Ch. 20- Processes of Adaptation (8)

Topics to Review

Actions to Avoid Heat Loss

• Warm Linen, Blankets, Hats

• Skin to Skin

• Radiant Warmer, use gradually bc APNEA is rapid heat gain occurs

  • like when you feel sleepy in a hot car

Surfactant

necessary to keep alveoli open for lung breathing

• usually sufficiant by 34-36 weeks G

• Expelled during vaginal birth

Initiation of Respiration

Chemical Factors

• short period of hypoxia causes Increase CO2

Physical factors

• Compression of Thorax

• temperature drop

• Drying, Skin to Skin, Lights

First breath must forse fluid into interstitail space

Which Fetal Organs are NOT in USE

Liver and Lungs

• due to shunting

Normal Temperature Range for newborn

97.7-99.5

Hypothermia

Their metabolic Rate rises, causing an increased need for Oxygen and Glucose

→ Possible metabolic Acidosis

Vasodilation occurs

• Sweating is UNUSUAL→ Fluid Loss

Thermoregulation

• Non-Shivering Thermogenesis

metabolism of Brown fat

• abundant blood vessels

• @: heart, kidneys, in-between scapula

• Born with a set amount, cant make more

• Hypoxia, Hypoglycemia, Acidosis limits use and development of Fat

Thermoregulation

• Effects of Cold Stress

Decrease Temperature can cause cold stress

• Increases Metabolic Rate by 200-300%

  • Increased use of Glucose and Oxygen

  • Decreases amount of Surfactant

  • → Hypoxia→Respiratory Distress

Thermoregulation

• Metabolism of Brown Fat

Increased Acid Production

• Metabolic acidosis

  • Jaundice and Displacement of Bilirubin

Thermoregulation

• Vasoconstriction

Peripheral Blood Vessels

→ Pale Cold Skin

Thermoregulation

• Pulmonary Vessels

Lethargic, Hypotonic, Weak from Cold Stress

Thermoregulation

• Neutral Thermal Environment

Infant can maintain a stable body temperature with minimal oxygen need and without an increase in metabolic rate

• 89.6-92.3 (undressed)

• 75.2-80.6 (dressed)

Thermoregulation

• Thermoneutral zone

What we strive for

Increases Risk for Hypoglycemia

Preterm babies, Small for Gestational Age babies, Distressed newborns, Asphyxia, Cold Stress

Signs of Neonatal Hypoglycemia

Jitteriness

CNS signs

Respiratory Difficulty

Decreased Temperature

Poor Feeding

Hypoglycemia

• Interventions

Early feedings, IV glucose, repeat testing per protocol

Keep baby warm

Evaluate respiratory status

use of glucose gel

Breastmilk is preferred but formula is similar

Physiologic Jaundice

1. Caused by Transient Hyperbilirubinemia

   1. Visible means levels are ABOVE 5mg

2. NEVER PRESENT DURING 1st 24 HR

3. DAY 2-3 Appears

4. Jaundice is visible when bilirubin levels greater than 5mg/dL

5. Rate of Rise and Fall of Bilirubin level is important

   1. peaks day 2-4 and falls to normal by Day 5-7

Physiologic jaundice

• Treatment/ Prevention

Early Initiation of Feedings (every 2-3 hours) bc excreted through feces

Monitor I&O

Keep them warm

Pathologic Jaundice

DOES occur within 24 hours of life

• result of excessive destruction of RBC or bilirubin coagulation problems

  • mom-baby blood incompatibilities

  • infection

  • metabolic disorders

  • pre- and late term

Unconjugated Bilirubin Crosses Blood-Brain Barrier→ STAINS AND DAMAGES!!!!

Pathologic Jaundice

• treatment

Early Feeding, Monitor I&O

Phototherapy needed

• Aids in conjugation process