Physiologic Function Just as changes occur in vital signs after birth, so do changes occur in all the major body

systems. Cardiovascular System Changes in the cardiovascular system are necessary after birth because now the lungs must oxygenate the blood that was formerly oxygenated by the placenta. When the cord is clamped, a neonate is forced to take in oxygen through the lungs. As the lungs inflate for the first time,

pressure decreases in the chest generally, and in the pulmonary artery specifically (the artery leading to the lungs). This decrease in pressure in the pulmonary artery plays a role in promoting closure of the ductus arteriosus, a fetal shunt. As pressure increases in the left side of the heart from increased blood volume, the foramen ovale between the two

atria closes because of the pressure against the lip of the structure (permanent closure does not occur for weeks). With the remaining fetal circulatory structures (umbilical vein, two umbilical arteries, and ductus veno- sus) no longer receiving blood, the blood within them clots, and the vessels atrophy over the next few weeks.

Figure 24.3 shows the respiratory and cardiovascular changes that occur at birth, beginning with the first breath. The peripheral circulation of a newborn remains slug- gish for at least the first 24 hours. It is common to observe cyanosis in the infants feet and hands (acrocyanosis) and for the feet to feel cold to the touch at this time. Respiratory System A first breath is a major undertaking because it requires a tremendous amount of pressure (about 40 to 70 cm H2O). It is initiated by a combination of cold receptors; a low- ered partial pressure of oxygen (PO2), which falls from 80 to as low as 15 mm Hg before a first breath; and an in- creased partial carbon dioxide pressure (PCO2), which rises as high as 70 mm Hg before a first breath. All new- borns have some fluid in their lungs from intrauterine life that eases the surface tension on alveolar walls and allows alveoli to inflate more easily than if the lung walls were dry. About a third of this fluid is forced out of the lungs by the pressure of vaginal birth. Additional fluid is quickly absorbed by lung blood vessels and lymphatics after the first breath. Once the alveoli have been inflated with a first breath, breathing becomes much easier for a baby, requiring only about 6 to 8 cm H2O pressure. Within 10 minutes after birth, most newborns have established a good residual volume. By 10 to 12 hours of age, vital capacity is established at newborn proportions. The heart in a newborn takes up proportionately more space than in an adult, so the amount of lung expansion space available is proportionately limited. A baby born by cesarean birth does not have as much lung fluid

expelled at birth as one born vaginally and mayhave more difficulty establishing effective respirations, because excessive fluid blocks air exchange space. New- borns who are immature and whose alveoli collapse each time they exhale (because of the lack of pulmonary sur- factant) have difficulty establishing effective residual capa- city and respirations. If the alveoli do not open well, a newborns cardiac system becomes compromised, because closure of the foramen ovale and ductus arteriosus depends on free blood flow through the pulmonary artery and good oxygenation of blood. Therefore, a newborn who has difficulty establishing respirations at birth should be examined closely in the postpartal period for a cardiac murmur or other indication that he or she still has patent cardiac structures, especially a patent ductus arteriosus.