Transition and Normal Newborn Care
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Transcript of Transition and Normal Newborn Care
Transition and Normal Newborn Care
Monica L. Scrudder, RNC-NIC, BSN, MSNFranciscan Health System
Regional Nurse Educator, Nursery Services
Objectives
• Identify primary features of fetal circulation.• Identify physiological changes that occur at
birth in the newborn’s transition to extrauterine homeostasis.
• Identify routine care for the newborn in the transition period.
• Identify signs and symptoms of common problems in the transition period.
• Identify nursing intervention that promote parental bonding.
What Is Transition???
The Transition Period
• Birth to 6 hours of age• Physiological change from placental
support to self-maintenance• Fetus prepares for transition over the
course of gestation• Transition depends on gestational age
and quality of placental support
The Cardiac Puzzle
Anatomy and Physiology
• Placental Fetal Circulation• Blood follows the path of least
resistance• Low pulmonary blood flow (only 8-10%
of right ventricular output secondary to high pulmonary vascular resistance
The Fetal Circulation
Ductus Venosus
Foramen Ovale
Ductus Arteriosis
Fetal Lungs
Fetal Metabolism and Hematology
• Glucose– Fetal concentrations 70-80% of maternal
glucose concentrations
• Glycogen– Large glycogen stores provide large energy
reserves to sustain newborn through transition period
• Brown Fat– Unique to newborn– Metabolized for heat
Cardiopulmonary Adaptation at Birth
Cardiovascular Adaptations At Birth
• Umbilical cord is clamped.• Three major shunts functionally close
during transition– Ductus Arteriosis– Foramen Ovale– Ductus Venosus
Pulmonary Adaptation At Birth
• Stimuli for initiating respiration– Mild hypercapnia, hypoxia and acidosis– Light, noise, touch– Thoracic squeeze during vaginal delivery
• Empties approximately 1/3 of fetal lung fluid
First Breath
• Air enters lungs at 2x normal pressure– 40-80 cm H2O
• Pulmonary vessels vasodilate in response to increased oxygen– Pulmonary vascular resistance decreases– Pulmonary blood flow increases
Continued Pulmonary Adaptations
• Pulmonary vascular resistance (PVR) decreases to reach adult levels at 2-3 weeks of age
• Lung compliance improves
Measurements
• Apgar score– Done at 1 minute and 5 minutes of age– If apgar less than 7 at 5 minutes of age,
continue every 5 minutes until greater than 7 for maximum of 20 minutes
The Apgar Score
Sign 0 1 2Heart rate Absent Slow (<100
bpm)> 100 bpm
Respirations Absent Weak cry,Hypo-ventilation
Good, strong cry
Muscle Tone Limp Some flexion Active motion
ReflexIrritability
No response Grimace Cough or sneeze
Color Blue or pale Body pink,Extremities blue
Completely pink
Assessment Findings During Transition
• Head circumference, length, weight• Gestational age assessment• Skin• Head• Respiratory assessment• Cardiac assessment• Gastrointestinal assessment• Extremities
Medications in Transition
• Erythromycin Ointment • Vitamin K (AquaMEPHYTON)• Hepatitis B vaccine/Hepatitis B
Immunoglobulin
Glucose Needs
Contraindications to Feeding
• Cyanosis• Shock or asphyxia• Increased work of breathing • Ongoing oxygen requirement
Routine Care Considerations
AAP/ACOG/AWHONN Guidelines
• Proper identification of newborn• Initial assessment within 2 hours of birth• Develop a plan of care• Document observations at least every 30 minutes until stable
for 2 hours• Prophylactic eye care within 1 hour of birth• Primary health care provider
– Perform initial physical exam no later than 24 hours of birth– Perform physical exam within 24 hours before discharge
• Document daily weight• Perform metabolic screening• Instruct parent in care of infant
Guidelines (Cont)
• Implement emergency measures, including resuscitation, when necessary using such programs as the Neonatal Resuscitation Program
• Observe parent-infant interactions• Identify with parent(s) the appropriate facility for follow-up• Inform parent(s) of importance of immunizations• Identify high-risk mothers• Evaluate home environment
Nursing Considerations
• Observations must be documented every 2 hours according to the State of Washington.– Follow hospital policy regarding this
guideline.• Vital sign routine• Daily weight• Physician notification• Timing of metabolic screening• Specific teaching issues for population
Nursing Observations
• Cardiac and Respiratory Status• Feeding• Temperature• Color• Tone • Activity• Output• Parent-infant bonding
Parent-Infant Bonding
• Bonding• Attachment• “En face”• “Parentese”• Red Flags
Assess Parenting Styles and Abilities
• Parents’ level of knowledge• Family’s communication• Parental expectations• Infant’s responses to parenting activities• Parental feelings about self and infant• Parental support• Cultural beliefs• Potential need for referral
Routine Care and Documentation
• Documentation of birth• Measurements• Medications• Physical assessment• Abduction prevention• Bathing/Hygiene• Cord Care• Feeding assessment• Metabolic screening• Elimination
Discharge Criteria
• Feedings• Discharge weight• Metabolic screening• Birth certificate worksheet/paternity
papers• Teaching documented• Hearing screening
Discharge Teaching
• Begins on admission• Assess Mother’s readiness to learn• Assess Father’s involvement• Involve Grandparents, siblings, and
other significant people
Teaching Documentation
• Thermoregulation• Holding and Positioning• Hygiene• Feeding• Bulb syringe• Choking• Elimination• Circumcision Care• Safety• When to Call the Physician
References
• Askin, DF. (2002) Complications in the Transition from Fetal to Neonatal Life. JOGNN 31(3): 318-27
• Buschbach, D., Schaub-Bordeaux, M. (2002) Newborn Physiological and Developmental Transitions: Integrating Key Components of Perinatal and Neonatal Assessment. Association of Women’s Health, Obstetric and Neonatal Nurses.
• Kenner, C., Wright-Lott, J. (2003) Comprehensive Neonatal Nursing: A Physiological Perspective. Philadelphia:Saunders
• Sansoucie DA, Cavaliere, TA. (1997) Transition from Fetal to Extrauterine Circulation. Neonatal Network, 16(2):5-12
• Verklan,TM, Walden, M., editors (2004) Core Curriculum for Neonatal Intensive Care Nursing (3rd ed.) St. Louis:Elsevier
References (2)
• http://www.cayuga-cc.edu/people/web_pages/greer/biol204/heart4/heart4.html
• http://dic.academic.ru/pictures/enwiki/80/Patent_ductus_arteriosus.jpg
• http://www.007b.com/breastfeeding_pictures.php
• http://pregnancy.about.com/od/newbornbabies/ig/Newborn-Photo-Gallery/index.01.htm