Transition to Extrauterine Life

Thermoregulation

•process of maintaining a core body temperature

•is a challenge for the newborn and is considered absolutely crucial for survival
•Teach new parents that swaddling or wrapping the newborn in clean, dry blankets
is essential to maintain body temperature. Newborns should consistently wear a
soft hat and be dressed in appropriate layers of clothing.
•One tip is to dress the infant in one layer more than the adults are wearing in the
same environment, plus a blanket.

Transition to Extrauterine Life

Temperature Assessment

•Assess rectal or axillary temperatures with a calibrated thermometer.

•Note temperatures above 37.5°C (99.5°F) or below 36°C (96.8°F); these temperatures
should be reported and an intervention initiated.
•Wrapping a newborn in extra blankets or removing a layer of blankets may be
enough to support thermoregulation.
•Continue to check the newborn’s temperature until stable.
Transition to Extrauterine Life
Respiratory System

•The newborn has a proportionally large head for the body size with a short neck,
small mandible, and large tongue making them more susceptible to airway
compromise
•The newborn also has a compliant rib cage with poorly developed intercostal
muscles, which allows the infant to progress from respiratory distress to respiratory
failure to respiratory arrest very quickly.
•The newborn has cartilaginous tracheal rings, and the cricoid ring is the narrowest
part of the airway.
•Newborns are obligate nose breathers and have narrow nasal passages that are
easily obstructed by mucus.
Transition to Extrauterine Life
Respiratory Assessment
•Inspect the lip color, nail color, and pulse oximetry; blood gases and hemoglobin
(Hgb) may be ordered as part of the assessment of the respiratory system if the
newborn demonstrates respiratory distress.
•Inspect for retractions, nasal flaring, use of accessory muscles, tachypnea, head
bobbing, and shoulder rolling, which all can indicate respiratory distress.
•Auscultate for adventitious or abnormal breath sounds such as rales, rhonchi,
wheezing, or stridor.
•Inspect for irregular respiratory rates and patterns.
Nutrition
An infant’s metabolic rate is almost twice that of an adult. Infants require more
calories, nutrients, and water for their body size in comparison to an adult.
Nutrition
•Breastfeeding or formula feeding exclusively until the infant is 6 months old.
•Feedings number about 8 to 12 per day at first, then gradually decrease with age.
•Foods are then introduced one at a time starting with iron-fortified infant cereals.
Nutrition
•Green vegetables are introduced after cereals are well established, followed by the
yellow and orange vegetables. Then purred fruits.
•Lean meats and egg yolks can be given starting at about 10 months. Vegan options
include mashed tofu, pureed beans, soy or other nondairy yogurt and cheeses.
•Egg whites are introduced after 10 months.
•NO COW’S MILK UNTIL AGE 12 MONTHS!
Physical Growth and Development
•The infant will triple his or her birth weight and double the birth length in the first 12
months.
•Infant’s weight increases by about 0.68 kg (1.5 lb) per month for the first 6 months
of life, then increases by about 0.34 kg (0.75 lb) per month the second 6
months.
•The infant’s length grows at an average of 2.54 cm (1 in.) per month in the first 6
months, reaching an average length of 73.66 cm (29 in.) by 12 months of age.
Physical Growth and Development
•Several factors influence the infant’s physical development:
●hereditary influences such as the height and weight of the parents
●the infant’s nutritional status and overall health, cultural factors
●growth patterns known as spurts and lags.

•An infant who is born prematurely will take several months to match the
average size of other infants the same age.

Physical Growth and Development

•The infant’s HC is measured at each well-child visit and plotted on standardized
growth charts.
• The nurse uses clean, disposable paper measuring tape and places the tape at
the level of the largest part of the head, usually right above the brow line.
•The infant’s HC, also known as the occipital frontal circumference (OFC), increases
by 1.25 cm (0.5 in.) per month for the first 6 months and increases a total of 33%
by the end of the first year.
Physical Growth and Development
•The purpose of the fontanel is to allow the infant’s cranium to expand or contract
as needed during the birth process.
•Posterior fontanel closes at 2 to 3 months of age
•Larger anterior fontanel at 12 to 18 months of age.
•Fontanels come in a variety of shapes and sizes and are therefore unique for each
infant.
•The nurse will also measure the infant’s chest circumference. The chest
circumference is typically 2 cm (0.78 in.) less than the infant’s HC. To measure
the chest circumference, the nurse places the paper measuring tape at the
level of the nipples
Physical Growth and Development
 •6-8 teeth during the first year.
•first at about 5 to 7 months.
•See FIGURE 18.4 for a description of development of the infant’s dentition.
•Parents should begin daily dental health by cleaning the infant’s teeth with a
damp cloth as soon as they erupt.
•Infants are at risk for dental caries (cavities) if they have a bottle or are breastfed
while they sleep.
•infants should be weaned from a bottle by 12 months of age to promote dental
health.

Vital Signs
•Heart rate of 120 to 160 bpm in the newborn period, slowing to 100 to 120 bpm by
the first year.
•Respiratory rate is 30 to 60 breaths/min, fluctuating greatly in the first few
weeks of life.
•Axillary temperature 36.5°C (97.7°F) to 37.5°C (99.5°F).
•Blood pressure in the newborn ranges from 50 to 75 mm Hg systolic over 30 to 45
mm Hg diastolic; pressure rises to an average of 90/60 mm Hg by 12 months.

Communication Development
•cooing at 1 to 2 months
•laughing at 2 to 4 months
•consonant sounds at 3 to 4 months of age
•imitative sounds at 6 months
•sign language.
•one to two words at 12 months.
Psychosocial Development
Bonding is a process of developing a meaningful relationship between the infant
and the caregiver.
Even ill infants should have the opportunity to bond with their parents; and all steps
to promote close physical contact should be provided, as medically indicated.

Crib Selection

Parents need to be instructed in safe crib selection. Older cribs may not be safe
if there is peeling paint (risk of lead poisoning) or intricate carved designs that
may trap limbs. Space between crib rail slats should not be wider than 2 3/8
inches because the young child might place the head between the bars and
suffocate. If the crib has wheels, they should be lockable. The crib should not
have drop-gate sides because these can cause injury. Top rails should be
plastic covered so that when the infant starts teething, there is not risk of wood
splinters. The crib should have a firm mattress and be free from toys, stuffed
animals, bumper pads, blankets, or any other suffocation risk.

Car Seat Safety

Health promotion includes providing infants with safe car restraints. Infants
should be placed in the center of the back seat, facing backward. In pickup
trucks where there is no back seat, the infant should be placed in the middle,
facing backward. Infants should always be placed in certified car seats
appropriate for their age and size. Children with special needs, or those with
orthopedic devices such as spica casts, need specialized car seats.

Children die each summer from heat deaths when parents leave their child in their
car unsupervised. Children should never be left, even just for a few minutes, to run
into a store or to run an errand—the inside of a car heats up much more than the
outside environmental temperature