) - transport of nutrients (gastrointestinal tract) - excretion of wastes (kidneys) - transfer of heat (skin)

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I.

Intrauterine Life

Placental Function:
- conjugation of drugs and hormones (liver) - production of various protein and steroid hormones (endocrine gland)

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II. Physiologic Adaptations
“ The most profound physiologic change required of the neonate is transition from fetal or placental circulation to independent respiration…” (Whaley and Wong, 1989)

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II. Physiologic Adaptations
A. Respiratory adaptations B. Cardiovascular adaptations C. Temperature regulation D. Urinary Adaptations E. Gastrointestinal Adaptation F. Hepatic Adaptation G. Immunologic System H. Neurologic and Sensory/ Perceptual Functioning
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II. Physiologic Adaptations
– most critical: first 24 hours – the most critical and immediate physiologic change required of the newborn is the onset of breathing slapping the infant’s feet/ buttocks has no beneficial effect
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A. Respiratory adaptations
Characteristics: - Normal rate: 30- 60 breaths per minute shallow and irregular depth and rhythm Primarily abdominal and synchronus with the chest mov’t Short periods of apnea are to be expected Pauses lasting 5- 15 secs, called periodic breathing, may occur
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II. Physiologic Adaptations

II. Physiologic Adaptations

B. Circulatory adaptations

Characteristics: - Heart rate: 100 bpm when asleep; 120- 150 when awake
Rates as high as 180 while crying may be normal Apical pulse rates should be obtained by auscultation for a full minute

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BP: resting: 74/47 mmHg
Crying may cause elevation
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II. Physiologic Adaptations

C. Thermogenic Adaptations

Neonatal Characteristics affecting thermal adaptation: - decreased subcutaneous fat and thin epidermis - blood vessels are closer to the skin - large body surface area - flexed posture - presence of Brown Adipose Tissue
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II. Physiologic Adaptations

C. Thermogenic Adaptations

Thermogenesis in newborn: - increased muscular activity and positional changes - chemical thermogenesis (non-shivering thermogenesis); increased basal metabolic rate - vasomotor control

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II. Physiologic Adaptations

D. Renal System

First voiding should occur within 24 hours Unable to concentrate urine Usually straw- colored and almost odorless Pseudo- menstruation in female infant

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II. Physiologic Adaptations
Loss of fluid, through urine, feces, lungs, increased metabolic rate and limited fluid intake results in 5- 10% loss of body weight. This usually occurs during the first 3-5 days. The infant usually regains the birth weight within 14 days after birth
At birth the total weight of the infant is 73% fluid as compared to 58% in the adult

The infant has a proportionately higher ratio of extracellular fluid than the adult
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II. Physiologic Adaptations

E. Gastrointestinal System

The ability to digest, absorb, and metabolize food stuff is adequate but limited in certain functions.
(Whaley and Wong, 1989)

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II. Physiologic Adaptations

E. Gastrointestinal System

A special mechanism coordinates breathing, sucking, and swallowing reflexes necessary for oral feeding Sucking in newborn takes place in small bursts of 3- 8 sucks at a time Unable to move food from the lips to the pharynx
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III. Physiologic Adaptations

F. Hepatic Regulation

Liver is immature Plays an important role: 1. conjugation of bilirubin 2. blood coagulation

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II. Physiologic Adaptations

G. Immunologic System

Cells that provide the infant with immunity are developed early in fetal life Not activated for several months First 3 months: passive immunity from the mother
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III. Physiologic Adaptations

G. Immunologic System

Breast- fed infants receives passive immunity through colostrums and breast milk Sepsis: respiratory distress Best protection: hand hygiene

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II. Physiologic Adaptations

H. Neurologic and Sensory/ Perceptual Functioning

Neither anatomically nor physiologically developed All neurons are present Uncoordinated in movement Labile in temperature regulation Have poor control over their musculature
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II. Physiologic Adaptations

H. Neurologic and Sensory/ Perceptual Functioning
Vision - the least mature at term - development continues for the first 6 months

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II. Physiologic Adaptations

H. Neurologic and Sensory/ Perceptual Functioning

Hearing - as soon as amniotic fluid is drained from the ear, hearing is similar as to that of an adult - react to high frequency sound with a startle - reacts to low- frequency sound by decreasing motor activity or stopping crying 22

II. Physiologic Adaptations

H. Neurologic and Sensory/ Perceptual Functioning

Smell - highly developed - by the 5th day, can recognize mother’s smell - breastfed infants are able to smell breastmilk and can differentiate their mother from other lactating women
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II. Physiologic Adaptations

H. Neurologic and Sensory/ Perceptual Functioning

Taste - tasteless solution: no response - sweet: eager sucking - sour: puckering of lips - bitter: grimace - newborns prefer glucose water to plain water
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II. Physiologic Adaptations

H. Neurologic and Sensory/ Perceptual Functioning
- responsive to all parts of the body - face, hands, and soles of the feet appear to be the most sensitive - touch and motion are essential to normal growth and

Touch

development

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