Maternal Exam 4
Unit 9 Newborn Care Part 1
Chapter 9: Physiological Transition of the Newborn pg. 283-331
General Information:
• APGAR
o Appearance
§ 0 – Blue everywhere
§ 1 - Blue extremities
§ 2 – No blue
o Pulse
§ 0 – No pulse
§ 1 – Under 100 BPM
§ 2 – Over 100 BPM
o Grimace
§ 0 – No Response
§ 1 – Grimace on stimulation
§ 2 – Cry on stimulation
o Activity
§ 0 – No movement
§ 1 – Some flexion
§ 2 – Flexed limbs that resist extension
o Respiratory Effort
§ 0 - No respirations
§ 1 - Weak, irregular, slow
§ 2 - Strong Cry
o Rating:
§ Critical: 3 and below
§ Low: 4-6
§ Normal: 7 and above
Transition Process:
• Respiratory: the first breath requires significant effort to overcome the surface tension of the fluid, fully
aerate the alveoli, and establish functional residual capacity
o Chemical:
§ Hypoxia: Low O2
§ Hypercapnia: High CO2, stimulates medulla to breath
§ Acidosis: Accumulation of CO2 that lowers blood pH
• Normal pH: 7.35-7.45
• Normal CO2:
§ pH blood test: ABGs drawn from umbilical cord immediately post delivery
o Sensory
§ Nerve impulses from stimulation (light, sound, physical delivery act) that trigger the
inspiratory gasp
o Thermal
§ Child goes from intrauterine environment (98.6-ish) to external environment, temperature
drop stimulates temp receptors in the skin and stimulates breathing
o Mechanical
, § Squeeze of the head during vaginal delivery, compression of the infant's chest, chest wall
recoils at birth, creating negative intra-thoracic pressure that draws air into the airways
o Prolonged asphyxia causes CNS-mediated respiratory depression
o Signs of respiratory distress: grunting, nasal flaring, sternal retractions
o Oxygenation:
§ Bulb suctioning: avoid roof of the mouth and back of the throat
§ Positioning: position the head to the side or downward if the infant is gagging or
vomiting
• Cardio:
o The placenta receives 50% of fetal blood flow
o The fetal circulatory system is a low-flow, high-pulmonary-resistance system
o Post-separation: Umbilical arteries + vein constrict
o 5 major changes:
§ Increased aortic pressure and decreased venous pressure
§ Increased systemic pressure and decreased pulmonary pressure
§ Closure of the foramen ovale
§ Closure of the ductus arteriosus
§ Closure of ductus venosus
o Special considerations:
§ Heart rate may reach 160-180 immediately after birth and then decrease to 120-160
during the first thirty minutes
• Thermogenic:
o Neutral Thermal Environment: range of temperature in the newborn that can be maintained with
minimal metabolic demands and O2 consumption
o Core Temp: @ birth: falls from 0.5-5.4 degrees F
o Negative Effects (of cold):
§ Anaerobic glycolysis: the process of turning glucose into lactate to provide energy for the
infant’s body (for 10 seconds to 2 minutes), will turn into lactic acid, then cause the
infant to go into metabolic acidosis
§ An infant cannot shiver; cold skin sends signals that make the body start burning “brown
adipose tissue” (BAT), located in the mid-scapula, axilla, and neck
o BAT causes the release of fatty acids, resulting in metabolic acidosis
o Nursing interventions for cold: prevent heat loss!!!!
§ Evaporation: moisture on babies’ skin (e.g., amniotic fluid, bathwater)
§ Conduction: heat loss through direct contact with cold surfaces (e.g., exam scales,
stethoscopes)
§ Convection: heat loss from surrounding cold air (e.g., AC, vents, fans)
§ Radiation: heat loss from a cold object NOT in direct contact with the baby (e.g. cold
windows, cold exterior walls)
• Hematopoietic:
o Blood volume is determined by cord clamping
Unit 9 Newborn Care Part 1
Chapter 9: Physiological Transition of the Newborn pg. 283-331
General Information:
• APGAR
o Appearance
§ 0 – Blue everywhere
§ 1 - Blue extremities
§ 2 – No blue
o Pulse
§ 0 – No pulse
§ 1 – Under 100 BPM
§ 2 – Over 100 BPM
o Grimace
§ 0 – No Response
§ 1 – Grimace on stimulation
§ 2 – Cry on stimulation
o Activity
§ 0 – No movement
§ 1 – Some flexion
§ 2 – Flexed limbs that resist extension
o Respiratory Effort
§ 0 - No respirations
§ 1 - Weak, irregular, slow
§ 2 - Strong Cry
o Rating:
§ Critical: 3 and below
§ Low: 4-6
§ Normal: 7 and above
Transition Process:
• Respiratory: the first breath requires significant effort to overcome the surface tension of the fluid, fully
aerate the alveoli, and establish functional residual capacity
o Chemical:
§ Hypoxia: Low O2
§ Hypercapnia: High CO2, stimulates medulla to breath
§ Acidosis: Accumulation of CO2 that lowers blood pH
• Normal pH: 7.35-7.45
• Normal CO2:
§ pH blood test: ABGs drawn from umbilical cord immediately post delivery
o Sensory
§ Nerve impulses from stimulation (light, sound, physical delivery act) that trigger the
inspiratory gasp
o Thermal
§ Child goes from intrauterine environment (98.6-ish) to external environment, temperature
drop stimulates temp receptors in the skin and stimulates breathing
o Mechanical
, § Squeeze of the head during vaginal delivery, compression of the infant's chest, chest wall
recoils at birth, creating negative intra-thoracic pressure that draws air into the airways
o Prolonged asphyxia causes CNS-mediated respiratory depression
o Signs of respiratory distress: grunting, nasal flaring, sternal retractions
o Oxygenation:
§ Bulb suctioning: avoid roof of the mouth and back of the throat
§ Positioning: position the head to the side or downward if the infant is gagging or
vomiting
• Cardio:
o The placenta receives 50% of fetal blood flow
o The fetal circulatory system is a low-flow, high-pulmonary-resistance system
o Post-separation: Umbilical arteries + vein constrict
o 5 major changes:
§ Increased aortic pressure and decreased venous pressure
§ Increased systemic pressure and decreased pulmonary pressure
§ Closure of the foramen ovale
§ Closure of the ductus arteriosus
§ Closure of ductus venosus
o Special considerations:
§ Heart rate may reach 160-180 immediately after birth and then decrease to 120-160
during the first thirty minutes
• Thermogenic:
o Neutral Thermal Environment: range of temperature in the newborn that can be maintained with
minimal metabolic demands and O2 consumption
o Core Temp: @ birth: falls from 0.5-5.4 degrees F
o Negative Effects (of cold):
§ Anaerobic glycolysis: the process of turning glucose into lactate to provide energy for the
infant’s body (for 10 seconds to 2 minutes), will turn into lactic acid, then cause the
infant to go into metabolic acidosis
§ An infant cannot shiver; cold skin sends signals that make the body start burning “brown
adipose tissue” (BAT), located in the mid-scapula, axilla, and neck
o BAT causes the release of fatty acids, resulting in metabolic acidosis
o Nursing interventions for cold: prevent heat loss!!!!
§ Evaporation: moisture on babies’ skin (e.g., amniotic fluid, bathwater)
§ Conduction: heat loss through direct contact with cold surfaces (e.g., exam scales,
stethoscopes)
§ Convection: heat loss from surrounding cold air (e.g., AC, vents, fans)
§ Radiation: heat loss from a cold object NOT in direct contact with the baby (e.g. cold
windows, cold exterior walls)
• Hematopoietic:
o Blood volume is determined by cord clamping
