THE NEONATAL PERIOD

HUMAN DEVELOPMENT
Vanessa M. Manila, RN
UP Manila College of Nursing
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 OBJECTIVES
1. Describe the newborn’s transition to
extrauterine life.
a. Intrauterine Life
b. Physiologic Adaptations
2. Describe the neonatal physical
characteristics
3. Describe the neonate’s behavioral
responses and developmental tasks
4. Discuss appropriate nursing care of
the newborn
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Transition from intrauterine
to
extrauterine life 3
 I. Intrauterine Life
Placental Function:
- transfer of gases (lungs)
- transport of nutrients (gastrointestinal
tract)
- excretion of wastes (kidneys)
- transfer of heat (skin)

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 I. Intrauterine Life
Placental Function:
- conjugation of drugs and hormones
(liver)
- production of various protein and
steroid hormones (endocrine
gland)

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 II. Physiologic
Adaptations
“ The most
profound
physiologic
change required
of the neonate is
transition from
fetal or placental
circulation to
independent
respiration…”
(Whaley and 6
Wong, 1989)
 II. Physiologic
Adaptations
A. Respiratory adaptations
B. Cardiovascular adaptations
C. Temperature regulation
D. Urinary Adaptations
E. Gastrointestinal Adaptation
F. Hepatic Adaptation
G. Immunologic System
H. Neurologic and Sensory/ Perceptual
Functioning
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 II. Physiologic
Adaptations
– most critical: first 24 hours
– the most critical and immediate
physiologic change required of the
newborn is the onset of
breathing
slapping the infant’s feet/
buttocks has no beneficial
effect
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II. Physiologic
Adaptations
A. Respiratory adaptations

Characteristics:
- Normal rate: 30- 60
breaths per minute
- shallow and irregular depth and rhythm
- Primarily abdominal and synchronus with
the chest mov’t
- Short periods of apnea are to be expected
- Pauses lasting 5- 15 secs, called periodic
breathing, may occur
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II. Physiologic
Adaptations
B. Circulatory adaptations

Characteristics:
- Heart rate: 100 bpm when asleep;
120- 150 when awake
- Rates as high as 180 while crying may
be normal
- Apical pulse rates should be obtained
by auscultation for a full minute
- BP: resting: 74/47 mmHg
- Crying may cause elevation
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II. Physiologic
Adaptations
C. Thermogenic Adaptations

Neonatal Characteristics affecting

thermal adaptation:
- decreased subcutaneous fat and thin
epidermis
- blood vessels are closer to the skin
- large body surface area
- flexed posture
- presence of Brown Adipose Tissue
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II. Physiologic
Adaptations
C. Thermogenic Adaptations

Thermogenesis in newborn:
- increased muscular activity and
positional changes
- chemical thermogenesis (non-shivering
thermogenesis); increased basal
metabolic rate
- vasomotor control

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II. Physiologic
Adaptations
D. Renal System

First voiding should occur within 24

hours
Unable to concentrate urine
Usually straw- colored and almost
odorless
Pseudo- menstruation in female infant

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II. Physiologic
Adaptations

Loss of fluid, through urine, feces, lungs,

increased metabolic rate and limited fluid
intake results in 5- 10% loss of body
weight. This usually occurs during the
first 3-5 days. The infant usually regains
the birth weight within 14 days after birth
At birth the total weight
of the infant is 73% fluid
as compared to 58% in
the adult
The infant has a
proportionately
higher ratio of
extracellular fluid
than the adult
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II. Physiologic
Adaptations
E. Gastrointestinal System

The ability to digest, absorb, and

metabolize food stuff is adequate but
limited in certain functions.
(Whaley and Wong, 1989)

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II. Physiologic
Adaptations
E. Gastrointestinal System
A special mechanism coordinates
breathing, sucking, and swallowing
reflexes necessary for oral feeding
Sucking in newborn takes place in
small bursts of 3- 8 sucks at a time
Unable to move food
from the lips to the
pharynx

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III. Physiologic
Adaptations
F. Hepatic Regulation

Liver is immature

Plays an important role:

1. conjugation of bilirubin
2. blood coagulation

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II. Physiologic
Adaptations
G. Immunologic System

Cells that provide the infant with

immunity are developed early in fetal
life
Not activated for several months
First 3 months: passive
immunity from the
mother

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III. Physiologic
Adaptations
G. Immunologic System

Breast- fed infants receives passive

immunity through colostrums and
breast milk
Sepsis: respiratory distress
Best protection: hand hygiene

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II. Physiologic
Adaptations
H. Neurologic and Sensory/
Perceptual Functioning

Neither anatomically nor physiologically

developed
All neurons are present
Uncoordinated in movement
Labile in temperature regulation
Have poor control over their
musculature
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II. Physiologic
Adaptations
H. Neurologic and Sensory/
Perceptual Functioning

Vision
- the least mature at
term
- development
continues for the first
6 months

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II. Physiologic
Adaptations
H. Neurologic and Sensory/
Perceptual Functioning
Hearing
- as soon as amniotic fluid is drained
from the ear, hearing is similar as to
that of an adult
- react to high frequency sound with a
startle
- reacts to low- frequency sound by
decreasing motor activity or stopping
crying 22
II. Physiologic
Adaptations
H. Neurologic and Sensory/
Perceptual Functioning
Smell
- highly developed
- by the 5th day, can recognize
mother’s smell
- breastfed infants are able to smell
breastmilk and can differentiate their
mother from other lactating women

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II. Physiologic
Adaptations
H. Neurologic and Sensory/
Perceptual Functioning
Taste
- tasteless solution: no response
- sweet: eager sucking
- sour: puckering of lips
- bitter: grimace
- newborns prefer
glucose water to plain
water
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II. Physiologic
Adaptations
H. Neurologic and Sensory/
Perceptual Functioning
Touch
- responsive to all
parts of the body
- face, hands, and soles
of the feet appear to be
the most sensitive
- touch and motion are
essential to normal
growth and
development 25