A nursery nurse is attending the birth of a post-term infant.

Exhibits

Upon review of the medical record, the infant newborn is at risk for developing which of the following symptoms? Select all that apply

Rationale for Correct Choices

• A change in mood: Isotretinoin can cause psychiatric adverse effects, including depression and suicidal ideation. Adolescents are particularly at risk, so any mood changes must be reported immediately to the provider for timely intervention and possible medication adjustment.

• Engagement in sexual activity: Isotretinoin is highly teratogenic, and pregnancy must be strictly avoided during therapy. Adolescents must notify the provider immediately if they engage in sexual activity, so proper pregnancy prevention measures and monitoring can be implemented.

Rationale for Incorrect Choices

• Dry mouth: While common with isotretinoin therapy, dry mouth is generally mild and manageable with hydration; it does not require immediate notification to the provider.

• The development of dry eyes: This is a known side effect of isotretinoin, often treated with lubricating drops. It is uncomfortable but not an urgent adverse effect requiring immediate reporting.

• Nausea: Mild gastrointestinal upset may occur but is typically self-limiting and does not necessitate urgent notification unless severe or persistent.

• Worsening of acne: Acne flare-ups can occur at the beginning of isotretinoin therapy but are expected and not considered an emergency; ongoing follow-up is sufficient.

• Sunburn: Increased photosensitivity is a known side effect. While the adolescent should take precautions, sunburn does not require immediate notification unless severe.

• Decreased night vision: Rare and usually reversible; it should be monitored but is not an immediate emergency unless it significantly impairs function.

Rationale:
A. "Supplement breastfeedings with water every 12 hours.": Breastfed infants do not require water supplementation because breast milk provides adequate hydration. Giving water can reduce milk intake, interfere with nutrition, and increase the risk of electrolyte imbalance.

B. "Limit the time your infant feeds to 10 minutes on each breast.": Feeding duration should be guided by the infant’s cues rather than a strict time limit. Limiting feeds can prevent the infant from receiving the hindmilk, which is richer in fat and essential for growth.

C. "Begin each feeding using the same breast.": Alternating the starting breast for each feeding helps ensure equal stimulation and milk production in both breasts. Starting with the same breast consistently may lead to uneven milk supply.

D. "Offer your infant the breast when he shows signs of hunger.": Responsive, cue-based feeding supports adequate nutrition, growth, and bonding. Feeding on demand—such as rooting, sucking on hands, or fussiness—helps establish and maintain milk supply and meets the infant’s needs effectively.