5/21/25, 8:24 PM NM717 Module 5 Newborn Midwifery Care of the Newborn Kelsey review guide p. 214-220, 222-223, 226-231/Newest Update Flas…
NM717 Module 5 Newborn Midwifery Care of the Newborn
Kelsey review guide p. 214-220, 222-223, 226-231/Newest
Updated
Immediate extrauterine —immediate transition from intrauterine to extrauterine life
newborn transition
—respiration,
Immediate extrauterine —circulation,
newborn transition depends —thermoregulation, and
on changes in four major —glucose regulation
areas:
Biochemical Factors in —relative hypoxia at the end of labor
initiation of respiration
Physical stimuli Factors in —cold, gravity, pain, light, noise
initiation of respiration
Physiologic Factor in initiation Recoil from pressure on thorax while passing through vagina
of respiration
a. Central nervous system (CNS) respiratory center
Sustained respiration
b. Aortic and carotid chemoreceptors
depends on
c. Thoracic mechanoreceptors
coordinated response
d. Diaphragm and respiratory muscles
of the following
a. Assist in conversion from fetal to extrauterine circulation
Initial breathing serves
b. Clear lungs of fluid
the following purposes
c. Establish lung volume and expand alveoli
a. Respiratory rate 30 to 60 breaths per minute
b. Irregular/fluctuating pattern
Characteristics of
c. Diaphragmatic and abdominal breathing
normal newborn d. Obligate nose breathing
respiration e. Absence of nasal flaring, grunting, and retractions
1/12
3
,5/21/25, 8:24 PM NM717 Module 5 Newborn Midwifery Care of the Newborn Kelsey review guide p. 214-220, 222-223, 226-231/Newest Update Flas…
Transition from fetal to adult circulation begins with
Circulatory changes
clamping of the umbilical cord and continues
throughout the first weeks of life
a. Low-pressure system, including placenta (low-resistance circuit)
Characteristics of fetal b. Minimal circulation to lungs; bypassed via foramen ovale and
circulation ductus arteriosus
c. Foramen ovale favors circulation of most oxygen-rich blood to
the brain
a. Increased systemic resistance due to loss of placental circuit
b. Increased pressure in left atrium causes functional closure of
foramen ovale
Transition from fetal to c. Initial respiration opens pulmonary vasculature, favoring
neonatal circulation circulation to lungs
d. Increased oxygenation of circulating blood causes
constriction and functional closure of ductus
arteriosus
e. Absence of placental circulation closes ductus venosus
a. Convection
Thermoregulation Mechanisms b. Conduction
of neonatal heat loss c. Radiation
d. Evaporation
a. Shivering (inefficient)
Thermoregulation Neonate
b. Muscle activity (limited benefit)
creates heat in three ways:
c. Thermogenesis by metabolism of brown adipose tissue (BAT)
High risks infants with (1) BAT stores are decreased in preterm and growth-restricted
ineffective Thermogenesis fetuses
(2) Hypoglycemia decreases efficiency of BAT metabolism
a. Increased oxygen consumption, leading to relative hypoxia and
Thermoregulation acidosis
b. Metabolism of BAT and release of fatty acids decreases pH
Consequences of cold
c. Increased use of glucose, depletion of glycogen stores, and
stress
hypoglycemia
d. Worsening hypoglycemia and acidosis may result in respiratory
distress
a. Skin-to-skin contact on mother's chest or abdomen with blanket
over both
Thermoregulation b. Prewarm blankets and resuscitation area
Management/Interventions to c. Dry the newborn immediately and replace wet blankets
promote d. Regulate room temperature and minimize exposure to air
convection
e. Postpone newborn bath at least two hours
f. Keep newborn warm and wrapped
2/12
3
,5/21/25, 8:24 PM NM717 Module 5 Newborn Midwifery Care of the Newborn Kelsey review guide p. 214-220, 222-223, 226-231/Newest Update Flas…
a. Predominantly in liver
Glucose regulation Glycogen
stores b. Accumulated in third trimester
a. Infants of diabetic mothers
b. Small for gestational age (SGA) or large for gestational age
Glucose regulation Risk (LGA)
factors for neonatal c. Preterm or post-term
hypoglycemia d. Intrapartum—perinatal acidemia, beta-agonist tocolysis, IV
glucose administration
e. Maternal substance abuse
a. Normal physiologic decrease in blood glucose
appears to be essential to stimulate physiologic
processes promoting glucose production
(1) Lowest at 1-1.5 to 5 hours after birth
(2) Stabilizes at three to four hours after birth
Glucose regulation in the (3) neonate hypoglycemia definition is controversial.
healthy neonate
Guidelines underscore the need to measure glucose
levels as soon as possible in symptomatic infants; if
symptomatic and < 40 mg/dl, IV glucose is
recommended for treatment.
(4) Infants without symptoms, ideally infants should feed
within one hour of birth, and glucose should be
screened 30 minutes after feeding; by 4-24 hours of
age, blood glucose levels should remain ≥ 45 mg/dl
(1) Symptomatic infants < 40mg/dl, or those with initial
Glucose regulation Indications
for serum glucose less than 25 mg/dL even without
treatment with intravenous symptoms
dextrose (2) Asymptomatic infants with persistent serum glucose less than
45 mg/dL
3/12
3
, 5/21/25, 8:24 PM NM717 Module 5 Newborn Midwifery Care of the Newborn Kelsey review guide p. 214-220, 222-223, 226-231/Newest Update Flas…
a. Weak cry
b. Jitteriness
Glucose regulation Signs and c. Cyanosis
symptoms of hypoglycemia d. Apnea
e. Lethargy
f. Poor feeding
a. Encourage feeding as soon as possible
Glucose regulation b. Observe for signs/symptoms of hypoglycemia
hypoglycemia c. Assess glucose levels if
Management signs/symptoms or risk factors are
present
(1) Intake of human milk or formula
Glucose regulation Sources (2) Glycogenolysis (use of glycogen stores)
and mechanisms of glucose (3) Gluconeogenesis (production of glucose from free
maintenance fatty acids), glycerol, and amino acids
Glucose regulation Mean 60 to 70 mg/dL
glucose levels from 4 to
72 hours are
(1) Predominates in fetal circulation
Hemoglobin F (2) High affinity for oxygen
(3) Gradually eliminated in first month of life
Physiologic Jaundice of the Short RBC life span leads to increased bilirubin
Newborn etiology
• Evidence of benefit particularly for preterm infant
• increase in blood volume by 25-40%
Delayed cord clamping • continued bolus of oxygenated blood during transition
benefits • volume expansion that promotes pulmonary capillary perfusion
• more rapid acheivement of adequate oxygenation
Neutral position on maternal
Delayed cord clamping abdomen is preferable Below
method
introitus—theoretically may
cause placental transfusion and
polycythemia
(a) 13.7-20.0 g/dL
(b) Slight rise in first few days of life
Normal Hemoglobin
due to decreased plasma volume
Newborn values
(c) Mean value at 2 months of age 12.0 g/dL
Normal Hematocrit Newborn 43-63%
4/12
3
NM717 Module 5 Newborn Midwifery Care of the Newborn
Kelsey review guide p. 214-220, 222-223, 226-231/Newest
Updated
Immediate extrauterine —immediate transition from intrauterine to extrauterine life
newborn transition
—respiration,
Immediate extrauterine —circulation,
newborn transition depends —thermoregulation, and
on changes in four major —glucose regulation
areas:
Biochemical Factors in —relative hypoxia at the end of labor
initiation of respiration
Physical stimuli Factors in —cold, gravity, pain, light, noise
initiation of respiration
Physiologic Factor in initiation Recoil from pressure on thorax while passing through vagina
of respiration
a. Central nervous system (CNS) respiratory center
Sustained respiration
b. Aortic and carotid chemoreceptors
depends on
c. Thoracic mechanoreceptors
coordinated response
d. Diaphragm and respiratory muscles
of the following
a. Assist in conversion from fetal to extrauterine circulation
Initial breathing serves
b. Clear lungs of fluid
the following purposes
c. Establish lung volume and expand alveoli
a. Respiratory rate 30 to 60 breaths per minute
b. Irregular/fluctuating pattern
Characteristics of
c. Diaphragmatic and abdominal breathing
normal newborn d. Obligate nose breathing
respiration e. Absence of nasal flaring, grunting, and retractions
1/12
3
,5/21/25, 8:24 PM NM717 Module 5 Newborn Midwifery Care of the Newborn Kelsey review guide p. 214-220, 222-223, 226-231/Newest Update Flas…
Transition from fetal to adult circulation begins with
Circulatory changes
clamping of the umbilical cord and continues
throughout the first weeks of life
a. Low-pressure system, including placenta (low-resistance circuit)
Characteristics of fetal b. Minimal circulation to lungs; bypassed via foramen ovale and
circulation ductus arteriosus
c. Foramen ovale favors circulation of most oxygen-rich blood to
the brain
a. Increased systemic resistance due to loss of placental circuit
b. Increased pressure in left atrium causes functional closure of
foramen ovale
Transition from fetal to c. Initial respiration opens pulmonary vasculature, favoring
neonatal circulation circulation to lungs
d. Increased oxygenation of circulating blood causes
constriction and functional closure of ductus
arteriosus
e. Absence of placental circulation closes ductus venosus
a. Convection
Thermoregulation Mechanisms b. Conduction
of neonatal heat loss c. Radiation
d. Evaporation
a. Shivering (inefficient)
Thermoregulation Neonate
b. Muscle activity (limited benefit)
creates heat in three ways:
c. Thermogenesis by metabolism of brown adipose tissue (BAT)
High risks infants with (1) BAT stores are decreased in preterm and growth-restricted
ineffective Thermogenesis fetuses
(2) Hypoglycemia decreases efficiency of BAT metabolism
a. Increased oxygen consumption, leading to relative hypoxia and
Thermoregulation acidosis
b. Metabolism of BAT and release of fatty acids decreases pH
Consequences of cold
c. Increased use of glucose, depletion of glycogen stores, and
stress
hypoglycemia
d. Worsening hypoglycemia and acidosis may result in respiratory
distress
a. Skin-to-skin contact on mother's chest or abdomen with blanket
over both
Thermoregulation b. Prewarm blankets and resuscitation area
Management/Interventions to c. Dry the newborn immediately and replace wet blankets
promote d. Regulate room temperature and minimize exposure to air
convection
e. Postpone newborn bath at least two hours
f. Keep newborn warm and wrapped
2/12
3
,5/21/25, 8:24 PM NM717 Module 5 Newborn Midwifery Care of the Newborn Kelsey review guide p. 214-220, 222-223, 226-231/Newest Update Flas…
a. Predominantly in liver
Glucose regulation Glycogen
stores b. Accumulated in third trimester
a. Infants of diabetic mothers
b. Small for gestational age (SGA) or large for gestational age
Glucose regulation Risk (LGA)
factors for neonatal c. Preterm or post-term
hypoglycemia d. Intrapartum—perinatal acidemia, beta-agonist tocolysis, IV
glucose administration
e. Maternal substance abuse
a. Normal physiologic decrease in blood glucose
appears to be essential to stimulate physiologic
processes promoting glucose production
(1) Lowest at 1-1.5 to 5 hours after birth
(2) Stabilizes at three to four hours after birth
Glucose regulation in the (3) neonate hypoglycemia definition is controversial.
healthy neonate
Guidelines underscore the need to measure glucose
levels as soon as possible in symptomatic infants; if
symptomatic and < 40 mg/dl, IV glucose is
recommended for treatment.
(4) Infants without symptoms, ideally infants should feed
within one hour of birth, and glucose should be
screened 30 minutes after feeding; by 4-24 hours of
age, blood glucose levels should remain ≥ 45 mg/dl
(1) Symptomatic infants < 40mg/dl, or those with initial
Glucose regulation Indications
for serum glucose less than 25 mg/dL even without
treatment with intravenous symptoms
dextrose (2) Asymptomatic infants with persistent serum glucose less than
45 mg/dL
3/12
3
, 5/21/25, 8:24 PM NM717 Module 5 Newborn Midwifery Care of the Newborn Kelsey review guide p. 214-220, 222-223, 226-231/Newest Update Flas…
a. Weak cry
b. Jitteriness
Glucose regulation Signs and c. Cyanosis
symptoms of hypoglycemia d. Apnea
e. Lethargy
f. Poor feeding
a. Encourage feeding as soon as possible
Glucose regulation b. Observe for signs/symptoms of hypoglycemia
hypoglycemia c. Assess glucose levels if
Management signs/symptoms or risk factors are
present
(1) Intake of human milk or formula
Glucose regulation Sources (2) Glycogenolysis (use of glycogen stores)
and mechanisms of glucose (3) Gluconeogenesis (production of glucose from free
maintenance fatty acids), glycerol, and amino acids
Glucose regulation Mean 60 to 70 mg/dL
glucose levels from 4 to
72 hours are
(1) Predominates in fetal circulation
Hemoglobin F (2) High affinity for oxygen
(3) Gradually eliminated in first month of life
Physiologic Jaundice of the Short RBC life span leads to increased bilirubin
Newborn etiology
• Evidence of benefit particularly for preterm infant
• increase in blood volume by 25-40%
Delayed cord clamping • continued bolus of oxygenated blood during transition
benefits • volume expansion that promotes pulmonary capillary perfusion
• more rapid acheivement of adequate oxygenation
Neutral position on maternal
Delayed cord clamping abdomen is preferable Below
method
introitus—theoretically may
cause placental transfusion and
polycythemia
(a) 13.7-20.0 g/dL
(b) Slight rise in first few days of life
Normal Hemoglobin
due to decreased plasma volume
Newborn values
(c) Mean value at 2 months of age 12.0 g/dL
Normal Hematocrit Newborn 43-63%
4/12
3
