All of these findings can indicate a possible bowel perforation in a preterm infant with necrotizing enterocolitis (NEC).NEC is a serious condition that causes inflammation and necrosis of the intestinal tissue, and can lead to a hole (perforation) in the bowel wall.Bacteria can leak through this hole and cause infection and sepsis.NEC usually develops within two to six weeks after birth, and mostly affects premature babies.

Choice A is wrong because bloody stools are not specific for bowel perforation.They can also be seen in mild cases of NEC or other causes of gastrointestinal bleeding.

Choice B is wrong because abdominal distension is a common sign of NEC, but not necessarily of bowel perforation.It can be caused by gas accumulation, fluid retention, or inflammation of the bowel wall.

Choice C is wrong because bilious vomitus is also a non-specific sign of NEC or other causes of bowel obstruction.It can indicate a problem with the passage of food or bile through the intestines.

This is the recommended method for measuring the head circumference of a preterm infant.

It ensures accuracy by capturing the largest dimension of the head, which reflects the growth of the brain.

Choice B is wrong because it does not measure the widest part of the head, which may be above or below the occiput.

Choice C is wrong because it does not measure the widest part of the head, which may be above or below the ears.

Choice D is wrong because it does not measure the widest part of the head, which may be above or below the chin.

The normal range for head circumference at birth for preterm infants born between 32 and 42 weeks gestation is about 25 to 36 cm.Head circumference should be measured and plotted regularly until two years of age for preterm infants.

ROP is a condition that affects the blood vessels of the retina in premature infants.

It can cause vision loss or blindness if not treated.

The main treatment for ROP is laser therapy or cryotherapy to stop abnormal blood vessel growth.

However, these treatments do not restore normal vision and may have complications.

Therefore, regular eye exams are needed to monitor the condition and detect any changes or problems.

Choice B is wrong because surgery is not a common treatment for ROP.

Surgery may be done in some cases to reattach the retina if it detaches from the eye wall, but this is a rare and serious complication of ROP.

Choice C is wrong because oxygen therapy can actually worsen ROP.

High levels of oxygen can stimulate the abnormal blood vessel growth in the retina.

Oxygen therapy should be used with caution and only when necessary for premature infants.

Choice D is wrong because glasses do not improve vision in ROP.

Glasses can correct refractive errors such as nearsightedness or farsightedness, but they cannot fix the damage to the retina caused by ROP.

This is because preterm infants are born before or during critical periods of brain development and need to reduce stress and promote neurological development.Cluster care means grouping care activities together and timing them according to the infant’s cues, such as alertness, hunger, and sleepiness.This way, the infant can have longer periods of undisturbed sleep, which is essential for brain maturation.

Choice B is wrong because keeping the lights and noise level high can cause sensory overload and stress for the preterm infant.The NICU environment should be dimmed and quiet to mimic the womb and support the infant’s circadian rhythm.

Choice C is wrong because avoiding touching or holding the infant can deprive the infant of human contact and bonding, which are important for emotional and social development.Preterm infants can benefit from gentle touch, massage, and kangaroo care, which is holding the baby with direct skin-to-skin contact.These interventions can help with body temperature, breastfeeding, weight gain, and attachment.

Choice D is wrong because changing the infant’s position frequently can disrupt the infant’s sleep and cause stress.Preterm infants should be positioned in a way that supports their posture and alignment, such as flexion, midline orientation, and containment.Positioning aids such as blankets, rolls, or nests can be used to provide boundaries and comfort for the infant.

This indicates that phototherapy was effective because it lowers the level of bilirubin in the blood by converting it into a form that can be excreted in urine and stool.

Choice A is wrong because bronze discoloration of the skin is a side effect of phototherapy, not an outcome.

Choice C is wrong because increased urine output and specific gravity are signs of dehydration, which can occur with phototherapy due to insensible water loss.

Choice D is wrong because normal vital signs and neurological status do not reflect the effectiveness of phototherapy on bilirubin levels.

Normal ranges for serum bilirubin levels vary by age and risk factors, but generally they should be less than 15 mg/dL (257 μmol/L) for term newborns and less than 18 mg/dL (308 μmol/L) for preterm newborns.