The document discusses the major physiologic adaptations newborns undergo after birth to transition to extrauterine life. Key changes include respiratory and cardiovascular system modifications. At birth, circulation shifts from placenta to lungs for gas exchange. The ductus arteriosus and ductus venosus close, and blood begins flowing through the lungs and liver. Thermoregulation and blood components also adapt during the neonatal period's first weeks. Behavioral patterns like clustering and rooting emerge as newborns adjust to their new environment.

1. NEWBORN
ADAPTATIONS AFTER BIRTH

2. Objectives
• Identify the major changes in body, systems that occur
as the newborns adapt to extrauterine life.
• List the primary challenges faced by the newborns
during the adaptation to extrauterine life
• Explain the three behavioral patterns of newborn
behavioral adaptaion
• Discuss the five typical behavioral responses of the-
newborn
• Discuse and have to understand fetal circulation-
• Know blood component for newborns-
• Know about surfactant hormone and wat it function-
• in the body

3. Introduction
:The neonatal period
.Is defined as the first 28 days of life
-
After Birth the newborn is exposed to a
whole new
Sound
Colors
Smells
Sensation
the newborn previously confined to the**
warm,dark,wet intra-uterine
.environment
Now is thrust into environment that much
.brighter and color

4. In this presentation we have to descripe the
physiologic changes of the newborn’s
major body systems.it also discusses the
behavioral adaptaions.Including
behavioral patterns and the newborn’s
behaviroal respones < that occur during
.this transition period

5. Physiologic adaptations
The mechanics of birth require a change in the newborn for
survival outside the uterus.Immediately,respiratory,gas
exchange,along with circulatory modification, must be
occur to sustain extrauterine life.during this time,as
.newborns strive to attain homeostasis
The also experience complex changes in major organ
.system
Although the transition usually takes place within the first 6-
10 hours of life ..many adaptation take weeks to attain
full maturity

6. Respiratory system
fetus :
fluid-filled,high-pressure system cause blood to be shunted
from the lungs through the ducts arterious to the rest of the
body.
Newborn :
Air-filled,low-pressure system encourge blood flow through
the lungs for gas exchange;increase o2 content of blood in
the lungs contributes to the closing of the ducts
(.arteriosus(becomes a ligament

7. Site of gas exchange
:Fetus
Placenta
:Newborn
Lungs

8. Hepatic portal circulation
:Fetus
Ductus venosus bypasses;maternal liver
.performs filtering fuction
:Newborn
Ductus venosus closes(becomes a
.ligment(;hepatic portal circulation begin

9. Circulation through the heart
:Fetus
Pressure in the right atrium are greater than in the
left,encourging blood flow through the foreman
ovale
:Newborn
Pressure in the left atrium are greater than in the
.right, causing circulation begins

10. Thermoregulation
: Fetus
Body temperature is maintained by maternal body
temperature and the warmth of the intrauterine
.environment
:Newborn
Body temperature is maintained through a flexed
posture and brown fat

11. Cardiovasular system adaptations

14. Cardiovasular system
adaptations
The umbilical vein carries oxygenated bld from placenta-
.to the fetus
The ductus venosus allows the majority of the umbilical-
vein bld to bypass the liver and merge with bld moving
.through the vena cava, bringing it to the heart sooner
The foramen ovale allows more than half the bld entering-
the right atrium to cross immedediatly to the left
artium,thereby passing the pulmory cicrulation
The ducuts arterious connects the pulmonary artery to the-
..aorta, which allow bypassing of pulmonary circuit

15. At birth : placental (fetal) circ~~~> pulmonary (newborn) gas
exchange
The physical forces of the contractions of labor and
birth,mild asphyxia, increased intracranial pressure as a
result of cord compression and uterine contraction,as
well as cold stress immediately experienced after birth
lead to an increased release in catecholamines that is
critical for the changes involved in the transition to
.extrauterine life
The increased level epinephrine and norepinephrine
stimulate increase cardiac output and contractility.
surfactant release and promotion of pulmonary fluid
.clearance

16. Fetal Structures
When umbilical cord is clamped---the first breath is taken and the lungs
begin to function as a Result
systemic vascular resistance increase and bld -
.return to the heart via the inferior vena cava decrease
With this change there is rapid decrease in pulmonary vascular-
resistance and increase in pulmonary bld flow
The foramen ovale functionally closes with a decrease in pulmonary
vascular resistance
Ductus arteriosus,ductus venosus,umbilical vessels that were vital during-
.fetal life are no longer needed
the increase left atrail pressure causes the foramen ovale to close ..-
..??)(Why

18. Foramen ovale closes with decrease pulmonary vascular resistance-
Increases pressure to left side of heart
chambers 4-
Ductus arteriosis closes due to increase of O2 to lungs.. ..( close-
(within few hours after birth
Ductus venosus close bcoz liver is activated..(close within few days-
.after birth( ~~~> convert to ligament in extrauterine life

19. Heart rate
.During the first few minutes after birth,HR=120-180 bpm-
.Thereafter begin decrease to average 120-130 pbm
THE newborn is highly dependent on heart rate for
.maintenance of cardiac output and BP
-
Transient functional cardiac murmurs may be heard
during the neonatal period as a result of changing
.dynamics of the cardiovascular system at birth
..So It’s Normal during first 12 hours at nb age
But after 12 hours we have to do evolution for nb

20. Heart rate- 120-180 fluctuations due to activity
An increase in activity, such as
wakefulness,movement,or crying, corresponds to an
.increase in HR and bld pressure
Tachycardia :> volume depletion,cardiorespiratory
dss,drug withdrawal and hyperthyroidism
Bradycardia :> associated with apnea and hypoxia

21. Blood Volume
The blood volume of the nb depend on the amount of-
bld transferred from the placenta at birth.It’s usually
.estimated to be 80-85 mlkg of body with the term infant
The volume may vary as much as 25%-40%,depending on
.where clamping of umbilical cord occurs
Recent studies show the benefits of delayed cord-
clamping as improving the nb cardiopulmonary
adaptation ,preventing childhood anemia without
increase hypervolemia-related risks, increasing bld
.pressure, improving o2 transport.abd increase RBC flow

22. Blood Components
Rbcs newborn life span= 80-10 days/120 in adult-
Hb initially declines as a result of decrese in neonatal red-
(.cell mass(physiolgic anemia of infancy
Leukocytosis (elevated white bld cell( is present as a-
.result of birth trauma soon after birth
The newborn platelet count and aggregation ability are-
.the same as adult

23. HB …17-20G-DL
Hematocrit …52%-63%
platelets … 100.000-300.000-Ul
Red blood cells … 5.1-5.8
White blood cells … 10-30/mm3

24. :The nb hematologic values are affected by
the site of the bld sample (capillary bld has -
higher levels of hb and hematocrit compared
.with venous bld
placental transfusion (delayed cord clamping-
and normal shift of plasma of extravascular
spaces,which cause higher levels of hb and
).hemoatocrit
Increse GA _ Increase RBS and Hb-

25. One of the most crucial adaptations that the nb
makes at birth is adjusting from a fluid-filled
intrauterine environment to a gaseous
extrauterine environment.during fetal life,the
lungs are expanded with an ultrafiltrate of the
amniotic fluid.during and after birth,this fluid
must be removed and replaced with air.passage
through the birth canal allows intermittent
compression of the thorax,which helps eliminate
.the fluid in the lungs
..Respiratory System Adap

26. Respiratory System Cont
The first breath of life is a gasp that generates an increase in
transpulmonary pressure and result in diaphragmatic
descent.hypercapnia,hypoxia,and acidocis resulting from normal
labor become stimuli for initiating respirations.=↑ Tidal Volume
Surfactant is a surface tension-reducing lipoprotien found in the nb
lungs that prevents alveolar colapse at the end of expiration and
loss of lung volume
Q : wat G-age surfactant Hormone is Formed and wats it function for
newborn body ??. and if surfactant dos’t complete form in newborn
..???baby..the baby maybe birth with
-
,
Normal lung function is dependent upon surfactant,which permits a-
decrease in surface tension at end-expiration( to prevent
atelectasis( and an increase in surface tension during lung
(.expansion( to facilitate elastic recoil on inspiration

27. :-Note
Baby born by cesarean delivery does not
have the same benefit of the birth canal
squeeze as does the nb born by vaginal
.delivery
Closely observe the respirations of the nb
.after cesarean delivery

28. Before the nb lungs can maintain
respiratory function,the following
:events must occur
Initiation of respiratory movement*-
expansion of the lungs*-
establishment of functional residual*-
capacity) ability to retain some air in the
).lungs on expiration
increased pulmonary bld flow*-
.redistribution of cardiac output*-

29. Respirations
After respiration are established in the nb,they are shallow and
irregular,ranging from 30 to 60 breaths per minute,with short periods
).of apnea(less than 15 second
Signs of respiratory distress to observe for include
cyanosis,tackypnea,expiratory grunting,sternal retractions and nasal
.flaring
In some cases, periodic breathing may occur,which is the cessation
of breathing that lasts 5 to 10 seconds without changes in color or
.HR
Apneic periods lasting more than 15 seconds with cyanosis and HR
.changes require further ecaluation

30. Body Temperature Regulation
One of the most important elements in a nb
survival is obtaining a stable body
temperature to promote an optimal
.transition to extrauterine life
Nb T= 36.5 to 37.5c
.. ??Thermoregulation*

31. Heat loss
:Newborn have several ch-ch that predispose them to heat loss
.thin skin with bld vessels close to the surface*-
lack of shivering ability to produce heat involuntarily*-
.limited use of voluntary muscles activity or movement to produce heat*-
.large body surface area relative to body weight*-
.lack subcutaneous fat, which provide insulation*-
.no ability to adjust their own clothing or blankets to achieve warmth*-
.Inability to communicate that they are too cold or too warm*-
(.little ability to conserve heat by changing posture (fetal postions*-

32. Types of Heat Loss
.Conduction- heat loss by contact with cooler surface-
.Convection- warm body to cool air currents-
.Evaporation- water converts to vapor -
Radiation-heated body to cooler object (no direct-
(.contact

34. Thermoregulation
-
Thermoregulation, the balance between heat loss and heat production,
is related to the newborn’s rate of metabolism and oxygen
.consumption
An environment in which body temperature is maintained without an
increase in metabolic rate or oxygen use is called neutral thermal
environment NTE
Bcoze the nb have difficulty maintaining their body heat through-
shivering or other mechanisms, they need higher environmental
Temperature to maintain NTE…If environmental decrease, the
newborn respond by~~~>increase in O2 consumping..the RR
increase(tackypnea) in response to increase o2.As a result , the
.newborn’s metabolic rate increase

35. The newborn’s primary method of heat production is through
nonshivering thermogenesis.a process in which brown fat (adipose
.tissue) is oxidizes in response to cold exposure
.Brown fat is special kind of highly vascular fat found only in newborn
-
Nb can experience heat loss through all four mechansim,ultimately
resulting in cold strees,COLD STRESS is excessive heat loss that
requires newborn to use compensatory mechanism(such as
).nonshivering thermogenesis and tackypnea
Body T decrease and Nb be less active,lethargic,hypotonic and---
.weaker
..Preterm baby have chance for cold stress great from term baby
..!!WHY
:Cold stress can lead to problems in newborn if n’t reversed-
depleted brown fat stores,increase O2 need,Rd,increase glucoze
consumption (haypoglycemia,metabolic acidosis,jaundice, and
decrease in surfctant production

36. Hepatic system function
:Placenta function in fetus = liver function in newborn
Iron storge -
Carbohydrate metabolism-
Blood coagulation-
.Conjuction of bilirubin-

37. Bilirubin Conjugating
It’s a yellow to orange bile pigment-
.produced by breakdown of Rbcs
Bilirubin normally circulates in plasma,is
taken up by liver cells,and is changed to a
water-soluble pigment that excreted in the
bile.This conjugated form of bilirubin is
excreted from the liver cells as a
.constituent of bile

38. Failure of the liver cells to breakdown and excrete bilirubin
can cause an increase amount of bilirubin in
.bloodstream, leading to Jaundice
-
When bilirubin pigment is deposited in the skin and
.mucous membranes,jaundice typically results
jaundice also known as icterus,refers to the yellowing of
the skin,sclera,and mucous membranes that result from
.increase bilirubin blood levels
-
Extremely elevated blood levels of bilirubin during the first-
week of life can cause Kernicterus…~~>(a permanent
.(and devastating form brain damage

40. The cause of newborn jaundice can be classified
into three groups based on the mechanism of
:accumlation
Bilirubin overproduction- 1
)bld incompatibilty Rh or ABO,drugs,trauma(
.Decrease bilirubin conjugation- 2
)hypothyridism,breastfeeding(
.Impaired bilirubin excertion- 3
)biliary atresia,sepsis,steriods,alcohol(

41. Gastrointestinal system adaptations
The full-term newborn has the capacity to
swallow,digest,metabolize,and absorb
food taken in soon after birth.At birth, the
ph of stomach contents is mildly acidic,
reflecting the ph of the amniotic fluid.the
oncesterile gut changes rapidly,depending
.on what feeding is received

42. Stomach and Digestion
The stomach nb=30-90ml
Immaturity of the pharyngoesophageal sphincter and
absence of lower esophageal peristaltic waves also
.contribute to the reflux of gastric content
Avoiding overfeeding and stimulating frequent burping
may minimize regurgitation. most digestive enzymes are
available at birth, allowing nb to digest simple protein
and carbohdrate.they have limited ability to digest
complex carbohyrates and fats,because amylase and
.lipase level are low at birth

43. Bowel Elimination
The evolution of a stool pattern begins with newborns first stool,which
.is Meconium
Meconium is comosed of amniotic fluid, shed mucosal cells,intestinal
.secretions and blood
It’s a greenish black tarry consistency..and usually passes within 12-24
(hours of birth….(It’s sterile
The stools of the breast-fed nb are yellow-gold,loose and stringy to
.pasty in consistency,and typically sour-smelling
The stools of the formula-fed nb vary depending on the type of formula
.ingested
They may be yellow,yellow green.or greenish and loose,pasty,or
.formed in consistency,and they have an unpleasant odor

44. Renal System Changes
Although the nb kidneys can produce urine,they are limited
in their ability to concentrate it until about 3months of
.age,when the kidney mature
AT birth the glomerular filtration rate(GFR( is approximately
30% of normal adults values.reaching approximately
50% of normal adult values by the 10th day of life and full
.adult values by the first year of life
The low GFR and limited excertion and conservation
capabilty of the kidney affect the nb abilty to excerte
.salt,waterloads and drugs

45. ..Immune System Adapt
The newborn’s immune system begins working early in gestation,but many of
respones to not function adequtely during the early neonatal period.The
intrauterine environment usually protect the fetus from harmful
.microorganisms and the need for defensive immunologic responses
:Responses of the immune system serve three purpose
(.defence(protection from inavding organism- 1
(.homeostasis(elimination of worn-out host cells- 2
.(.surveillance(recognition and removal of enemy cells- 3
the nb immune system response involves recognition of the pathogen or other
foreign material,followes by activation of mechanisms to react against and
.eliminate it
The immune system’s responses can divided into two categories-
natural- 1
active- 2

46. Natural Immunity
Natural immunity includes responses or mechanism that do not require
previous exposure to the microogansim or antigen to operate
.efficiently
physical barriers-
(such as intact skin and mucous membranes(
chemical barriers-
(such as gastric acids and digestive enzymes(
and resident nonpathologic organsims make up the nb natural
.immune system
Natural immunity involve the most basic host defense responses
.ingestion and killing of micro organsims by phagocyric cells

47. Acquired Immunity
:It have 2 primary processes
the development of circulating antibodies or- 1
immunoglobulins capable of targeting specific
.invading agents(intigens(for destrcution
formation of activated lymphocytes desinged to- 2
destroy foreign invaders.acquired immunity is
absent until after the first invasion by foreign
.organism or toxin

48. .In adult Immunoglobulins are subdivided five classes: IgA,IgD,IgE,IgG,IgM
The newborn depends largely on three immunoglobulins for defense
.mechansim:IgG,IgA,IgM
-
IgG is the major immunoglobulin and the most abundant,making up about
80% of all circulating antibodies.(it’s found in serum&interstitial fluid(..It is the
only class able to cross the placenta,with active placental
transfer beginning at approximately 20 to 22 weeks’ gestation.IgG
.PRODUCE antibodies against bacteria,bacterial,and viral agents
-
IgA is the second most abundant immunoglbulin in the serum.IgA does
not cross the placenta,and maximum levels are reaches during
childhood.IgA is predominantly found in the gastrointestinal and respiratory
.tracts,tears,saliva,colostrum,and BREAST MILK
IgM is found in blood and lymph fluid and is the first immunoglobulin to-
.respond to infection..It’s don’t cross to the placenta

49. ..Integumentary system Adap
The most important function of skin is to provide protective barrier
between body and environment. its limit to loss water.prevent
.absorption harmful agents.protects against physical truma
The epidermal barrier begins to develop during mid-gestation and fully
develop in 32 weeks gestationl.although neonatal epidermis similer
to the adult in thickness and lipid compostion.Skin is nt complete at
.birth
It’s less mature the skin function
Also in newborn, the risk of injury producing break in the skin from
.tape, monitors and handling is greater than for an adult
Skin coloring varied, depending on the nb age;race;ethnic groub
At birth the nb skin is dark red ro purple.as the newborn begins to
breath air,the skin color changes to red.this redness normally begins
.to fade the first day

50. ..Neurologic system Adapt
Myelin develops early on in sensory impulse transmitters.thus,the newborn has
an acute sense of hearing,smell,and taste.the newborn’s sensory
:capabilities include
.Hearing-well developed at birth,responds to noise by turing to sound-
.Taste-ability to distinguish between sweet and sour by 72 hours old-
Smell-ability to distinguish between mother’s breast milk and breast milk from-
.others
.Touch-sensitivity to pain;responds to tactile stimuli-
( Vision-ability to focus on objects only in close proximity(7-12 inches way-
…??Myopia
The presence and strength of a reflex is an important indication of..(
neurologic development and function.A Reflex is an involuntry muscular
.response to a sensory stimulate

51. Behavioral Adaptation
First period of Reactivity
.THE first period of reactivity begins at birth and lasts for 30 minute
The nb is alert and moving and may appear hungry(movement
eyes,sucking motions;chewing;rooting.respiration and HR are
(elevated but gradually begin to slow as the next period
This period of alertness allows parents to interact with their newborn
.and to enjoy close contact with their new baby
The appearance of sucking and rooting behaviors provides good..(
….(opportunity for initating breast feeding

52. Period of Decrease
Responsiveness
At 30-120 minute of age.the newborn enters the
second stage of transition that of sleep or
decrease in activity.Movement are less jerky and
less frequent.HR&RR decline as the newborn
enters the sleep phase. muscle become
relaxed.no interst in sucking is shown. here can
mother and baby togther take rest after labor
.and birthing experience

53. Second Period of Reactivity
The second period of reactivity begins as the newborn
awakens and shows in interest in environmental
stimuli.this period lasts 2-8 hours in the normal
.newborn
.HH&RR increase.motor activity and muscle tone increase
Here interaction between mother and newborn during this
second period of reactivity is encouraged if the mother
.has rested and desire it
Teaching about feeding.postion for feedong and diaper-changing…(
..((techniques can be reinforced this period

54. HamzeH al-HarayzeH
Nursing School