A nurse is completing the admission assessment of a newborn.
Which of the following anatomical landmarks should the nurse use when measuring the newborn’s chest circumference?

Choice A rationale

Wiping the cord daily with alcohol prep pads is not recommended. Current guidelines suggest keeping the cord clean and dry without the use of alcohol, as it can delay the natural drying and falling off process.

Choice B rationale

Keeping the cord moist is not recommended. The cord should be kept dry to promote natural drying and separation. Moisture can increase the risk of infection.

Choice C rationale

Folding the top of the diaper underneath the cord is recommended to keep the cord exposed to air and prevent irritation from urine or stool. This helps the cord dry out and fall off naturally.

Choice D rationale

Applying petroleum jelly to the cord stump is not recommended. The cord should be kept dry, and the use of ointments or creams can interfere with the natural drying process. .

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.