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Transitional Assessment – Periods of Reactivity For a Newborn
The newborn presents behavioral and physiological characteristics that may at first glance appear as signs of stress. However, during the first 24 hours, changes in heart rate, breathing, motor activity, color, mucus production, and bowel activity occur in an orderly and predictable sequence, which is normal and indicates a lack of stress. Distressed infants also progress through these stages, but at a slower rate.
For 6-8 hours after birth, the newborn is in the first period of reactivity. For the first 30 minutes, the infant is very alert, cries vigorously, may suck his fist greedily, and seems very interested in his surroundings. At this time, his eyes are usually open, suggesting that this is a great opportunity for mother, father, and child to see each other. For this reason, he has a vigorous sucking reflex, an opportune time to start breastfeeding. The mother. It is especially important for doctors to remember this, because it is not unlikely that after these initially very active states the infant will be quite drowsy and uninterested in sucking. Physiologically, respiratory rate may reach 80 breaths/minute, rales may be heard, heart rate may reach 180 beats/minute, bowel sounds are active, mucous secretions are increased, and temperature may decrease.
After this initial stage of alertness and activity, the infant’s responsiveness decreases. Heart and respiratory rates decrease, temperature continues to drop, mucus production decreases, and urine or stool is usually not passed. The infant is in a state of sleep and relative calm. Any attempt to stimulate it usually elicits minimal response. This second stage of the first reactive period generally lasts from 2 to 4 hours. Due to the continued drop in body temperature, it is best to avoid undressing or bathing the infant during this time.
The second reactivity period begins when the infant awakens from deep sleep following the first period. The infant is again alert and responsive, heart and respiratory rates increase, gag reflex is active, gastric and respiratory secretions are increased, and passage of meconium occurs frequently. This second responsive period lasts approximately 2-5 hours and provides another great opportunity for child and parent to interact. This period is usually over when the amount of respiratory mucus has decreased. After this stage, there is a period of stabilization of physiological systems and a wobbly pattern of sleep and activity.
After a discussion of apparently erratic behavioral patterns in the newborn, it appears that in order to identify abnormalities or signs of distress in the respiratory, cardiovascular, or neurological system, the physician must have a good understanding of normal characteristics. Observation, not machines, is the physician’s best assessment tool, and the nursing goal is the anticipation and prevention of neonatal stress. The timing of nursing care is based on observation of the newborn’s physiological status. For example, the infant should be dried immediately after delivery to minimize evaporative heat loss; the initial bath should be postponed until the body temperature has stabilized; eye drops should be instilled after parents and child have made eye contact; and breast or bottle feeding should be initiated during one of two responsive periods.
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