NEWBORN TRANSITION

Transition Defined

The period in which a fetus becomes a neonate, becoming an independent organism

Carried out over hours or days Most difficult period in the human life cycle

A rtiic l e Talk

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Ada:ptati1on to extrauterine lifeFrom W ikliped ia, t1he free enc yclopedia

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At me end of pregnancy, Urie Jetus must take me journey of iehHdbirttl to leave the repro outside til e uterus.

Contents [hide]

1 Breathing and circulation

2 En,ergy met abolis m

3 Temp erature regulation

4 See also

5 References

Breath in,gand circulation [ edit ]

Pierfusil1lg its body by breathing il1ldependel1ltl'y il1lstead of t1tililzi111g place ntal oxygen deliv

Physiologic Transition

Most immediate are respiratory and cardiovascular changes

Each body system goes through a transition cycle The successful transition of each system is

dependent on the transition of the others

Stages of Transition

Triggers of labor Prepare the fetus for birth

Pressure changes related to loss of amniotic fluid and uterine contractions

Entrance into the world, exposed to new stimuli First breath Clamping the cord

In the beginning . . .

Fetal Circulation

Lower PaO2

Enters at 30-35 mmHg Leaves at 25 mmHg

Fetal Hemoglobin (HbF)

Presence of 3 ducts: Ductus venosus Foramen ovale Ductus arteriosus

FETAL

Na+ CIK+Cl-

Air

NEONATAL

Oxygen Spontaneous labor

drenaline

lucocorticoids3 Na+

Na

Na+

Water

0S C1t t:J &1V\,

Pulmona capillary Lymphatics

Transition of the Cardiovascular System

Onset of ventilation Loss of placental circulation

Results in increase in systemic vascular resistance

Rise in blood oxygen content Causes drop in pulmonary vascular resistance Flow through DA dramatically decreases

When should it be clamped?

Speaking of the cord . . .

The 2015 ILCOR systematic review confirms that DCC is associated with less intraventricular hemorrhage (IVH) of any grade, higher blood pressure and blood volume, less need for transfusion after birth, and less necrotizing enterocolitis . . . The only negative consequence appears to be a slightly increased level of bilirubin, associated with more need for phototherapy. These findings have led to national recommendations that DCC be practiced when possible. DCC for longer than 30 seconds is reasonable for both term and preterm infants who do not require resuscitation at birth

“The current evidence suggests that clamping should be delayed for at least 30 to 60 seconds for most vigorous term and preterm newborns. If cord clamping is delayed, the baby should be placed skin-to-skin on the mother’s chest or abdomen, or held securely in a warm, dry towel or blanket.”

“If the placental circulation is not intact, such as after a placental abruption, bleeding placental previa, or cord avulsion, the cord should be clamped immediately after birth.”

\.

/

\ The American College of§ Obstet ricians and Gynecologists

WOM EN' S HEAU H CARI; PHYSICIANS

C O M M I T T E E O P I N I O NNumber 684 • UiJnuiJry 7017 (Replaces Committee Opinion Number 543, December 2012/

Committee on Obstetric Practice11,e America11 Academy of Jlediatri and th American Colkg ofWtIS developed by the Ameri II College of Obstetri ituis anrl Gy11

,m e- Midwives e,ulorse this docume.rJt. 11 , Committee. Opi11io11 ologists' O, mmittce o,i Obstctri Practi : in ollaboration with

commiflee m mbers Maria A. Mascola, MD; T. Flint Porter. MD; and Tamaro Tin-Ma y C/1110,MD.11,is documem reflects emerging clinical mid sdenri fic advanas as of 1l1e date issued and is subj t to cl1a11ge. 11,e infor ma1iot1 shouldnot be amstmcd a dictntitig a11 exclu ive course of treatment or prore.dure tQ befollowed.

Delayed Umbilical Cord Clamping After BirthAB S T R AC T: Delayed umbilical cord clamping appears to be beneficial for term and preterm infan ts. In erminfa nts, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the firsseveral months of life. which may have a favorable effect on developmental outcomes. There is a small increase injaundice that requires phototherapy in this group of infants. Consequen ly, heal h care providers adopting delayedumbil ical cord clamping in term infants should ensure that mechanisms are in place to monitor for and treat neonatal jaundice. In preterm .infants, delayed umbilical cord clamping is associated with signitican t neonatal benefits,including improved transitional circulation. etter establishm ent of red blood cell volume, decrease need forblood

Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30–60 seconds after birth.

Closure of Ductus Venosus

In late pregnancy, only ~20% flows through the DV

Functionally closed within minutes of birth with clamping of the umbilical cord

Anatomically closed 7-14 days

Becomes Ligamentum venosus

Closure of the Foramen Ovale

After clamping the cord, left atrial pressure rises above that of right atrial pressure and the flap valve closes

Anatomically closed by 1 month

May remain patent in some individuals

Closure of the Ductus Arteriosus

Flow through the DA reverses due to increasing SVR

Functionally closed by most at 12-14 hours of extrauterine life Closed in 96 hours in nearly all

infants

Murmur may be auscultated during closure

Anatomically closed at 2-3 months

Label your Hearts

1. Right Common Carotid2. Left Common Carotid3. Right Subclavian4. Left Subclavian

5. Ductus Arteriosus

Label your Hearts

1. Right Common Carotid2. Left Common Carotid3. Right Subclavian4. Left Subclavian

5. Ductus Arteriosus

Label your Hearts

1. Right Common Carotid2. Left Common Carotid3. Right Subclavian4. Left Subclavian

5. Ductus Arteriosus

6. Coronary Arteries Most oxygenated blood HR good indicator of O2 status

Transition of the Respiratory System

Thorax markedly depressed in birth canal, expelling fluid as nares are exposed Recoil of chest allows for passive expiration

First breath is extremely critical in all of transition processes Must occur within seconds of placental separation Interdependent with cardiovascular events Only term, healthy babies can do this well

Lungs begin absorbing fluid as opposed to secreting fluid Begins in early labor Expedited by increased pulmonary blood flow

FETAL

Na+ CIK+Cl-

Air

NEONATAL

Oxygen Spontaneous labor

drenaline

lucocorticoids3 Na+

Na

Na+

Water

0S C1t t:J &1V\,

Pulmona capillary Lymphatics

Fetal Lung Fluid Clearance

Let’s talk about Oxygen . . .

Where does the fetus get his oxygen from? What is the partial pressure of oxygen in maternal

mixed venous blood? About 40 mmHg Placenta takes some,fetus gets about 30-35 mmHg

What is the fetal SpO2? About 60%

After birth, where does the newborn get his oxy

essure of oxygen in room air? W 2 A 2

gen?hat is the partial pr 1% of what? tmospheric Pressure a 1% of 760 = ~160

t m

sea level = 760 mmHg mHg

Let’s talk about Oxygen . . .

The newborn doesn’t necessarily need oxygen . . .

How do you know if the newborn needs oxygen?

O l . . n 2 0 1 1

A. 30%B. 60%C. 80%D. 90%

What is the normal oxygensaturation of a newborn at1 minute of life

A. 60%B. 70%C. 80%D. 90%

What is the normal oxygensaturation of a newborn at3 minutes of life

A. 60%B. 70%C. 80%D. 90%

What is the normal oxygensaturation of a newborn at5 minutes of life

A. 70%B. 80%C. 90%D. 100%

What is the normal oxygensaturation of a newborn at10 minutes of life

Normal SaO2 Values

1 minute: 60%3 minutes: 70%5 minutes: 80%10 minutes: 90%

Normal SaO2 Values

1 minute:60%3 minutes: 70%

5 minutes:80%10 minutes: 90%

References

Blackburn, S.T. (2013). Maternal, fetal, and neonatal physiology: A clinical perspective (4th ed.). St. Louis: Mosby.

Sansoucie, D.A., & Cavaliere, T.A. (1997). Transition from fetal to extrauterine circulation. Neonatal Network, 16(2), 5-12.

References

Angeles, D.M. (1992). Pathophysiology and nursing management of persistent pulmonary hypertension of the newborn. MCN, 17, 314-322.

Askin, D.F. (2002). Complications in the transition from fetal to neonatal life. JOGNN, 31(3), 318-327.

Jain, L., & Eaton, D.C. (2006). Physiology of fetal lung fluid clearance and the effect of labor. Seminars in Perinatology, 30, 34-33.