A nurse is contributing to the plan of care for a preterm newborn. To help the newborn conserve energy, which of the following actions should the nurse recommend?

Choice A reason:

Hypoglycemia is a common complication for newborns whose mothers have diabetes mellitus. This is because the newborn's pancreas produces excessive insulin in response to the high glucose levels in the mother's blood during pregnancy. After birth, the newborn's glucose levels drop rapidly, while the insulin levels remain high, resulting in hypoglycemia. The nurse should monitor the newborn's blood glucose levels and signs of hypoglycemia, such as jitteriness, lethargy, poor feeding, and temperature instability.

Choice B reason:

Decreased RBC is not a likely complication for newborns whose mothers have diabetes mellitus. In fact, these newborns may have increased RBC due to chronic fetal hypoxia caused by placental insufficiency. The nurse should monitor the newborn's hematocrit and signs of polycythemia, such as ruddy skin, jaundice, and respiratory distress.

Choice C reason:

Hyperbilirubinemia is not a likely complication for newborns whose mothers have diabetes mellitus. In fact, these newborns may have increased bilirubin levels due to hemolysis of excess RBC and delayed hepatic clearance. The nurse should monitor the newborn's serum bilirubin levels and signs of jaundice, such as yellow skin and sclera, poor feeding, and lethargy.

Choice D reason:

Hypercalcemia is not a likely complication for newborns whose mothers have diabetes mellitus. In fact, these newborns may have hypocalcemia due to decreased parathyroid hormone secretion and increased calcium binding to albumin. The nurse should monitor the newborn's serum calcium levels and signs of hypocalcemia, such as jitteriness, tremors, seizures, and cardiac arrhythmias.

Choice A reason:

Sleepiness is not a symptom of withdrawal in newborns. Sleepiness may be caused by other factors such as hypoglycemia, hypothermia, or infection.

Choice B reason:

Constipation is not a symptom of withdrawal in newborns. Constipation may be caused by dehydration, formula intolerance, or lack of bowel stimulation.

Choice C reason:

Irritability is a symptom of withdrawal in newborns. Irritability may manifest as excessive crying, jitteriness, tremors, or increased muscle tone. Irritability is caused by the overstimulation of the central nervous system due to the absence of the drug that the newborn was exposed to in utero.

Choice D reason:

Absent or startle reflex is not a symptom of withdrawal in newborns. Absent or startle reflex may indicate neurological damage, hypoxia, or brachial plexus injury. The startle reflex, also known as the Moro reflex, is a normal response to sudden stimuli in newborns.