NEONATAL ADAPTATION

Adaptation :
the process by which one adjusts
and becomes more attuned to the
environment.

Neonatal adaptation :
Functional adjustment from intrauterine
to extrauterine life
Ability to adjust --- HOMEOSTASIS
Maladaptation --- Morbidity
 NEONATAL ADAPTATION

ADAPTATION depend on :
 MATURATION
 NUTRITIONAL STATUS
 Tolerance
 ADAPTIVE CAPACITY
 NEONATAL ADAPTATION

ADAPTATION depend on :
 MATURATION
Related to gestational
age
 NUTRITIONAL STATUS
 Tolerance
 ADAPTATION
 NEONATAL ADAPTATION

ADAPTATION depend on :
 MATURATION
 NUTRITIONAL STATUS
Related to birth weight
 Tolerance
 ADAPTATION
 NEONATAL ADAPTATION

ADAPTATION depend on :
 MATURATION
 NUTRITIONAL STATUS
 Tolerance
The ability to overcome the
new environment
Tolerability to hypoxia,
hypoglycemia, caloric intake, etc.
 ADAPTATION
 NEONATAL ADAPTATION

ADAPTATION depend on :
 MATURATION
 NUTRITIONAL STATUS
 Tolerance
 ADAPTIVE CAPACITY

the potential or ability of a

system to adapt to the
effects of change
 NEONATAL ADAPTATION

Adaptation involved
multi-organ function,
include :
 Cardio-circulatory system
 Respiratory system
 Intestinal tract
 Metabolism
 Central nervous system
 Circulatory ADAPTATION

 Fetus - from 8 weeks until birth organs

mature to support external life

 Fetal circulation
– umbilical-placental circuit via umbilical cord
– circulatory shunts to bypass
 Liver
ductus venosus to inferior vena cava
 Lungs
@ foramen ovale between right & left atria
@ ductus arteriosus connects pulmonary artery
to aorta
CIRCULATORY ADAPTATION

Umbilical vein
Ductus venosus
Foramen Ovale
Ductus arteriosus
Pulmonary circ.
Systemic circ.
Umbilical artery
CIRCULATORY ADAPTATION

DUCTUS
VENOSUS

BY PASS I
CIRCULATORY ADAPTATION

BY PASS II
FORAMEN
OVALE
 CIRCULATORY ADAPTATION

BY PASS III

PATENT
DUCTUS
ARTERIOSUS
 CIRCULATORY ADAPTATION
FETAL CIRCULATION
High pulmonary resistance
Low resistance in systemic blood flow

RIGHT to LEFT shunt

Foramen Ovale
(Left atrial pressure low because returned lung blood is low and
right atrial pressure high due to large volume of blood from
placenta)

Ductus arteriosus
(High pulmonary resistance, Low fetal systemiv blood and
prostaglandin function)
 CIRCULATORY ADAPTATION

NEONATAL CIRCULATION
 Profound changes of circulation at birth
 Increased pulmonary blood flow due to the drops of
pulmonary resistance - lung expansions.
 Venous return from lung increase.
 Left arterial press. is raised; Right art.press.decrease
 foramen ovale closed.
 Systemic resistance higher than pulmonary resistance
(24 hours)  Prostaglandin function  Ductus close
 Constrict umbilical arteries and placental blood stops.
NEONATAL ADAPTATION

NEONATAL
FETAL CIRCULATION
CIRCULATION
 NEONATAL ADAPTATION

CIRCULATORY ADAPTATION
Fetus Newborn
Pulmonary Active, less Active, increased
circulation develop. development

Foramen ovale Open Close

Ductus arteriosus
Open Close
Botali
Ductus Venosus
Open Close
Arantii
Active with
Systemic Active with low
increase
circulation resistance
resistance
Circulatory ADAPTATION
NEONATAL ADAPTATION

FETAL
PULMONARY
DEVELOPMENT
Alveoli present : 25 weeks
fill with lung fluids
Breathing movements:
• Intermittently
• Lung developments
• Control of breathing

Fetus : gas exchange 

placenta
 NEONATAL ADAPTATION

Temperature

Touch Proprioceptive

FIRST Mechanical
Pain BREATH

Diafragm Chemoreceptor
Neonatal Respiration
Irregular
Abdominal respiration
 NEONATAL ADAPTATION

PULMONARY ADAPTATION
CHAIN OF EVENTS AFTER FIRST
BREATH :
※ Converts fetal to adult circulation

※ Empties the lung fluids.

※ Begin pulmonary function.

THE
NEWBORN
RESPIRATION
BEGIN
 PULMONARY ADAPTATION

FETUS NEWBORN
Alveolus Colaps Develops

Pulmonary vessels Non active Active

Pulmonary
High Decrease
resistance
Pulmonary blood Low Increase

Oxygen needs Placenta Lung

CO2 excretion Placenta Lung

 NEONATAL ADAPTATION
Progressive developments of the duodenum,
liver, pancreas and biliary apparatus

Gest.Age 4 wk

Gest.Age 6 wk

Duodenum : occluded - reformation of lumen –X atresia

Liver & biliary : Begin at 6 and 12 weeks  failure to
canalization –X biliary atresia
Pancreas : Insulin secretion and glucagon - 10 and 15
weeks
 ADAPTASI NEONATUS

GASTRO INTESTINAL ADAPTATION

FETUS :
 Caloric and nutritional needs derived from mother
 placenta.
 Intestinal motility  non active
 No need for enzyme metabolism.
NEWBORN
 Intestinal motility begin in function.
 Increase needs of calori/nutritional and enzyme
metabolism.
 NEONATAL ADAPTATION

GASTROINTESTINAL
ADAPTATION
Fetus Newborn
Nutritional
Non active Active
absorption
Bacterial
Negative Positive
colonization
Meconium
Feces Meconium
Feces

Enzyme Non function Active

 NEONATAL ADAPTATION

UROGENITAL ADAPTATION
 Renal organogenesis – a continuous process –
6 till 36 weeks gestation
 The developments of urogenital funtion
continuous after birth
 Fetal urine production – maintaining amniotic
fluid volume
 More than 90% newborn void in the first 24
hours.
 Newborn’ urine production : 1-2 ml/kg BW/hour.
 NEONATAL ADAPTATION

UROGENITAL ADAPTATION
ALLERTNESS
OLIGOHYDRAMNIOS
May suggest renal agenesis; hypoplasia; dysplasia; urinary tract
obstruction.

POLYHYDRAMNIOS
Gastrointestinal anomalies; transplacental transfusion syndr.;
congenital DM

DELAYED MICTURITION (>48 hours)

Inadequate renal perfusion (Hypovolemia/hypoxia); Failure
urine production; urine flow obstruction.
 NEONATAL ADAPTATION

IMMUNOLOGIC STATUS of
the FETUS and NEWBORN
FETUS :
Phagocytic cells
Granulocytes cells Identified at 4 mo
Monocytes cells gestation.

NEWBORN :
Immune system even in term - lower than adults.
Between 3-12 mo  transient immunodeficiency.
The risk enhance by :
• Prematurity
• Traumatic delivery
• Neonatal stress, etc.

PREVENTION FROM INFECTIONS

 Body Temperature in the NB

37.5 C
Normal range
36.5 C
Cold stress ---------- Cause for concern
36.0 C
Moderate hypothermia --- WARM BABY
32.0 C
Severe hypothermia / outlook grave
Skilled care urgently needed
 NEONATAL ADAPTATION

TEMPERATURE ADAPTATION
FETUS :
Body temperature  intrauterine
environment
NEWBORN :
Expose to extra uterine condition
 homeothermy capabilities is
limited due to : large surface area;
poor thermal insulation; low ability
to conserve heat.

PREVENT OF HEAT LOSS

 NEONATAL ADAPTATION

HEAT LOSS.
Transfer of body heat to
 CONDUCTION skin surface.
 CONVECTION
 EVAPORATION
 RADIATION

Dry and wrap the baby

Place in a warm mattress
 NEONATAL ADAPTATION

HEAT LOSS
 CONDUCTION
 CONVECTION Skin heat loss depends on
air temperature/flow.
 EVAPORATION
 RADIATION

Wrap the baby and control

room temperature
 NEONATAL ADAPTATION

HEAT LOSS.
 CONDUCTION
 CONVECTION
 EVAPORATION Depend upon air humidity
 RADIATION

Control humidity and

room temperature
 NEONATAL ADAPTATION

HEAT LOSS
 CONDUCTION
 CONVECTION
 EVAPORATION
 RADIATION The transfer of body heat to
environmental temperature

Radiant heater and

control room temperature
 NEONATAL ADAPTATION

Normal newborn :
 Term infants : 37 – 42 weeks GA
 Birth weight : 2500 – 4000 g
 Birth Length : 44 – 53 cm
 Head circumference : 31 -36 cm
 Apgar Score : 7 – 10
 Congenital anomalies : negative