Neonatal Adaptation _GDS-K3.1 lalalal

8/13/2019 Neonatal Adaptation _GDS-K3.1 lalalal

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PediatricsObstetrics

Perinatology

PERINATOLOGY


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Perinatology Coverage

22 weeks Born 1 Month

(GA 5 month)

Obstetric Pediatric(pregnancy monitor) Neonatologist

(intensif care)


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Normal newborn :

Term infants : 3742 weeks GA

Birth weight : 25004000 g

Birth Length : 4453 cm

Head circumference : 31 -36 cmApgar Score : 710

Congenital anomalies : negative


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Fetus Neonates

*

* Fetal circulation * Neonatal circulation

* O2 depend to Utero * O2 own produce

placental circulation by breathing

* Nutrition depend on * Feed ---- Breast feeding

maternal status


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Fetus Neonate

Birth

Resuscitation daptation

NEONATAL ADAPTATION


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NEONATAL ADAPTATION

Adaptation:the process by which one adjustsand becomes more attuned to the

environment.Neonatal adaptation :Functional adjustment from intrauterine

to extrauterine lifeAbility to adjust --- HOMEOSTASIS

Maladaptation --- Morbidity


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NEONATAL ADAPTATION

ADAPTATION depend on :

MATURATION

NUTRITIONAL STATUS

TOLARANCE

ADAPTIVE CAPACITY


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MATURATION

Related to gestationalage

NUTRITIONAL STATUS

TOLARANCE

ADAPTATION

NEONATAL ADAPTATION


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MATURATION

NUTRITIONAL STATUS

Related to birth weight

TOLARANCE

ADAPTATION

NEONATAL ADAPTATION


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NEONATAL ADAPTATION


MATURATION

NUTRITIONAL STATUS

TOLARANCE

The ability to overcome thenew environment

Tolerability to hypoxia,hypoglycemia, caloric intake, etc.

ADAPTATION


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MATURATION

NUTRITIONAL STATUS

TOLARANCE

ADAPTIVE CAPACITY

the potential or ability of asystem to adapt to theeffects of change

NEONATAL ADAPTATION


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NEONATAL ADAPTATION

Cardio-circulatory system Respiratory system

Intestinal tract

Metabolism

Central nervous system

Adaptation involved multiorgan function include:


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Circulatory daptation Fetus - from 8 weeks until birth organs

mature to support external life

Fetal circulation

umbilical-placental circuit via umbilical cordcirculatory shunts to bypass

Liver

ductus venosus to inferior vena cava

Lungs

@ foramen ovale between right & left atria

@ ductus arteriosus connects pulmonary artery

to aorta


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CIRCULATORY ADAPTATION

DUCTUSVENOSUS

BY PASS I


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FORAMENOVALE

BY PASS II


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PATENTDUCTUS

ARTERIOSUS

BY PASS III


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FETAL CIRCULATIONHigh pulmonary resistanceLow resistance in systemic blood flow

RIGHT to LEFT shunt

Foramen Ovale

(Left artrial pressure low because returned lung blood is low and

right atrial pressure high due to large volume of blood fromplacenta)

Ductus arteriosus

(High pulmonary resistance, Low fetal systemic blood and

prostaglandin function)


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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.decreaseforamen ovale closed.

Systemic resistance higher than pulmonary resistance(24 hours) Prostaglandin function Ductus close

Constrict umbilical arteries and placental blood stops.


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NEONATAL ADAPTATION

FETAL

CIRCULATION

NEONATAL

CIRCULATION


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NEONATAL ADAPTATION


Fetus Newborn

Pulmonary

circulation

Active, less

develop.

Active, increased

development

Foramen ovale Open Close

Ductus arteriosus

BotaliOpen Close

Ductus VenosusArantii

Open Close

Systemic

circulationActive with low

resistance

Active with

increase

resistance


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Circulatory Adaptation


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FETAL PULMONARY DEVELOPMENT

Alveoli present : 25 weeks

fill with lung fluids

Breathing movements:

Intermittently

Lung developments

Control of breathing

Fetus : gas exchange

placenta


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NEONATAL ADAPTATION

FIRST

BREATHMechanical

Proprioceptive

Chemoreceptor

Temperature

Touch

Diafragm

Neonatal Respiration

Irregular

Abdominal respiration

Pain


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PULMONARY ADAPTATION

FETUS NEWBORN

Alveolus Colaps Develops

Pulmonary vessels Non active Active

Pulmonary

resistanceHigh Decrease

Pulmonary blood Low Increase

Oxygen needs Placenta Lung

CO2 excretion Placenta Lung


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

Gest.Age 4 wk

Gest.Age 6 wkDuodenum : occluded - reformation of lumen Xatresia

Liver & biliary : Begin at 6 and 12 weeksfailure to canalization Xbiliary atresia

Pancreas : Insulin secretion and glucagon - 10 and 15 weeks


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GASTRO INTESTINAL ADAPTATION

FETUS :

Caloric and nutritional needs derived from motherplacenta.

Intestinal motility non active

No need for enzyme metabolism.

NEWBORNIntestinal motility begin in function.

Increase needs of calori/nutritional and enzymemetabolism


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NEONATAL ADAPTATION

GASTROINTESTINALADAPTATION

Fetus Newborn

Nutritional

absorptionNon active Active

Bacterial

colonizationNegative Positive

Feces MeconiumMeconium

Feces

Enzyme Non function Active


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UROGENITAL ADAPTATIONALLERTNESS

OLIGOHYDRAMNIOS

May suggest renal agenesis; hypoplasia; dysplasia; urinary tractobstruction.

POLYHYDRAMNIOS

Gastrointestinal anomalies; transplacental transfusion syndr.;

congenital DM

DELAYED MICTURITION (>48 hours)

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


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IMMUNOLOGIC STATUS ofthe FETUS and NEWBORN

FETUS :Phagocytic cells

Granulocytes cells

Monocytes cells

NEWBORN :

Immune system even in term -lower than adults.

Between 3-12 motransient immunodeficiency.

The risk enhance by :PrematurityTraumatic deliveryNeonatal stress, etc.

PREVENTION FROM INFECTIONS

Identified at 4 mo

gestation.


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Body Temperaturein the NB

37.5 C

36.5 C36.0 C

32.0 C

Normal range

Cold stress ---------- Cause for concern

Moderate hypothermia --- WARM BABY

Severe hypothermia / outlook grave

Skilled care urgently needed


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TEMPERATURE ADAPTATIONFETUS :

Body temperature intrauterine environment

NEWBORN :Expose to extra uterine condition

homeothermy capabilities is limited due to : largesurface area; poor thermal insulation; low ability

to conserve heat.

PREVENT OF HEAT LOSS


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Neonatal Adaptation _GDS-K3.1 lalalal

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