Which of the following findings in the newborn's electronic medical record (EMR) are risk factors for the newborn to develop a complication? (Select all that apply.)

Choice A rationale

. Decreased urination, or oliguria, is typically associated with fluid volume deficit or impaired renal perfusion, not directly with uncomplicated hyperglycemia. In fact, hyperglycemia causes an osmotic diuresis because the excess glucose filtered by the glomeruli exceeds the renal tubules' reabsorption capacity. This results in the excretion of glucose, which draws water with it, leading to polyuria (increased urination), the opposite of the expected manifestation. Normal blood glucose is 70 to 100 mg/dL.

Choice B rationale

. Shallow respirations are not a characteristic sign of hyperglycemia in a client who is pregnant, unless the condition has progressed to severe diabetic ketoacidosis (DKA). DKA causes a metabolic acidosis, which triggers Kussmaul respirations—deep and labored breathing—as a compensatory mechanism to increase CO_2 elimination and raise the blood pH. Shallow breathing would decrease ventilation.

Choice C rationale

. Increased hunger, or polyphagia, is a classic manifestation of hyperglycemia due to the body's inability to utilize glucose effectively as an energy source, despite high blood glucose levels. The cells signal a state of starvation because glucose cannot enter the cells without sufficient insulin, prompting the release of neuropeptides that stimulate appetite and increased caloric intake.

Choice D rationale

. Increased thirst, or polydipsia, is a direct physiological response to the osmotic diuresis caused by hyperglycemia. The high concentration of glucose in the blood increases the plasma osmolarity, which pulls water from the intracellular space into the vascular space, causing cellular dehydration. This triggers the osmoreceptors in the hypothalamus, stimulating the sensation of thirst to encourage fluid intake.

Choice A rationale

The newborn's weight is an important metric used to assess appropriate growth. While deviations (e.g., small for gestational age or large for gestational age) are risk factors, the mere recording of the weight itself in the EMR is a standard measurement, not inherently a risk factor. It becomes a risk factor only when the measurement falls outside the expected range for the newborn's gestational age.

Choice B rationale

The type of birth (e.g., vaginal, Cesarean section) is a risk factor for complications. Cesarean birth, especially without labor, is associated with an increased risk of transient tachypnea of the newborn (TTN) due to retained fetal lung fluid. Conversely, a prolonged or operative vaginal birth can increase the risk of birth trauma, suggesting the type of birth itself introduces specific complication risks.

Choice C rationale

Apgar scores are a rapid assessment of five physiological signs (Appearance, Pulse, Grimace, Activity, Respiration) at one and five minutes of life. A low Apgar score (typically ≤ 7 at five minutes) is a significant and immediate indicator of neonatal distress and a strong risk factor for long-term neurological complications, necessitating prompt and potentially intensive resuscitation.

Choice D rationale

Gestational age is a primary determinant of neonatal maturity and viability. Preterm birth (less than 37 weeks) is a major risk factor for complications, including respiratory distress syndrome (due to surfactant deficiency), thermoregulation difficulties, and developmental issues. Post-term birth (over 42 weeks) is also a risk for placental insufficiency and meconium aspiration.

Choice E rationale

The recording of heart sounds in the EMR is part of a standard newborn physical assessment. The presence of a normal finding (e.g., regular rhythm, no murmurs) is a sign of health, not a risk factor. An abnormal finding, such as a persistent murmur suggestive of a congenital heart defect, would be the risk factor, but the standard documentation is just a physiological assessment.

Choice F rationale

The newborn's length is a standard anthropometric measurement, assessing overall growth and proportional development. Like weight, recording the length itself is a standard parameter, not a risk factor. It only becomes clinically significant as an indicator of an underlying issue if it is disproportionate or falls significantly outside the expected percentile range for the newborn's gestational age.