The Neonate (recorded lecture)
Fetus
★ A FETUS TOTALLY DEPENDENT on his Mother but at the moment of birth transitions to a
NEONATE WHO IS TOTALLY INDEPENDENT
Fetal circulation
★ Fetal circulatory system uses 3 shunts
○ Shunt: small passages that direct blood that needs to be oxygenated
○ Purpose: bypass the lungs and liver
○ 2 main shunts: Ductus arteriosus and Ductus venosus
■ Umbilical cord has 1 vein & 2 arteries
○ Foramen ovale: in the heart, allows the blood to mix in the heart
○ We look at the newborn to see if theres 2 arteries and a vein, this shows us if there's
appropriate circulation during the fetal development
Blood Circulation After Birth
★ Umbilical cord is clamped -> baby no longer gets oxygen and nutrients from the mother
★ 1st breath -> lungs start to expand, alveoli are cleared of fluid
★ This causes an INC in the baby's BP
○ Major reduction in the pulmonary pressures = reduced need for the ductus arteriosus
to shunt blood
★ These changes help the shunt close
★ These changes raise pressure in the LA of the heart and lower pressure in RA
★ The shift in pressure stimulates the foramen ovale to close
★ The closure of the ductus arteriosus, ductus venosus, and foramen ovale completes the change
of fetal circulation to newborn circulation
○ Shunts = flaps of skin
○ Initially flop down and close → not solid yet → takes a few weeks to become permanent
changes → will see shifts in the first 24 hours listening with stethoscope
○ ***names of 3 shunts, where the shunts are, what they bypass, how fetal circulation is
different from newborn circulation***
Transitions
★ First 24-48 hours, be prepared for this!!!
How do we prepare to assist this transition to extrauterine life
★ Know the Risk factors (nurse needs to know)
★ Expected Gestational Age
○ Important bc younger babies/post date babies = higher risk
★ Ensure appropriately supplies/equipment
○ Set up like there is going to be a problem
★ Thermoregulation: source of heat, Skin to skin, radiant warmer, warmed blankets, etc.
, ○ We WANT chest to chest, but anticipate if the transition goes wrong, if baby needs CPR
★ Stimulation: “rough towels”, bulb syringe
○ Syringe bc lots of fluid in lungs, suction mouth/nose
★ Positive pressure ventilation (PPV): Neonatal bag and mask attached to O2 source and
manometer
★ ***Interventions if…..
○ HR less than 100 bpm = 15 seconds of “PPV”
■ If baby needs help expanding alveoli/opening lungs
○ HR less than 60 bpm = CHEST COMPRESSIONS
Gestational age
★ Preterm: less than 37 weeks
★ Late preterm: 37-38 weeks
★ FULL Term: 280 days/40 weeks
★ Post term: AFTER 41 completed weeks
★ Size associated with dates
○ AGA- Average for Gestational Age
○ SGA –Small for Gestational Age
○ LGA- Large for Gestational Age
Transition begins
★ This transition to extrauterine life begins the moment the cord is cut
★ Babies delivered vaginally benefit from the birth squeeze which helps to push fluid out of the
lungs
○ C-section babies tend to have more fluid in lungs, more at risk for assistance
APGAR*******
★ “APGAR SCORE” at 1 and 5 minutes after birth to assess these things…..
★ Score of 0-3
○ Severe distress
○ Needs IMMEDIATE resuscitation
■ PPV → chest compressions → medications
★ Score of 4-6
○ Moderate difficulty
○ Interventions specific to deficits
■ Suction, oxygen, drying baby, stimulating baby
★ Score 7-10
○ Stable neonate- continue to monitor (HR, temp, keep warm, suction)
Umbilical cord
★ The umbilical cord contains 2 arteries and 1 vein
★ The vessels are surrounded by “Wharton’s jelly”
Fetus
★ A FETUS TOTALLY DEPENDENT on his Mother but at the moment of birth transitions to a
NEONATE WHO IS TOTALLY INDEPENDENT
Fetal circulation
★ Fetal circulatory system uses 3 shunts
○ Shunt: small passages that direct blood that needs to be oxygenated
○ Purpose: bypass the lungs and liver
○ 2 main shunts: Ductus arteriosus and Ductus venosus
■ Umbilical cord has 1 vein & 2 arteries
○ Foramen ovale: in the heart, allows the blood to mix in the heart
○ We look at the newborn to see if theres 2 arteries and a vein, this shows us if there's
appropriate circulation during the fetal development
Blood Circulation After Birth
★ Umbilical cord is clamped -> baby no longer gets oxygen and nutrients from the mother
★ 1st breath -> lungs start to expand, alveoli are cleared of fluid
★ This causes an INC in the baby's BP
○ Major reduction in the pulmonary pressures = reduced need for the ductus arteriosus
to shunt blood
★ These changes help the shunt close
★ These changes raise pressure in the LA of the heart and lower pressure in RA
★ The shift in pressure stimulates the foramen ovale to close
★ The closure of the ductus arteriosus, ductus venosus, and foramen ovale completes the change
of fetal circulation to newborn circulation
○ Shunts = flaps of skin
○ Initially flop down and close → not solid yet → takes a few weeks to become permanent
changes → will see shifts in the first 24 hours listening with stethoscope
○ ***names of 3 shunts, where the shunts are, what they bypass, how fetal circulation is
different from newborn circulation***
Transitions
★ First 24-48 hours, be prepared for this!!!
How do we prepare to assist this transition to extrauterine life
★ Know the Risk factors (nurse needs to know)
★ Expected Gestational Age
○ Important bc younger babies/post date babies = higher risk
★ Ensure appropriately supplies/equipment
○ Set up like there is going to be a problem
★ Thermoregulation: source of heat, Skin to skin, radiant warmer, warmed blankets, etc.
, ○ We WANT chest to chest, but anticipate if the transition goes wrong, if baby needs CPR
★ Stimulation: “rough towels”, bulb syringe
○ Syringe bc lots of fluid in lungs, suction mouth/nose
★ Positive pressure ventilation (PPV): Neonatal bag and mask attached to O2 source and
manometer
★ ***Interventions if…..
○ HR less than 100 bpm = 15 seconds of “PPV”
■ If baby needs help expanding alveoli/opening lungs
○ HR less than 60 bpm = CHEST COMPRESSIONS
Gestational age
★ Preterm: less than 37 weeks
★ Late preterm: 37-38 weeks
★ FULL Term: 280 days/40 weeks
★ Post term: AFTER 41 completed weeks
★ Size associated with dates
○ AGA- Average for Gestational Age
○ SGA –Small for Gestational Age
○ LGA- Large for Gestational Age
Transition begins
★ This transition to extrauterine life begins the moment the cord is cut
★ Babies delivered vaginally benefit from the birth squeeze which helps to push fluid out of the
lungs
○ C-section babies tend to have more fluid in lungs, more at risk for assistance
APGAR*******
★ “APGAR SCORE” at 1 and 5 minutes after birth to assess these things…..
★ Score of 0-3
○ Severe distress
○ Needs IMMEDIATE resuscitation
■ PPV → chest compressions → medications
★ Score of 4-6
○ Moderate difficulty
○ Interventions specific to deficits
■ Suction, oxygen, drying baby, stimulating baby
★ Score 7-10
○ Stable neonate- continue to monitor (HR, temp, keep warm, suction)
Umbilical cord
★ The umbilical cord contains 2 arteries and 1 vein
★ The vessels are surrounded by “Wharton’s jelly”
