Transition to extrauterine life

Cold stress s/s

-Axillary temperature at or below 36.5°C (97.7°F) -Cool skin -Lethargy -Pallor -Tachypnea -Grunting -Hypoglycemia -Hypotonia -Jitteriness -Weak suck

Transitional stool

-Begins around the 3rd day & can continue for 3 or 4 days. -Transitions from black, to greenish black, to greenish brown, to greenish yellow. (Occurs in both breastfed & formula-fed.)

Meconium stool

-Begins to form during the 4th gestational month. -The first stool eliminated by the neonate. -Sticky, thick, black, odorless. -Is first passed within 24-48 hours.

Signs of respiratory distress

-Cyanosis -Abnormal respiratory pattern (apnea, tachycardia) -Retractions of chest wall -Grunting -Flaring of nostrils -Hypotonia

Two factors that negatively affect transition to extrauterine respirations

-Decreased surfactant levels related to immature lungs. -Persistent hypoxemia & acidosis that leads to constriction of the pulmonary arteries.

Risk factors for hypoglycemia (neonate)

-Diabetic mother -Weighing >4,000 grams -Large or small for gestational age -Post-term or preterm -Hypothermia -Infection -Respiratory distress -Neonatal resuscitation -Birth trauma

3 major fetal circulatory structures that undergo changes

-Ductus venosus -Foramen ovale -Ductus arteriosus

Neonates are at higher risk for thermoregulatory problems r/t:

-Higher body surface-area-to-body-mass ratio -Higher metabolic rate -Limited & immature thermoregulatory abilities

Neonate responds to cold by:

-Increase in metabolic rate -Increase of muscle activity -Peripheral vascular constriction -Metabolism of brown fat

Hypoglycemia s/s (neonate)

-Jitteriness -Hypotonia -Irritability -Apnea -Lethargy -Temperature instability

Decline of maternally acquired vitamin K levels is greater in neonates:

-who are breastfed -with a history of perinatal asphyxia -of mothers who are on warfarin

Optimal range for plasma glucose

70-100mg/dL

Indirect/unconjugated bilirubin

A fat-soluble substance produced from the breakdown of red blood cells. Is converted to direct/conjugated bilirubin by liver enzymes.

Surfactant

A phospholipid. In alveoli: -assists in establishment of functional residual capacity, which -assists in keeping alveolar sacs partially open at end of exhalation, which -decreases amount of pressure & energy required on inspiration.

Direct/conjugated bilirubin

A water-soluble substance, converted (from indirect/unconjugated bilirubin) by liver enzymes. Is in a form that can be excreted in the urine & stool.

Neutral thermal environment (NTE)

An environment that maintains body temperature with minimal metabolic changes and/or oxygen consumption. -Decreases possible complications related to the delayed response to environmental temperature changes.

Hypoglycemia (neonate)

Blood glucose level under 40mg/dL. Common during transitional time.

Hyperbilirubinemia

Condition in which there is a high level of unconjugated bilirubin in the neonate's blood, related to: -immature liver function, -high RBC count, & -increased hemolysis caused by the shorter life span of fetal RBCs.

Ductus arteriosus

Connects pulmonary artery with descending aorta. Usually closes within 15 hours post-birth. Closure occurs when: pulmonary vascular resistance becomes less than system vascular resistance → left to right shunt → closure of ductus arteriosus. (Will remain open if lungs fail to expand or PaO2 levels drop.)

Ductus venosus

Connects umbilical vein to inferior vena cava. Blood flow through umbilical vein stops once cord is clamped. Closes by day 3 of life & becomes a ligament.

Formula-fed stool

Drier & more formed than breastfed stools; paler yellow or brownish yellow & has an unpleasant odor.

The most critical & immediate physiological change

Establishment of extrauterine respirations.

Cold stress

Excessive heat loss that leads to hypothermia & results in the utilization of compensatory mechanisms to maintain the neonate's body temperature.

Nursing intervention for hypoglycemia (neonate)

Feed either: -formula or -dextrose water as per institutional protocol, generally 5 mL/kg.

Neonatal period

From birth through the first 28 days of life.

Brown adipose tissue (BAT)/brown fat/nonshivering thermogenesis

Highly dense & vascular adipose tissue. Helps transition by promoting: -increase in metabolism, -heat production (by intense lipid metabolic metabolism of BAT), -heat transfer to the peripheral system. Neonates possess large amounts. (-Preterm neonates have limited.) Reserves are rapidly depleted during periods of cold stress.

Diarrheal stool

Loose & green.

Convection (heat loss)

Loss of heat from the neonate's warm body surface to cooler air currents. (air conditioners or oxygen masks)

Evaporation (heat loss)

Loss of heat that occurs when water on the neonate's skin is converted to vapors. (during bathing or directly after birth)

Phototherapy

Most widely used & effective treatment for hyperbilirubinemia. Results in photoconverting bilirubin molecules to water-soluble isomers that can be excreted in the urine & stool without conjugation in the liver.

Foramen ovale

Opening between right & left atrium. Closes when left atrial pressure is higher than right atrial pressure. This closure occurs when: increased PaO2 → decreased pulmonary pressure → increased pulmonary blood flow → increased pressure in left atrium → closure of foramen ovale. (Significant neonatal hypoxia can cause a reopening.)

Systems that undergo the most critical & dynamic changes

Respiratory & cardiovascular.

"Golden hour"

The first hour of baby's life as they transition to extrauterine life.

Systems that also undergo significant changes

Thermoregulatory, metabolic, hepatic, gastrointestinal, renal, immune.

Focus of nursing care during neonatal period

To protect & support the neonate as undergoes numerous physiological changes & adapts to extrauterine life. Accomplished by: -maintaining body heat -maintaining respiratory function -decreasing risk for infection -assisting parents in providing appropriate nutrition & hydration -assisting parents in learning to care for their newborn.

Radiation (heat loss)

Transfer of heat from the neonate to cooler objects that are not in direct contact with the neonate. (cold walls of the isolette or cold equipment near the neonate)

Conduction (heat loss)

Transfer of heat to cooler surface by direct skin contact. (cold hands of caregivers or cold equipment)

Breastfed stool

Yellow & semiformed. Later becomes a golden yellow with a pasty consistency & has a sour odor.

Transition to extrauterine life begins:

at birth when umbilical cord is clamped & the neonate takes first breath.