CHAPTER 23
1
2
3
Analyze the physiologic
adaptations that the
neonate must make
during the transition from
the intrauterine to the
extrauterine
environment.
Describe the behavioral
adaptations that are
characteristic of the
newborn during the
transition period.
Explain the mechanisms
of thermoregulation in
the neonate and the
potential consequences
of hypothermia and
hyperthermia.
LEARNING OBJECTIVES (1 OF 2)
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1
Describe newborn
reflexes and
differentiate
characteristic
responses from
abnormal responses.
2
Discuss the sensory
and perceptual
functioning of the
neonate.
3
Identify signs that the
neonate is at risk
related to problems
with each body
system.
LEARNING OBJECTIVES (2 OF 2)
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3
INTRODUCTION

Neonatal Period: from birth through day 28 of life

Newborn Physiologic adjustment tasks involve:

1.
establishing and maintaining respirations;
2.
adjusting to circulatory changes;
3.
regulating temperature;
4.
ingesting, retaining, and digesting nutrients;
5.
eliminating waste;
6.
regulating weight
Newborn Behavioral tasks include:
1.
establishing a regulated behavioral tempo
independent of the mother, which involves
self-regulating arousal, self-monitoring
changes in state, and patterning sleep;
2.
processing, storing, and organizing multiple
stimuli;
3.
establishing a relationship with caregivers
and the environment
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STAGES OF
TRANSITION TO
EXTRAUTERINE
LIFE (1 OF 2)

Major adaptations associated with
transition from intrauterine to
extrauterine life occur during the first
6 to 8 hours after birth

First period of reactivity


Lasts up to 30 minutes after
birth

Newborn’s heart rate
increases to 160 to 180
beats per minute but
gradually decreases after
30 minutes

The infant is alert
Period of decreased responsiveness:
lasts from 60 to 100 minutes

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After first period of
reactivity, newborn either
sleeps or has a marked
decrease in motor activity
5
STAGES OF
TRANSITION TO
EXTRAUTERINE LIFE (2
OF 2)

Second period of reactivity
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
Occurs 2 to 8 hours
after birth

Lasts from 10 minutes
to several hours

Tachycardia,
tachypnea occur

Increased muscle
tone

Improved skin color

Mucous production

Meconium typically
passed
6

Respiratory System

PHYSIOLOGIC
ADAPTATIONS
(1 OF 14)
Initiation of breathing

Chemical factors

Mechanical factors

Thermal factors

Sensory factors

Establishing Respiration

Signs of respiratory distress


Nasal flaring

Intercostal or
subcostal retractions

Grunting
Acrocyanosis: normal
finding in the first 24 hours
after birth
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
Cardiovascular system

Heart rate and sounds

Blood pressure

Blood volume

Signs of cardiovascular
problems

Persistent
tachycardia

Persistent
bradycardia

Skin color: pallor,
cyanosis
PHYSIOLOGIC
ADAPTATIONS
(2 OF 14)
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
Hematopoietic system

Red blood cells: because fetal circulation is less
efficient at oxygen exchange than the lungs, the
fetus needs additional RBCs for transport of
oxygen in utero; these levels are higher in a
newborn than an adult’s at birth

Leukocytes

Platelets

Blood groups
PHYSIOLOGIC ADAPTATIONS
(3 OF 14)
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
PHYSIOLOGIC
ADAPTATIONS
(4 OF 14)
Thermogenic system: goal of
care is to provide a neutral
thermal environment

Thermoregulation: the
maintenance of balance
between heat loss and
heat production

Hypothermia

Heat loss by the following:

Convection

Radiation

Evaporation

Conduction

Thermogenesis

Hypothermia and Cold
stress

Hyperthermia
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
Renal system

An infant who has not voided by 24 hours should
be assessed for

adequacy of fluid intake,

bladder distention,

restlessness, and

signs of discomfort.

Fluid and electrolyte balance

Signs of renal system problems
PHYSIOLOGIC ADAPTATIONS
(5 OF 14)
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
Gastrointestinal system

PHYSIOLOGIC
ADAPTATIONS
(6 OF 14)
Feeding behavior is related to:

gestational age

neuromuscular maturity

maternal medications
during labor and birth

type of initial feeding

Breastfeeding is important in
establishing the intestinal
microbiome of the newborn

Digestion

Stools

Meconium

Feeding behaviors

Signs of gastrointestinal
problems
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
Hepatic system

Iron storage

PHYSIOLOGIC
ADAPTATIONS
(7 OF 14)
Fetal liver begins
storing iron in utero

Glucose Homeostasis

Fatty Acid Metabolism

Bilirubin Synthesis

Jaundice

Physiologic Jaundice

Pathologic Jaundice
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
PHYSIOLOGIC
ADAPTATIONS
(8 OF 14)
Hepatic system

Jaundice Related to
Breastfeeding:

Two forms of
breastfeeding-related
jaundice: breastfeeding
does not cause the
jaundice; rather it is a lack
of effective breastfeeding
that contributes to the
hyperbilirubinemia

Breastfeedingassociated jaundice
 Early-onset
jaundice

Breast milk jaundice
 Late-onset
jaundice
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
Hepatic system

Coagulation

PHYSIOLOGIC
ADAPTATIONS
(9 OF 14)
The lack of intestinal
bacteria needed to
synthesize vitamin K
results in transient
blood coagulation
deficiency between
the second and fifth
days of life

Drug Metabolism

Signs of Hepatic System
Problems
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
Immune system

Compared to adults, the immune response at birth
is reduced, leading to increased susceptibility to
pathogens

Neonatal levels of circulating immunoglobins are
low

Many components of breast milk strengthen the
neonate's immune system

Risk for infection

Early signs and symptoms of infection

Greatest risk factor for neonatal infection is
prematurity
PHYSIOLOGIC ADAPTATIONS
(10 OF 14)
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
Integumentary system

Vernix caseosa

Sweat glands; milia

Desquamation

Mongolian spots

Nevi: nevus flammeus and
nevus vascularis

Infantile Hemangioma

Erythema toxicum

Signs of integumentary
problems
PHYSIOLOGIC
ADAPTATIONS
(11 OF 14)
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
PHYSIOLOGIC
ADAPTATIONS
(12 OF 14)
Reproductive system

Female

Male

Swelling of breast tissue:
caused by the
hyperestrogenism of
pregnancy; subsides
within a few days

Signs of Reproductive
System Problems

Ambiguous genitalia

Hypospadias

Undescended testes

Inguinal hernias
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PHYSIOLOGIC ADAPTATIONS (13 OF 14)

Skeletal system

Head and Skull

Molding

Caput succedaneum

Cephalhematoma

Subgaleal hemorrhage

Spine

Extremities


Oligodactyly;
polydactyly; syndactyly

Developmental dysplasia
of the hips (DDH)
Signs of Skeletal Problems
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
PHYSIOLOGIC
ADAPTATIONS
(14 OF 14)
Neuromuscular system

Almost completely
developed at birth

Normal tremors, tremors
(jitteriness) of
hypoglycemia, and
seizure activity must be
differentiated

Newborn reflexes
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Newborns progress through a hierarchy of behavioral developmental
challenges:
regulate their
physiologic or
autonomic system
regulate or control their
motor behavior
state regulation, the
ability to modulate the
state of consciousness
attention and social
interaction
Sleep-wake states
Six states form a continuum from deep sleep to
extreme irritability
the ability to make smooth transitions between
states is called state modulation
BEHAVIORAL CHARACTERISTICS (1
OF 3)
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Other factors influencing behavior of newborns include the following:
•Gestational age
•Time
•Stimuli
•Medication
BEHAVIORAL
CHARACTERISTICS
(2 OF 3)
Sensory behaviors
•Vision
•Hearing
•Routine hearing screening
•Smell
•Taste
•Touch
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
BEHAVIORAL
CHARACTERISTICS
(3 OF 3)
Response to Environmental
Stimuli

Temperament

Habituation

Consolability

Cuddliness

Irritability

Crying
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BEHAVIORAL CHARACTERISTICS (3 OF
3) CONT’D.
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By term gestation, the neonate’s
anatomic and physiologic
systems have reached a level of
development and functioning to
allow physical existence apart
from the mother.
KEY
POINTS (1
OF 4)
The neonate’s most critical
adaptation to extrauterine life is
to establish effective respirations.
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

Heat loss in the healthy term
newborn can exceed the
capacity to produce heat; this
can lead to cold stress and
metabolic and respiratory
complications that threaten
the newborn’s well-being.
KEY POINTS (2
OF 4)
Physiologic jaundice occurs in
60% of term infants.
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

Jaundice is considered
pathologic if it appears within
the first 24 hours of life, if serum
bilirubin levels increase by
more than 6 mg/dl in 24 hours,
or if serum bilirubin exceeds 15
mg/dl at any time.
KEY POINTS (3
OF 4)
Some reflex behaviors are
important for the newborn’s
survival.
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KEY POINTS (4
OF 4)

The healthy newborn has
sensory abilities that indicate a
state of readiness for social
interaction.

Sleep-wake states and other
factors influence the
newborn’s behavior.

Newborn behavior progresses
from self-regulation of
autonomic processes to social
interaction.

Each full-term newborn has a
predisposed capacity to
handle the multitude of stimuli
in the external world.
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The nurse is assessing a newborn
at 5 hours of age and finds a soft
mass over the infant’s occiput.
The soft mass crosses the suture
line. The nurse documents this
finding as which of the following?
QUESTION
a. Subgaleal hemorrhage
b. Caput succedaneum
c. Cephalhematoma
d. Hydrocephalus
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B. Caput
succedaneum
ANSWER
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