Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Physiological Transition of the
Newborn
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Question 1
 A newborn is placed under a radiant heat warmer.
The nurse knows that thermoregulation presents a
problem for newborns because:
 a. Their renal function is not fully developed, and
heat is lost in the urine.
 b. Their small body surface area favors more rapid
heat loss than does an adult’s body surface area.
 c. They have a relatively thin layer of subcutaneous
fat that provides poor insulation.
 d. Their normal flexed posture favors heat loss
through perspiration
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Adaptations of the
Respiratory System
 Intrapulmonary fluid
 Reduces pulmonary resistance to blood flow
 Facilitates initiation of air breathing
 Surfactant
 Decreases surface tension within alveoli
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
The First Breath
 Internal stimuli
 Chemical factors
 External stimuli
 Sensory factors
 Thermal factors
 Mechanical factors
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Cardiopulmonary Transitions
 Increased pulmonary blood volume
 Conversion from fetal to neonatal circulation
 Immediate assessment necessary
 Skin color
 Respiratory rate; breathing pattern
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Cardiopulmonary Adaptation
 Increased aortic pressure and decreased venous
pressure
 Increased systemic pressure and decreased pulmonary
pressure
 Closure of foramen ovale, ductus arteriosus, and
ductus venosus
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Assessing the
Cardiovascular Transition
 Pulse
 Within 30 minutes—120 to 160 bpm
 Capillary refill
 <3 seconds adequate
 >4 seconds possible underlying problem
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Thermogenic Adaptation
 Newborns are homeothermic
 Neutral thermal environment
 Cold stress
 Large body area
 Limited subcutaneous fat
 Limited ability to shiver
 Thin skin and blood vessels close to surface
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Adaptations to Increase
Heat Production
 Increased BMR and muscle activity
 Peripheral vasoconstriction
 Nonshivering thermogenesis
 Brown adipose tissue
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Mechanisms for
Neonatal Heat Loss
 Evaporation
 Insensible water loss
 Conduction
 Convection
 Radiation
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Hematopoietic Adaptation
 Blood volume
 Blood components
 Erythrocytes and hemoglobin
 Hematocrit
 Leukocytes
 Platelets
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Hepatic adaptation
 Glycogen and blood glucose maintenance
 Iron storage
 Conjugation of bilirubin
 Coagulation of blood
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Hyperbilirubinemia
 Physiologic jaundice—appears 24 to 48 hours after
birth; transient
 Pathologic jaundice—present at birth or within 24
hours
 Breastfeeding jaundice—2 to 4 days
 Breast milk jaundice—7 days; peaks at 10 days
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Gastrointestinal Adaptation
 Stomach and digestive enzymes
 Intestinal peristalsis
 Meconium
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Genitourinary Adaptation
 Kidney function
 Bladder capacity 6 to 44 mL
 Fluid requirements—60 to 80 mL/kg
 Urine output 1 to 3 mL/kg/hour
 Nursing assessments
 Careful monitoring of I/O
 Assess appearance of urine
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Immunological Adaptation
 Active acquired immunity
 Passive acquired immunity
 Immunoglobulins
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Psychosocial Adaptation
 Early stages of activity
 First period of reactivity
 Period of inactivity and sleep
 Second period of reactivity
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Behavioral
States
 Sleep
 Deep, quiet; REM
 Alert
 Drowsy/semidozing
 Wide awake
 Active awake
 Crying
Susan Ward
Shelton Hisley