A nurse is planning care immediately following birth for a newborn who has a myelomeningocele that is leaking cerebrospinal fluid. Which of the following actions should the nurse include in the plan of care?

Neonatal abstinence syndrome (NAS) occurs in newborns who were exposed to addictive substances, such as opioids, during pregnancy. Infants with NAS may experience withdrawal symptoms and can be hypersensitive to stimuli. Therefore, it is important to minimize unnecessary handling to help reduce stimulation and discomfort for the newborn.

Option a) Swaddling the newborn with his legs extended may increase discomfort for a newborn with NAS. It is often recommended to swaddle newborns with NAS in a flexed position to provide a sense of security and comfort.

Option b) Maintaining eye contact during feedings may be overwhelming for a newborn with NAS. Maintaining a calm, quiet environment during feedings can help reduce overstimulation and improve feeding success.

Option c) Scheduling larger volume feedings at less frequent intervals may not be appropriate for a newborn with NAS. These infants may have poor feeding tolerance and may benefit from smaller, more frequent feedings to avoid overwhelming their gastrointestinal system.

Therefore, option d) Plan care to minimize handling of the newborn is the correct action to take when caring for a newborn with neonatal abstinence syndrome. It helps reduce stimulation and discomfort for the newborn.

Amniocentesis is a prenatal testing procedure that involves inserting a thin needle through the abdomen into the uterus and withdrawing a small amount of amniotic fluid, which contains fetal cells and other substances¹. The fluid is then analyzed in a laboratory to detect certain chromosomal conditions (such as Down syndrome or trisomy 18), genetic conditions (such as cystic fibrosis or Tay-Sachs disease), or neural tube defects (such as spina bifida or anencephaly) ¹². Amniocentesis can also be used to determine the sex of the fetus, but this is not the primary purpose of the test¹².

The other options are incorrect because:
a) Amniocentesis cannot be scheduled for later today if the client requests it. Amniocentesis requires informed consent, pre-test counseling, and preparation of the equipment and laboratory. Amniocentesis is usually performed between 14 and 20 weeks of gestation, and some medical facilities may perform it as early as 11 weeks, but not on the same day as the request¹²³.
c) The client cannot have an amniocentesis until she is at least 35 years of age. This is a common misconception, as advanced maternal age (35 years or older) is one of the risk factors for chromosomal abnormalities in the fetus, and therefore an indication for amniocentesis. However, amniocentesis can be offered to any pregnant woman who has a personal or family history of genetic conditions, abnormal prenatal screening results, or other indications for fetal diagnosis¹²³.
d) The provider will not schedule a chorionic villus sampling (CVS) to determine the sex of the baby. CVS is another prenatal testing procedure that involves taking a small sample of placental tissue, either through the cervix or the abdomen, and analyzing it for chromosomal or genetic conditions. CVS can also determine the sex of the fetus, but it is usually performed earlier than amniocentesis, between 10 and 13 weeks of gestation. CVS has some advantages over amniocentesis, such as earlier diagnosis and shorter waiting time for results, but it also has some disadvantages, such as higher risk of miscarriage, infection, bleeding, or limb defects¹²⁴. CVS is not routinely offered to all pregnant women, and it is not a substitute for amniocentesis.