NEONATAL ENVIRONMENT

A neonate is also called a newborn. The neonatal period

is the first 4 weeks of a child's life. It is a time when
changes are very rapid. Many critical events can occur in
this period:

•Feeding patterns are established.

•Bonding between parents and infant begin.

•The risk for infections that may become more serious are
higher.

•Many birth or congenital defects are first noted.

 LOW BIRTH WEIGHT AND PRETERM INFANTS
Three conditions pose threats to many newborns: low birth weight,
preterm birth, and being small for date.

Low birth weight infants weigh less than 5½ pounds at birth. Very low
birth weight newborns weigh less than 3 pounds, and extremely low
birth weight newborns weigh less than 2 pounds.

Preterm infants are born three weeks or more before the pregnancy
has reached its full term—in other words, 35 or fewer weeks after
conception.

Small for date infants or small for gestational age infants have a birth
weight that is below normal when the length of the pregnancy is
considered. They weigh less than 90 percent of all babies of the same
gestational age. Small for date infants may be preterm or full term.
One study found that small for date infants have a 400 percent greater
risk of death.
Consequences of Low Birth Weight

Although most preterm and low birth weight infants are healthy, as a
group they have more health and developmental problems than do
infants of normal birth weight

Extremely preterm infants are those born at less than 28 weeks

gestation, and very preterm infants are those born between 28 and
33 weeks of gestational age. The number and severity of these
problems increase when infants are born very early and as their birth
weight decreases.

Survival rates for such infants have risen, but with this have come
increased rates of severe brain damage . A recent study revealed
that very preterm, low birth weight infants had abnormal axon
development in their brains and impaired cognitive development at
9 years of age.
Low birth weight children are more likely than their normal birth
weight counterparts to develop a learning disability, attention
deficit hyperactivity disorder, autism spectrum disorders, or
breathing problems such as asthma.

Approximately 50 percent of all low birth weight children are

enrolled in special education programs. And a recent study in four
Asian countries revealed that very low birth weight infants were
likely to have a much higher mortality rate as neonates.
Nurturing Low Birth Weight and
Preterm Infants

Two increasingly used interventions in

the neonatal intensive care unit
(NICU) are kangaroo care and
massage therapy.

Kangaroo care involves skin-to-skin

contact in which the baby, wearing
only a diaper, is held upright against
the parent’s bare chest, much as a
baby kangaroo is carried by its
mother. Kangaroo care is typically
practiced for two to three hours per
day over an extended time in early
infancy.
•Preterm infants often have difficulty coordinating their breathing and
heart rate, and the close physical contact with the parent provided by
kangaroo care can help stabilize the preterm infant’s heartbeat,
temperature, and breathing. Maternal-newborn kangaroo care with
preterm infants was linked to better respiratory and cardiovascular
functioning, sleep patterns, and cognitive functioning.

•Preterm infants who experience kangaroo care also gain more weight
and show better physical development.

•Kangaroo care also decreases pain responses in preterm infants.

• Preterm infants who experienced kangaroo care for 16 weeks also

show more complex electroencephalogram (EEG) patterns (which
reflects neurological maturation) at 40 weeks of age.

•Overall kangaroo care was associated with a reduction in the risk of

the babies’ mortality
BONDING

A special component of the parent-infant relationship is bonding, the

formation of a connection, especially a physical bond, between
parents and their newborn infant during the period shortly after birth.

Some physicians believe that during the “critical period” shortly after
birth the parents and newborn need to form an emotional attachment
as a foundation for optimal development in the years to come.

Although some research supports this bonding hypothesis, a body of

research challenges the significance of the first few days of life as a
critical period.
The extreme form of the bonding hypothesis—the insistence that
the newborn must have close contact with the mother in the first
few days of life to develop optimally—is not true.

However such contact brings pleasure to many mothers and may

dispel maternal anxiety about the baby’s health and safety. In some
cases—including preterm infants, adolescent mothers, and mothers
from disadvantaged circumstances—early close contact is key to
establishing a climate for improved interaction after the mother
and infant leave the hospital.

Many hospitals now offer a rooming-in arrangement, in which the

baby remains in the mother’s room most of the time during its
hospital stay.
THE POSTPARTUM PERIOD The postpartum period is the period
after childbirth or delivery that lasts for about six weeks or until the
mother’s body has completed its adjustment and has returned to a
nearly pre-pregnant state. The weeks after childbirth present
challenges for many new parents and their offspring.

It is a time when the woman adjusts, both physically and

psychologically, to the process of childbearing.

A woman’s body makes numerous physical adjustments in the first

days and weeks after childbirth. She may have a great deal of
energy or feel exhausted and let down. Though these changes are
normal, the fatigue can undermine the new mother’s sense of
well-being and confidence in her ability to cope with a new baby
and a new family life.
A concern is the loss of sleep that the primary caregiver experiences
during the postpartum period. A substantial percentage of women
reported loss of sleep during pregnancy and in the postpartum
period. The loss of sleep can contribute to stress, marital conflict,
and impaired decision making.

After delivery, the mother’s body undergoes sudden and dramatic

changes in hormone production. When the placenta is delivered,
estrogen and progesterone levels drop steeply and remain low until
the ovaries start producing hormones again.

Involution is the process by which the uterus returns to its

prepregnant size five or six weeks after birth. Immediately following
birth, the uterus weighs 2 to 3 pounds. By the end of five or six
weeks, the uterus weighs 2 to 3½ ounces. Nursing the baby helps
contract the uterus at a rapid rate.
2H8HS3H6
Emotional and Psychological Adjustments
Emotional fluctuations are common for mothers in the postpartum
period. For some women, emotional fluctuations decrease within
several weeks after the delivery, but other women experience more
long-lasting emotional swings

Postpartum Blues and Depression: About 70 percent of new mothers

in the United States have what are called the postpartum blues. About
two to three days after birth, they begin to feel depressed, anxious,
and upset. These feelings may come and go for several months after
the birth, often peaking about three to five days after birth. Even
without treatment, these feelings usually go away after one or two
weeks.

However, some women develop postpartum depression, which

involves a major depressive episode that typically occurs about four
weeks after delivery.
Women with postpartum depression have strong feelings of sadness,
anxiety, or despair that for at least a two-week period they have
trouble coping with their daily tasks. Without treatment, postpartum
depression may become worse and last for many months.

Many women with postpartum depression don’t seek help. Estimates

indicate that 10 to 14 percent of new mothers experience postpartum
depression. Also, a recent study found that depression during
pregnancy, a history of physical abuse, migrant status, and
postpartum physical complications were major risk factors for
postpartum depression

Several antidepressant drugs are effective in treating postpartum

depression and appear to be safe for breast-feeding women and their
infants. Psychotherapy, especially cognitive therapy, also is an
effective treatment of postpartum depression for many women.
Engaging in regular exercise may help to relieve postpartum
depression.
A mother’s postpartum depression affects the way she interacts
with her infant. A research review concluded that the interaction
difficulties of depressed mothers and their infants occur across
cultures and socioeconomic status groups, comprising reduced
sensitivity of the mothers and decreased responsiveness on the
part of infants. Several care giving activities also are compromised,
including feeding, sleep routines, and safety practices.

Fathers also undergo considerable adjustment during the

postpartum period, even when they work away from home all day.
When the mother develops postpartum depression, many fathers
also experience depressed feelings .

The father’s support and caring can influence whether the mother
develops postpartum depression. Research reveals that higher
support by fathers was related to a lower incidence of postpartum
depression in women.
OTHER FACTORS INFLUENCING THE NEONATAL ENVIRONMENT

•Appearance of the Infant

•Behavior
•Sex of the Infant
•Birth Experience
•Helplessness
•Multiple Births
•Socio-economic and Cultural difficulties