Pathophysiology of the Newborn

Debbie Gonzalez

Neonatal Period: Birth to 28 days. Term Infant: 38 - 42 weeks of gestation. Transition Period: Phases of instability during the first 6-8 hours after birth Circulatory: Transitional Circulation equals acrocyanosis Peripheral circulation is sluggish, High: RBC 4.8-7.1; Hgb 14-24; Hct 44-64, WBC 18,000 @ birth; 23-24,000 @ 1 day. Coagulation: Vitamin K dependent clotting factors are decreased. Platelet counts ok (150,000-350,000) Respiratory: Before birth O2 needs met by placenta. After delivery, need mature lungs that are vascularized, have surfactant and sacules, usually adequate by 32-35 weeks. At term the lungs hold approximately 20 ml of fluid/kg. Gastrointestinal System: Immature at birth, reaches maturity at 2-3 years of age. Initial fecal material is meconium. Sucking becomes coordinated at 32 weeks. Newborn has little saliva until 3 months of age. Bowel sounds after 1 hour of birth. Newborns have difficulty digesting complex starches and fat. Abdomen becomes easily distended after eating. There is no normal flora at birth in GI system to synthesize Vitamin K. Temperature Regulation: Non-Shivering thermogenesis: brown fat is the primary source of heat production. Brown fat is broken down into glycerol & fatty acids producing heat. Brown fat is found @ the nape of the neck, axillae, around the kidneys and in the mediastinum. Slightly warmer to touch than normal skin. Cold Stress: An increase in the metabolic rate associated with non-shivering thermogenesis equals increased O2 demands and caloric consumption. It is important to provide a neutral thermal environment to prevent metabolic acidosis and prevent depleted brown fat. Immune System: Limited specific and Non-specific immunity at birth. Passive immunity for the first 3 months of life. This will be reduced if baby is born premature. Breastfeeding will increase passive immunity. Kidneys and Urination: Ninety two percent of all healthy infants void in the first 24 hrs of birth. Initial urine: cloudy, scant amounts, uric acid crystals appear with a reddish stain on diaper. Kidneys are not fully functional until 2 years old. Hepatic Function: Stores needed iron for the first few months. Preterm & small infants have lower iron stores than full term and heavier infants. (full term infants stores last 4-6 mo) Liver produces substances essential for clotting of blood. At risk for physiologic jaundice after 24 hours of age due to increased breakdown of RBCs and immature liver functioning. Increased Bilirubin Levels: Bilirubin level greater than 12 at any time needs further attention. Jaundice in the 1st day is NOT normal. Maternal causes of increased bilirubin levels in the NB: epidural use, oxytocin induced labor, infection, hepatitis. Neurologic:All neurons are present, but many are immature. Uncoordinated movements and poor muscle control. Startle easily. Tremors in extremities. Weight Loss: It is normal for the newborn infant to lose 5-10% of weight in the first 4 to 5 days of life.