A nurse is providing discharge instructions to parents of a circumcised newborn. To prevent diaper adherence to the penis, what will be recommended to apply during diaper changes?

Choice A rationale:

Hyporeactivity, or reduced responsiveness to stimuli, is not typically associated with neonatal abstinence syndrome (NAS) NAS is characterized by increased irritability and not reduced activity.

Choice B rationale:

An excessive high-pitched cry is a common manifestation of neonatal abstinence syndrome. Infants exposed to substances like methadone during pregnancy may experience heightened sensitivity and exhibit a high-pitched cry as a sign of withdrawal.

Choice C rationale:

Acrocyanosis, a bluish discoloration of the hands and feet, is not a specific indicator of neonatal abstinence syndrome. It is a common finding in newborns and often resolves on its own.

Choice D rationale:

A respiratory rate of 50/min is within the normal range for a newborn. It is not an indication of neonatal abstinence syndrome.

The correct answer is: A. Hemoglobin 12 g/dL.

Choice A reason:

Hemoglobin levels in newborns are expected to be significantly higher than in adults due to the physiological adaptation to life outside the womb. The normal range for a newborn’s hemoglobin is approximately 14 to 24 g/dL1234. A level of 12 g/dL is below the expected range and could indicate anemia or other underlying conditions that may require further investigation and intervention by the healthcare provider.

Choice B reason:

The glucose level in a newborn can vary, especially within the first few hours after birth. Normal blood glucose levels for a newborn 1 to 2 hours old can be as low as 25 mg/dL and can rise to adult levels (60-100 mg/dL) within the first few days5. A glucose level of 50 mg/dL in a 24-hour-old newborn falls within the acceptable range and would not typically require reporting to the provider unless accompanied by symptoms of hypoglycemia.

Choice C reason:

Bilirubin levels in newborns can be elevated due to the normal breakdown of fetal hemoglobin as the baby’s liver matures. Normal bilirubin levels for a newborn can range from 1.0 to 12.0 mg/dL6. A bilirubin level of 4 mg/dL is within the normal range for a 24-hour-old newborn and is not typically a cause for concern unless there are signs of jaundice or other symptoms.

Choice D reason:

The normal platelet count for a newborn ranges from 150,000 to 450,000/mm³7. A platelet count of 200,000/mm³ is well within the normal range for a newborn and would not need to be reported to the healthcare provider.