A nurse is collecting data from a late-preterm newborn.
Which of the following findings should the nurse expect?

Rationale for correct condition Neonatal abstinence syndrome (NAS) occurs in newborns exposed to opioids in utero. Symptoms include high-pitched cry, tremors, irritability, poor feeding, and hyperactive reflexes. This newborn has a positive meconium drug screen for opioids and clinical signs consistent with NAS. The onset of symptoms on day 3 aligns with typical NAS timing. The Finnegan score guides diagnosis and treatment.

Rationale for correct actions Morphine reduces central nervous system hyperexcitability by binding to μ-opioid receptors, mitigating withdrawal symptoms. It stabilizes autonomic function and improves feeding and sleep. Small, frequent feedings reduce metabolic stress and support caloric intake, especially in infants with poor suck and loose stools. This helps prevent weight loss and hypoglycemia.

Rationale for correct parameters The Finnegan score quantifies NAS severity using a standardized scale, guiding pharmacologic treatment. Scores ≥8 typically indicate need for medication. Heart rate variability reflects autonomic nervous system function, often disrupted in NAS due to sympathetic overactivity. Monitoring helps assess treatment response.

Rationale for incorrect conditions Hypoglycemia presents with jitteriness and poor feeding but lacks high-pitched cry and hyperactive reflexes. Sepsis may cause irritability and mottling but typically includes temperature instability and abnormal WBC count. Respiratory distress syndrome presents with grunting, nasal flaring, and retractions, not high-pitched cry or tremors.

Rationale for incorrect actions IV dextrose treats hypoglycemia, not opioid withdrawal. Blood cultures are diagnostic for sepsis, not indicated here. Oxygen therapy is used for hypoxia or respiratory distress, which is not present.

Rationale for incorrect parameters Blood glucose is not the primary concern once stabilized. Oxygen saturation is normal, so not a priority. Temperature monitoring is more relevant for infection than NAS.

Take home points

• NAS should be suspected in opioid-exposed newborns with neurologic and gastrointestinal symptoms.
• The Finnegan score is essential for assessing NAS severity and guiding treatment.
• Morphine and supportive care like frequent feedings are first-line interventions.
• Differentiate NAS from hypoglycemia, sepsis, and respiratory distress based on timing, symptoms, and labs.

Choice A rationale

Hyperglycemia in gestational diabetes typically leads to increased urination, or polyuria, not decreased urination. Elevated blood glucose levels overwhelm the renal tubules' reabsorption capacity, leading to glucose spilling into the urine, which then draws water osmotically, increasing urine output.

Choice B rationale

Shallow respirations are not a direct manifestation of hyperglycemia in this context. While severe diabetic ketoacidosis (DKA), a complication of uncontrolled diabetes, can lead to Kussmaul respirations (deep, rapid breathing) due to metabolic acidosis, hyperglycemia alone typically does not cause shallow respirations.

Choice C rationale

Thirst, or polydipsia, is a classic manifestation of hyperglycemia. High blood glucose levels increase the osmolality of the blood, stimulating osmoreceptors in the hypothalamus, which then trigger the sensation of thirst as the body attempts to dilute the excess glucose and restore fluid balance.

Choice D rationale

While hunger (polyphagia) is a common symptom in uncontrolled type 1 diabetes due to cellular inability to utilize glucose, in gestational diabetes with hyperglycemia, hunger is not a predominant or consistent symptom. The body typically has sufficient insulin, but there is insulin resistance or insufficient production.