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1. Unit 1, Introduction.pptx
1. NEONATOLOGY
FOR NN II YEAR
BY MERGA BAYOU (BSc, MSc child health)
March 19, 2023
By Merga B. 1
2. Introduction
March 19, 2023
By Merga B.
2
Neonatology is a subspecialty of pediatrics that
consists of the medical care of newborn infants,
especially the ill or premature newborn infant and
their development.
It is a hospital-based specialty, and is usually
practiced in neonatal intensive care units (NICUs).
3. Cont. …
March 19, 2023
By Merga B.
3
The principal patients of neonatologists are
newborn infants who are ill or requiring special
medical care due to:-
Prematurity
Low birth weight
IUGR
Congenital malformations (birth defects)
Sepsis, pulmonary hyperplasia
Extremes of maternal age ( <16 yrs, > 35yrs )
Medical illnesses etc.
4. Definition of terms
March 19, 2023
By Merga B.
4
Perinatal period : from the 28 wk of gestation
through the 7th day after birth can be:-
20th wk of gestation to the 7th days , and
20th wk of gestation to the 28th day )
Neonatal period : is defined as less than 28th day
of life
Period 1 = birth to less than 24 hr ,
Period 2 = 24 hr to less than 7 days and
Period 3 = from 7 days to less than 28 day of life .
6. Objectives
March 19, 2023
By Merga B.
6 On completion of this lesson, the student will be able to:-
1. Identify respiratory adaptations that occur as the
newborn makes the transition to life outside the womb.
2. Outline cardiovascular changes that occur immediately
after birth.
3. Explain thermoregulatory capabilities of the newborn
and why he has a difficult time maintaining body heat.
4. Discuss the role of the liver in the newborn’s adaptation
to extrauterine life.
5. Describe expected behavioral characteristics of the
newborn.
7. Introduction
March 19, 2023
By Merga B.
7 The newborn is a unique individual different from
the fetus, older infant, child, and adult.
The newborn’s anatomy and physiology change
immediately after birth and continue to change as
he or she grows
It is essential for the health profession to be aware
of adjustments the newborn must make as he or she
transitions to life outside the womb
8. Respiratory Adaptation
March 19, 2023
By Merga B.
8
Fetal lungs are uninflated and full of amniotic
fluid because they are not needed for oxygen
exchange.
Immediately after birth, the newborn’s lungs must
inflate, the remaining fluid must be absorbed, and
oxygen exchange must begin.
9. Cont. ..
March 19, 2023
By Merga B.
9
Important factor in the newborn’s respiratory
adaptation:-
10. Cont. …
March 19, 2023
By Merga B.
10
1. Labor:-fluid is squeezed out as the fetus moves
down the birth canal
2. Vaginal squeeze:- The pressure of the birth canal
on the fetal chest is released immediately when the
infant is born.
The lowered pressure from chest expansion draws air
into the lungs
11. Cont. ….
March 19, 2023
By Merga B.
11
3. Chemical changes:- stimulate respiratory centers
in the brain.
Clamping/Cutting of umbilical cord
Oxygen levels fall and carbon
dioxide levels rise
Newborn’s pH fall acidosis
Stimulates the respiratory centers
in brain
12. Cont. …..
March 19, 2023
By Merga B.
12
4. Crying:- crying helps to open the small air sacs
(alveoli) in the lungs. Immediate sensory and
thermal changes stimulate the newborn to cry.
5. Surfactant:- surfactant is a substance found in the
lungs of mature fetuses, keeps the alveoli from
collapsing after they first expand, used to ease
the work of the lung
13. Cont. ….
March 19, 2023
By Merga B.
13
By the end of 35 weeks’ gestation, the fetus usually
has enough surfactant to breathe without lung
collapse.
14. Cardiovascular Adaptation
March 19, 2023
By Merga B.
14
During fetal life only a small amount of blood flows to
the lungs.
The rest is shunted away from the lungs.
Fetal blood that circulates to the heart has already
been oxygenated through the placenta, so only the
blood that is needed to supply oxygen to the lung tissue
goes to the lungs.
15. Cont. …
March 19, 2023
By Merga B.
15
The lungs are small and noncompliant in utero; the
respiratory system is a resistant, high-pressure
system; and pressures in the right atrium are higher
than in the left.
These pressures help route blood through the
foreman ovale and ductus arteriosus, away from
the nonfunctioning lungs, back into the general
circulation
16. Cont. …
March 19, 2023
By Merga B.
16
The ductus venosus shunts fetal blood away from
the liver because the woman’s liver provides most of
the filtering and metabolic functions necessary for
fetal life. But Newborn circulation is similar to adult
circulation.
17. Cont. …
March 19, 2023
By Merga B.
17
New born blood circulation:-
Deoxygenated blood that enters the heart after birth
must go to the lungs for gas exchange; therefore, the
fetal shunts must close.
Several factors contribute to their closing.
The lungs fill with air, causing the pressure to drop in
the chest as soon as the newborn takes his first breath.
18. Cont. …
March 19, 2023
By Merga B.
18
This change results in a reversal of pressures in the
right and left atria, causing the foreman ovale to
close so that blood is redirected to the lungs.
The oxygen content of blood circulating through the
lungs increases with the first few breaths.
19. Cont. …
March 19, 2023
By Merga B.
19
This chemical change contributes to the closing of
the ductus arteriosus, which eventually becomes a
ligament.
The ductus venosus also closes, allowing nutrient-
rich blood from the gut to circulate through the
newborn’s liver.
20. Thermoregulatory adaptation
March 19, 2023
By Merga B.
20
This process is developed poorly in the newborn
because of two key factors.
1. The newborn is prone to heat loss.
The newborn’s ratio of body mass to body surface
area is much smaller than that of an adult, means
the amount of heat-producing tissue, such as muscle
and adipose tissue, is small in relation to the amount
of skin that is exposed to the environment.
21. Cont. …
March 19, 2023
By Merga B.
21
Second, the newborn is not readily able to produce
heat by muscle movement and shivering.
There are ways in which newborn can lose heat
What are they?
Any way to control body heat lose?
22. Cont. …
March 19, 2023
By Merga B.
22
There are four main ways that a newborn loses
heat:-
1.Conduction:- when baby in cold object and heat
transferred to the cold object
2.Convection:- when air currents blow over the newborn’s
body
3.Radiation:-heat lost to a cold object that is close to, but
not touching, the newborn
4.Evaporation:- when the newborn’s skin is wet and the
moisture evaporates from the body surface, heat is taken
with the moisture.
24. Cont. ….
March 19, 2023
By Merga B.
24
Caution:- It takes oxygen to produce heat. If the
newborn is allowed to become cold stressed, he will
eventually develop respiratory distress. This is one
important reason to protect the newborn from
unnecessary heat loss.
25. Cont. …
March 19, 2023
By Merga B.
25
The normal newborn is not entirely without
protection from heat loss.
The newborn naturally assumes a flexed, fetal
position that conserves body heat by reducing the
amount of skin exposed to the surface and
conserving core heat.
26. Cont. …
March 19, 2023
By Merga B.
26
The newborn can also produce heat by burning
brown fat, a specialized form of heat-producing
tissue found only in fetuses and newborns
Deposits of brown fat are located at the nape of
the neck, in the armpits, between the shoulder
blades, along the abdominal aorta, and around the
kidneys and sternum.
27. Cont. …
March 19, 2023
By Merga B.
27
Unfortunately, brown fat is not renewable; once
stores are depleted, the newborn can no longer use
this form of heat production.
28. Cont. …
March 19, 2023
By Merga B.
28
TEST YOURSELF
Name two ways a vaginal birth assists the
newborn’s respiratory adaptation.
What is the function of surfactant?
Describe two factors that make it difficult for a
newborn to maintain his body temperature.
29. Metabolic Adaptation
March 19, 2023
By Merga B.
29
Throughout life a steady supply of blood glucose is
necessary to carry out metabolic processes and
produce energy.
Glucose is also an essential nutrient for brain tissue.
Neonatal hypoglycemia is defined as a blood
glucose level of less than 40 mg/dL.
30. Cont. ….
March 19, 2023
By Merga B.
30
The newborn is highly susceptible to hypoglycemia
if he is excessively stressed during labor or during
the transition period immediately after birth.
Respiratory distress and cold stress are two
stressors that often lead to neonatal hypoglycemia.
31. Hepatic Adaptation
March 19, 2023
By Merga B.
31
Although immature, the newborn’s liver must handle
a heavy task.
The fetus has a high percentage of circulating red
blood cells to make use of all available oxygen in a
low-oxygen environment.
32. Cont. …
March 19, 2023
By Merga B.
32
After birth, the newborn’s lungs begin to function,
and more oxygen is available immediately.
Therefore, the “extra” red blood cells gradually die
and must be broken down by the liver
Bilirubin (a yellow pigment) is released as the
blood cells are broken down.
33. Cont. …
March 19, 2023
By Merga B.
33
Normally the liver conjugates bilirubin (i.e., makes
it water soluble), and then bilirubin is excreted in
the feces.
However, in the newborn’s case, the liver is immature
and overwhelmed easily by the large volume of red
blood cells.
Unconjugated bilirubin is fat soluble.
34. Cont. ….
March 19, 2023
By Merga B.
34
As unconjugated bilirubin builds up in the
bloodstream, it crosses into the cell and stains them
yellow.
If a large amount of unconjugated bilirubin is present
(serum levels of 4 to 6
mg/dL and greater), a yellow staining of the skin
occurs, which is called jaundice.
35. Cont. …
March 19, 2023
By Merga B.
35
Jaundice is first seen on the head and face; as
bilirubin levels rise, it progresses to the trunk and
then to the extremities in a cephalocaudal manner
36. Cont. …
March 19, 2023
By Merga B.
36
Physiologic jaundice is characterized by jaundice
that:-
Occurs after the first 24 hours of life (usually on day 2
or 3 after birth),
Bilirubin levels that peak between days 3 and 5, and
Bilirubin levels that do not rise rapidly (>5 mg/dl per
day).
37. Cont. …
March 19, 2023
By Merga B.
37
Pathologic:- Jaundice that occurs within the first 24
hours.
The liver manufactures clotting factors necessary for
normal blood coagulation.
38. Cont. …
March 19, 2023
By Merga B.
38
Several of the factors require vitamin K in their
production.
Bacteria that produce vitamin K normally are found
in the gastrointestinal tract.
However, the newborn’s gut is sterile because
normal flora have not yet taken up residence.
39. Cont. …
March 19, 2023
By Merga B.
39
Therefore, the newborn cannot produce vitamin K,
which in turn causes the liver to be unable to
produce some clotting factors.
This situation could lead to bleeding problems, so
newborns are given vitamin K intramuscularly
shortly after birth to prevent hemorrhage
41. BEHAVIORAL AND SOCIAL
ADAPTATION
March 19, 2023
By Merga B.
41
Dr. Brazelton identified six sleep and activity
patterns that are characteristic of newborns.
It is important to remember that individual infants
display uniqueness in their sleep–wake cycles.
Brazelton’s states of reactivity are as follows:
42. Cont. …
March 19, 2023
By Merga B.
42
1. Deep sleep: quiet, non restless sleep state; newborn
is hard to awaken
2. Light sleep: eyes are closed, but more activity is
noted; newborn moves actively and may show
sucking behavior
3. Drowsy: eyes open and close and the eyelids look
heavy; body activity is present with intermittent
periods of fussiness
43. Cont. ….
March 19, 2023
By Merga B.
43
3. Quiet alert: quiet state with little body movement,
but the newborn’s eyes are open and she is attentive
to people and things that are in close proximity to
her; this is a good time for the parents to interact
with their newborn
44. Cont. …
March 19, 2023
By Merga B.
44
5. Active alert: eyes are open and active body
movements are present; newborn responds to
stimuli with activity
6. Crying: eyes may be tightly closed, thrashing
movements are made in conjunction with active
crying
45. Cont. …
March 19, 2023
By Merga B.
45
TEST YOURSELF
Define neonatal hypoglycemia.
What pigment causes jaundice?
Describe the quiet alert state of the newborn
