A nurse is completing a full assessment of a newborn at 4 hours of life.

For each of the assessment findings below, click to specify if this is an expected (normal) newborn finding or an abnormal finding.

Note: each column must have at least one response option selected.

Choice A rationale

Erythema toxicum is a common, benign rash seen in newborns. It appears as red patches with small white or yellow pustules in the center. It is not characterized by small raised pearly white spots on the nose and chin.

Choice B rationale

Milia spots are small raised pearly white spots that commonly appear on the nose, chin, and cheeks of newborns. They are caused by trapped keratin and are harmless, usually resolving on their own within a few weeks.

Choice C rationale

Mongolian spots are flat, blue-gray patches commonly found on the lower back and buttocks of newborns, especially those with darker skin. They are not raised and do not appear on the nose and chin.

Choice D rationale

Epstein’s pearls are small white or yellow cysts found on the gums or roof of the mouth in newborns. They are not found on the nose and chin. .

Hyperbilirubinemia

• Symptoms: The neonate does show signs of jaundice (yellowish skin), which is a symptom of hyperbilirubinemia. However, the primary concern here is thelow blood glucose level (30 mg/dL), which is more immediately life-threatening and needs urgent attention.
• Diagnostic Results: The total serum bilirubin level is 5 mg/dL, which is elevated but not critically high. Hyperbilirubinemia might be a secondary concern, but the immediate symptoms and diagnostic results point more towards hypoglycemia.

Neonatal Abstinence Syndrome (NAS)

• Symptoms: NAS typically occurs in newborns exposed to addictive substances in utero, leading to withdrawal symptoms after birth. Common symptoms include irritability, high-pitched crying, tremors, and feeding difficulties.
• History: There is no mention of maternal substance use or withdrawal symptoms like frequent yawning or irritability. The jitteriness and poor feeding could overlap with NAS, but the history of gestational diabetes and the low blood glucose level make hypoglycemia a more likely diagnosis.

Summary

• Hypoglycemia: The neonate’s symptoms (jitteriness, lethargy, poor feeding) and the critically low blood glucose level (30 mg/dL) strongly indicate hypoglycemia. This condition is common in infants of diabetic mothers and large-for-gestational-age infants.