adaptasi neonatus (kuliah m'siswa tk.iv) prof.asril

8/12/2019 Adaptasi Neonatus (Kuliah m'Siswa Tk.iv) Prof.asril

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NEONATAL ADAPTATION

Adaptation:the process by which one adjustsand becomes more attuned to the

environment.Neonatal adaptation :Functional adjustment from intrauterine

to extrauterine lifeAbility to adjust --- HOMEOSTASIS

Maladaptation --- Morbidity


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NEONATAL ADAPTATION

ADAPTATION depend on :

MATURATION

NUTRITIONAL STATUS

TOLARANCE

ADAPTIVE CAPACITY


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NEONATAL ADAPTATION


MATURATION

Related to gestationalage

NUTRITIONAL STATUS

TOLARANCE

ADAPTATION


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NEONATAL ADAPTATION


MATURATION

NUTRITIONAL STATUS

Related to birth weight

TOLARANCEADAPTATION


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NEONATAL ADAPTATION


MATURATION

NUTRITIONAL STATUS

TOLARANCE

The ability to overcome the

new environment

Tolerability to hypoxia,hypoglycemia, caloric intake, etc.

ADAPTATION


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NEONATAL ADAPTATION


MATURATION

NUTRITIONAL STATUS

TOLARANCE

ADAPTIVE CAPACITY

the potential or ability of asystem to adapt to theeffects of change


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NEONATAL ADAPTATION

Cardio-circulatory system Respiratory system

Intestinal tract

Metabolism

Central nervous system

Adaptation involved multi-organfunction include :


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Circulatory ADAPTATION Fetus - from 8 weeks until birth organs

mature to support external life

Fetal circulation

umbilical-placental circuit via umbilical cordcirculatory shunts to bypass

Liver

ductus venosus to inferior vena cava

Lungs

@ foramen ovale between right & left atria

@ ductus arteriosus connects pulmonary artery

to aorta


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CIRCULATORY ADAPTATION

Umbilical vein

Ductus venosus

Foramen Ovale

Ductus arteriosus

Pulmonary circ.

Systemic circ.

Umbilical artery


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DUCTUSVENOSUS

BY PASS I


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FORAMENOVALE

BY PASS II


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PATENTDUCTUS

ARTERIOSUS

BY PASS III


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FETAL CIRCULATIONHigh pulmonary resistanceLow resistance in systemic blood flow

RIGHT to LEFT shunt

Foramen Ovale

(Left arterial pressure low because returned lung blood is low andright atrial pressure high due to large volume of blood from

placenta)

Ductus arteriosus

(High pulmonary resistance, Low fetal systemiv blood and

prostaglandin function)


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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.decreaseforamen ovale closed.

Systemic resistance higher than pulmonary resistance(24 hours) Prostaglandin function Ductus close

Constrict umbilical arteries and placental blood stops.


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NEONATAL ADAPTATION

FETAL

CIRCULATION

NEONATAL

CIRCULATION


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NEONATAL ADAPTATION


Fetus Newborn

Pulmonary

circulation

Active, less

develop.

Active, increased

development

Foramen ovale Open Close

Ductus arteriosus

BotaliOpen Close

Ductus Venosus

ArantiiOpen Close

Systemic

circulationActive with low

resistance

Active with

increase

resistance


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Circulatory ADAPTATION


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NEONATAL ADAPTATIONFETAL

PULMONARYDEVELOPMENT

Alveoli present : 25 weeks

fill with lung fluidsBreathing movements:

IntermittentlyLung developmentsControl of breathing

Fetus : gas exchange placenta


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NEONATAL ADAPTATION

FIRST

BREATHMechanical

Proprioceptive

Chemoreceptor

Temperature

Touch

Diafragm

Neonatal Respiration

Irregular

Abdominal respiration

Pain


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NEONATAL ADAPTATIONPULMONARY ADAPTATION

CHAIN OF EVENTS AFTER FIRSTBREATH :

Converts fetal to adult circulation

Empties the lung fluids.

Begin pulmonary function.

THENEWBORN

RESPIRATION

BEGIN


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PULMONARY ADAPTATION

FETUS NEWBORN

Alveolus Colaps Develops

Pulmonary vessels Non active Active

Pulmonary

resistanceHigh Decrease

Pulmonary blood Low Increase

Oxygen needs Placenta Lung

CO2 excretion Placenta Lung


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NEONATAL ADAPTATIONProgressive developments of the duodenum,

liver, pancreas and biliary apparatus

Gest.Age 4 wk

Gest.Age 6 wkDuodenum : occluded - reformation of lumen Xatresia

Liver & biliary : Begin at 6 and 12 weeksfailure to canalization Xbiliary atresia

Pancreas : Insulin secretion and glucagon - 10 and 15 weeks


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ADAPTASI NEONATUS

GASTRO INTESTINAL ADAPTATION

FETUS :

Caloric and nutritional needs derived from motherplacenta.

Intestinal motility non active

No need for enzyme metabolism.

NEWBORN

Intestinal motility begin in function.

Increase needs of calori/nutritional and enzymemetabolism.


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NEONATAL ADAPTATION

GASTROINTESTINALADAPTATION

Fetus Newborn

Nutritional

absorptionNon active Active

Bacterial

colonizationNegative Positive

Feces MeconiumMeconium

Feces

Enzyme Non function Active


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NEONATAL ADAPTATIONUROGENITAL ADAPTATION

Renal organogenesisa continuous process6 till 36 weeks gestation

The developments of urogenital funtioncontinuous after birth

Fetal urine productionmaintaining amnioticfluid volume

More than 90% newborn void in the first 24hours.

Newborn urine production : 1-2 ml/kg BW/hour.


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NEONATAL ADAPTATIONUROGENITAL ADAPTATION

ALLERTNESS

OLIGOHYDRAMNIOS

May suggest renal agenesis; hypoplasia; dysplasia; urinary tractobstruction.

POLYHYDRAMNIOS

Gastrointestinal anomalies; transplacental transfusion syndr.;

congenital DM

DELAYED MICTURITION (>48 hours)

Inadequate renal perfusion (Hypovolemia/hypoxia); Failureurine production; urine flow obstruction.


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NEONATAL ADAPTATION

IMMUNOLOGIC STATUS ofthe FETUS and NEWBORN

FETUS :Phagocytic cells

Granulocytes cells

Monocytes cells

NEWBORN :

Immune system even in term -lower than adults.

Between 3-12 motransient immunodeficiency.

The risk enhance by :PrematurityTraumatic deliveryNeonatal stress, etc.

PREVENTION FROM INFECTIONS

Identified at 4 mo

gestation.


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37.5 C

36.5 C

36.0 C

32.0 C

Normal range

Cold stress ---------- Cause for concern

Moderate hypothermia --- WARM BABY

Severe hypothermia / outlook grave

Skilled care urgently needed


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NEONATAL ADAPTATIONTEMPERATURE ADAPTATIONFETUS :

Body temperature intrauterineenvironment

NEWBORN :

Expose to extra uterine conditionhomeothermy capabilities is

limited due to : large surface area;poor thermal insulation; low abilityto conserve heat.

PREVENT OF HEAT LOSS


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NEONATAL ADAPTATION

HEAT LOSS.

CONDUCTION

CONVECTION

EVAPORATION

RADIATION

Transfer of body heat toskin surface.

Dry and wrap the babyPlace in a warm mattress


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NEONATAL ADAPTATION

HEAT LOSS

CONDUCTION

CONVECTION

EVAPORATION

RADIATION

Skin heat loss depends onair temperature/flow.

Wrap the baby and controlroom temperature


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NEONATAL ADAPTATION

HEAT LOSS.

CONDUCTION

CONVECTION

EVAPORATION

RADIATION

Depend upon air humidity

Control humidity androom temperature


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NEONATAL ADAPTATION

HEAT LOSS

CONDUCTION

CONVECTION

EVAPORATION

RADIATION The transfer of body heat toenvironmental temperature

Radiant heater andcontrol room temperature


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NEONATAL ADAPTATION

Normal newborn :

Term infants : 3742 weeks GA

Birth weight : 25004000 g

Birth Length : 4453 cm

Head circumference : 31 -36 cm

Apgar Score : 710

Congenital anomalies : negative

adaptasi neonatus (kuliah m'siswa tk.iv) prof.asril

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