Adaptation to EUA

To provide an overview of a normal newborn’s adjustment to his/her new environment

To understand baby’s behavioural cues

Aims:

Adaptation to EUA

1. Appreciate the contrast in environment between in-utero and extra uterine

2. Consider the impact on the differences on the baby  

Learning Outcomes:

Learning Outcomes (cont):

3. Discuss how the midwife can minimise any adverse effects of birth

 

4. Identify ways in which the care giver can assist developmental progress in the newborn

Temperature Respiration

 Circulation Nutrition

 Infection Protection/Love

 Movement

Comparison of In Utero & EU Environment

Adaptation to EU Life

Effects on Baby?

How to minimise trauma?

Comparison of In Utero & EU Environment

    Temperature: 37.70C 26.00C

Breathing: 1-2 per minute 30-50 pm

Obligatory nasal breathers

Comparison of In Utero & EU Environment

Heart rate: 120-160 per minute

100-120 pm

 

Nutrition: diffusion from mother

  Breast feeding / AF

Infection & protection:

bag of membranes, uterus, maternal abdominal tissue

 

Comparison of In Utero & EU Environment

Comparison of In Utero & EU Environment

Movements: from about 7/40

Some light penetrates the uterine wall – stimulates activity when very bright

Kicking increases in response to mother’s stress/ sounds of high frequency

Fetal Circulation & Adaptation to Extra Uterine Life

Primitive heart:

starts beating at about 4 weeks

Circulatory System of fetus:

established between 8-12 weeks gestation

Fetal Circulation

 Fetus develops its own blood

– fetal blood does not mix with maternal blood

  Separated by layers of:

•synciotrophoblast

•cytotrophoblast

•walls of capillaries

Fetal Circulation

Fetal Circulation

Lungs only receive a very tiny proportion of fetal blood

Placenta is responsible for blood oxygenation and elimination of waste

products

Fetal Circulation

Three shunts:

•Ductus arteriosus

•Ductus venosus

•Foramen ovale

Circulatory Adjustments at birth

dramatic fall in pulmonary vascular resistance

marked increase in pulmonary blood flow

progressive thinning of the walls of the pulmonary arteries

Fetal Circulation

Fetal Structure Adult Structure

Foramen Ovale Fossa Ovalis

Umbilical Vein Ligamentum teres

Umbilical Arteries Umbilical ligaments,Ductus Venosus Ligamentum venosum

Ductus Arteriosum Ligamentum arteriosum

Fetal Circulation

Consider MW’s Role in Maximising Health

Temperature Control

Difficult in the newborn due to:

-large surface area

-poor insulation

-wet & exposed body

-inability to shiver

-immature temp. regulating centre

Temperature Control

Heat loss through:

•Conduction

•Convection

•Evaporation

•Radiation

Temperature Control

Consider M/W’s Role in Maximising Health

NEONATAL INFECTION

All neonates are susceptible to infection

WHY?

Diminished immunity

NEONATAL INFECTION

•skin is a poor barrier

•don’t sweat until 1 month

•don’t have tears (lysozome is bactericidal)

• low gastric juice until 4 weeks

NEONATAL INFECTION

•low T lymphocyte function

•low levels of fetal antibody levels at birth (unless been exposed to intrauterine infection)

•invasive procedures (PKU)

NEONATAL INFECTION

ROUTES OF INFECTION

 (1)Transplacentally

(2) Ascending Infection/ Intrapartum early SROM

(3) Postnatally

NEONATAL INFECTION

Consider M/W’s Role in Maximising Health

Emotional Development

The development of the baby involves dynamic exchanges within the environment.

  In-utero environment

Dark

Muffled sounds

Temp –37.50 C

Emotional Development

Role of the midwife is therefore:

•to facilitate

•to enhance

a positive environment for optimum health, both physically as well as emotionally

Emotional DevelopmentConsider the in-utero environment:

• Dark

• Muffled sounds

• Constant contact with mother

• Temp –37.50 C

Emotional Development

Attachment & Trust – they are the key developmental issues of infancy

The infant-carer dyad is pivotal in this

Emotional Development

The baby is interested in his surroundings for at least the 1st hour or so, before going to sleep

  Time to CONNECT!!!

Emotional Development

‘LOVE & NURTURING’ 

• SKIN TO SKIN CONTACT

•  PREFERENCE FOR FACE RATHER THAN OBJECTS

Emotional Development

Baby’s control of his environment

• THUMBSUCKING (don’t cover hands)

• GAZING ( face distance –22cm/9 inch)

Emotional Development

Baby’s control of his environment

•Turning away

• Positing

• Hiccups

• Colour change

Emotional Development

Carer’s facilitation

• Hand to Chest

• Swaddling

 

Emotional Development

• Adjust light if too bright

• Do not start a procedure abruptly

 

Hand over chest- stops startles 

Adaptation to EU LifeConclusion

Many adaptations

Midwife’s role:

• minimise stress

• maximise health