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1. KRISHNA INSTITUTE OF NURSING
SCIENCE AND RESEARCH
PRESENTED TO:
Shalini Vishnoi
Asst. professor [OBG]
K.I.N.S.R.
KANPUR
PRESENTED BY:
Abhisikta Raikwar
B.Sc nursing 4th year (20-21)
SUBJECT: Obstetrics and gynecology
TOPIC: ADAPTATION IN NEWBORN

2. ADAPTATION IN NEW
BORN

3. “Adaptation is process of adjustment in Extrauterine
environment from intrauterine environment”
WHAT IS ADAPTATION IN
NEWBORN ?

4. INTRODUCTION
At the end of pregnancy , the fetus must take the journey of
childbirth to leave the reproductive mother.Upon its entry to
the air breathing world, the newborn must begin to adjust to
the life outside the uterus.

5. New born adaptation in extra-uterine life
• The immediate postpartum period is a time of significant physiological
adaptation for both the mother and baby. The newborn must adapt from
being completely dependent on another for life sustaining oxygen and
nutrients to an independent being, a task accomplished over a period of hours
to days.
• Successful transition from fetal to neonatal life requires a complex interaction
between the following systems:
1. Respiratory adaptation.
2. thermoregulation.
3. liver adaptation.
4. GI adaptation.
5. Immunologic adaptation.
6. HB adaptation
7. Urinary adaptation.

6. RESPIRATORY ADAPTATION

7. 1.1:- FETAL CIRCULATION
In utero, oxygenated blood flows to the fetus from the placenta through the
umbilical vein.
Although a small amount of oxygenated blood is delivered to the liver, most
blood diverts the hepatic system through the ductus venosus, which forms a
connection between the umbilical vein and the inferior vena cava
Oxygenated blood from the inferior vena cava enters the right atrium and
most of it is directed through the foramen ovale to the left atrium, then to the
left ventricle, and onto the ascending aorta, where it is primarily directed to
the fetal heart and brain.

8. Deoxygenated blood from the head and upper extremities comes back to the
right atrium by the superior vena cava, where it blends with oxygenated blood
from the placent
Some blood enters the right ventricle and pulmonary artery, where 90% of
blood is shunted across the ductus arteriosus and into the descending
aorta, providing oxygen to the lower half of the fetal body draining back to
the placenta through the two umbilical arteries.
The remaining 10% of the blood coming from the right ventricle perfuses
lung tissue to meet metabolic needs

10. 1.2 NEONATAL CIRCULATION
.
At birth, the clamping of the umbilical cord eliminates the placenta as a reservoir
for blood, triggering an increase in systemic vascular resistance (SVR), an
increase in blood pressure, and increased pressures in the left side of the heart..
The removal of the placenta also eliminates the need for blood flow through
the ductus venosus, causing functional elimination of this fetal shunt.
Systemic venous blood flow is then directed through the portal system for
hepatic circulation. Umbilical vessels constrict, with functional closure
occurring immediately
Successful transition and closure of fetal shunts creates a neonatal circulation
where deoxygenated blood returns to the heart through the inferior and
superior vena cava

11. Blood then enters the right atrium to the right ventricle and
travels through the pulmonary artery to the pulmonary vascular
bed.
Oxygenated blood returns through pulmonary veins to the left
atrium, the left ventricle, and through the aorta to systemic
circulation.
Hypoxia, acidosis and congenital heart defects are conditions
that lead to a sustained high PVR and may interfere with the
normal sequence of events.

12. THERMOREGULATION;
 Maintain a neutral thermal environment is one of the
key physiologic challenges that a newborn must face
after delivery .
 Large body surface are compared to maas
• type of heat loss
1.Conduction
2.Convection
3.Radiation
4.Evaporation

15. LIVER ADAPTATION:-
• Iron content stored in liver.
• Low carbohydrate reserves.
• Main source of energy is glucose.
• Lack of intestinal flora results in low level of vitamin K.
1. The absence of normal flora in newborn gut need to synthesis vitamin K result
in low vitamin K level until 5th day of life.
2.Every newborn gets injected with vitamin K (AQUA MEPHYTON or
PHYTONADIONE) to prevent problems.

16. GI ADAPTATION
• BEFORE BIRTH, baby has already swallowed and peristalsis begins.
• Stomach hold 50-60 ml.
• GI tract mature 36-38 weeks gestation.
• By 24 hours,the intestines air filled.
• Saliva is hardly produced until 3 months babies regurgitate due to
immature sphincter .
• Newborns lose 5-10% baby weight in 5-10 day.

17. IMMUNOLOGIC ADAPTATION
• IgG- active acquired immunity (35 week).
provides bacterial and viral protection for 4-8 months.
• IgM -produced by fetus starting 10-15 week.
elevated level indicated infection in uterus.
• IgA- passive immunity from colostrum.
protects respiratory,GI and eyes.

18. REACTIVITY STATE IN THE NEWBORN
• FIRST PERIOD OF REACTIVITY- First 40 min. baby is alert, responsive,eager to
explore the world.
• SLEEP PERIOD -1-3 hours after birth. may continue for 3-6 hrs. baby is in a deep
sleep, difficult to arouse. respiration rate and heart rate decrease
• SECOND PERIOD OF REACTIVITY- 3-6 hours after birth. baby is awake,respiration
are rapid , irregular and may have periods of apnea. may cough and regular mucus
etc keep bulb syringe handly. heart rate again increase.

19. HB ADAPTATION
• Fetal hemoglobin [HbF] is replaced with adult hemoglobin by 6 month of age.
• The hemoglobin level decline during the first 2 months of life, leading to
phenomenon known as physiological anemia of the newborn. the lowest
hemoglobin level occur around 3 month of age and is called the physiologic nadir.

20. URINARY ADAPTATION
• Many new born void immediately after birth and 90% by 24 hours of life .
• A new born is not voided by 48 hrs of life should be evaluated for adequacy of fluid
intake or urinary bladder anomalies.
• Pink urine ,called ‘brick dust spot’,will occasionally be seen . these are caused by
urates and totally harmless.
• Blood may be observe in diapers of female newborn called psudomenstruation is
related to maternal withdrawl of hormones.

21. Aren’t babies a miracle??
THANK YOU