- Heat loss: Evaporation, radiation, conduction, convection.
- Heat production: Mainly through nonshivering thermogenesis (lipolysis of brown adipose tissue).
- From placenta to lungs.
- Fetal Hb allows fetus to maintain lower arterial oxygen tension (greater affinity for oxygen binding than adult Hb).
Effective Breathing and Pulmonary Inflation
- From sporadic breathing to continuous breaths.
- Replacement of fetal lung fluid with air (decreased production and increased absorption).
- In fetus: ↑ PVR, ↓ SVR.
- At birth: SVR increases with removal of placenta; PVR decreases with replacement of fetal lung fluid with oxygen and endogenous nitric oxide production, causing vasodilation.
- Mixed circulation persists during this “transition” secondary to ductus arteriosus (closes within 2 wk, but flow decreases within a few hours of birth) and foramen ovale (right-to-left flow reverses soon after birth).
- Temperature (36.5°C–37.4°C)
- Respirations (<60 breaths/min with no signs of respiratory distress)
- HR (100–160 beats/min)
Head Circumference, Length, Weight, and Assessment of Gestational Age
- Activity, color, abnormalities
- Color, normal rashes (erythema toxicum, pustular melanosis), mongolian spots, abnormalities (nevi, hemangiomas)
- Swelling (caput, cephalohematoma, subgaleal hemorrhage), trauma (forceps marks, scalp electrode marks), scleral hemorrhage, symmetric pupillary response, presence of red reflex, choanal atresia, cleft lip/palate, ear pits/tags, facial symmetry
- Clavicles, cysts, webbing, masses
- Equal breath sounds, respiratory distress (grunting, retracting)
- Nipples (supernumerary), sternal abnormalities (ie, pectus excavatum or carinatum)
- S1/S2 , rate, murmur, PMI, brachial and femoral pulses
- Bowel sounds, defects, organomegaly, masses, appearance, cord vessels (two arteries, one vein)
- Patent anus, ambiguous genitalia, abnormal anatomy (hypospadias, epispadias)
- Boys: Descended testicles, penile length
- Girls: Perforate hymen, clitoral length
- Tone, equal movement, perfusion, digits, Barlow and Ortolani maneuvers for hip dysplasia
New Ballard score for assessment of fetal maturation of newly born infants. (Reproduced with permission from Ballard JL, et al: New Ballard score, expanded to include extremely premature infants. J Pediatr 1991;119:417. New York: McGraw-Hill. Copyright © The McGraw-Hill Companies. All rights reserved.)
Infant evaluation at birth—Apgar score. (Reproduced with permission from Hay WW Jr, Levin MJ, Sondheimer JM, Deterding RR: Current Diagnosis & Treatment: Pediatrics, 19th ed. New York: McGraw-Hill. Copyright © The McGraw-Hill Companies. All rights reserved.)
aOne minute and 5 minutes after complete birth of the ...
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