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

Choice A rationale

Placenta previa, a condition where the placenta partially or completely covers the cervix, is primarily associated with risk factors such as previous cesarean sections, multiparity, and advanced maternal age. Heroin use does not have a direct causal link to the development of placenta previa.

Choice B rationale

Heroin use during pregnancy is strongly associated with an increased risk of preterm labor. Opioids can cause uterine contractions and alter placental blood flow, leading to premature cervical changes and the onset of labor before 37 weeks of gestation, impacting fetal development.

Choice C rationale

Chromosomal abnormalities, such as Down syndrome or Turner syndrome, result from errors in chromosome number or structure during cell division. These genetic errors are not caused by maternal heroin use, although substance abuse can affect fetal development in other ways.

Choice D rationale

An increase in amniotic fluid, known as polyhydramnios, is often associated with conditions such as maternal diabetes, fetal gastrointestinal anomalies, or multiple gestations. Heroin use does not typically lead to polyhydramnios; rather, it is more commonly associated with oligohydramnios due to fetal growth restriction.

Choice A rationale: Skin-to-skin contact, also known as kangaroo care, is scientifically supported to stabilize neonatal autonomic functions such as heart rate, respiratory rate, and temperature. It promotes oxytocin release in both the parent and infant, which reduces stress and enhances bonding. For neonates experiencing neonatal abstinence syndrome (NAS), this contact can reduce irritability and improve feeding behaviors by providing a calming sensory input that mimics the intrauterine environment.

Choice B rationale: Decreasing environmental stimuli such as lighting is a key nonpharmacologic intervention for infants with NAS. Bright lights can exacerbate neurologic excitability, leading to increased irritability, tremors, and poor feeding. Dimming the lights helps reduce sensory overload, allowing the infant’s overstimulated nervous system to settle. This intervention supports autonomic regulation and is consistent with evidence-based care for managing withdrawal symptoms in neonates.

Choice C rationale: Singing to the newborn introduces rhythmic auditory stimulation, which has been shown to soothe infants and promote neurobehavioral organization. In NAS, where infants are hypersensitive to stimuli, soft singing can provide a predictable and calming input that may improve feeding coordination and reduce crying. Auditory bonding also supports maternal-infant attachment, which is critical in the context of maternal substance use and psychosocial stressors.

Choice D rationale: Avoiding a pacifier is contraindicated in NAS care. Non-nutritive sucking via pacifiers is a well-established intervention to soothe irritable neonates and improve feeding coordination. It activates the sucking reflex, which has a calming effect on the central nervous system. Denying this comfort measure may increase distress and worsen symptoms such as tremors and high-pitched crying, making this choice scientifically inappropriate.

Choice E rationale: Swaddling with the legs flexed mimics the fetal position and provides proprioceptive input that helps calm the overstimulated nervous system in NAS. This positioning reduces excessive motor activity and supports neuromuscular control. Flexed swaddling also enhances sleep quality and decreases the frequency of tremors and startle responses, which are hallmark symptoms of opioid withdrawal in neonates.