A nurse is teaching the parents of a newborn about the critical congenital heart disease screening.
Which of the following statements should the nurse include in the teaching?

Step 1 is to determine the number of days from April 1 to December 26. Days in April = 30 - 1 + 1 = 30 days. Days in May = 31 days. Days in June = 30 days. Days in July = 31 days. Days in August = 31 days. Days in September = 30 days. Days in October = 31 days. Days in November = 30 days. Days in December = 26 days. Total number of days = 30 + 31 + 30 + 31 + 31 + 30 + 31 + 30 + 26 = 270 days.

Step 2 is to convert the total number of days into weeks. 270 days ÷ 7 days/week = 38.57 weeks.

Step 3 is to round to the nearest whole week. The anticipated gestational age is 39 weeks.

The nurse should further evaluate respiratory characteristics and muscle tone to determine if the newborn is experiencing a complication.

Rationale for correct answers
Respiratory characteristics are critical to assess because irregular and shallow breathing in a newborn can indicate neurological or respiratory dysfunction. Normal neonatal respiratory rate ranges from 30 to 60 breaths per minute with regular pattern; deviations may signal distress or central nervous system issues. Muscle tone evaluation is essential since increased tone with tremors suggests possible neurologic irritability or withdrawal. Normal newborn muscle tone should be moderate, neither hypotonic nor hypertonic, with symmetrical movement. These signs correlate with the high-pitched cry, tremors, and exaggerated reflexes noted, which may indicate neurological complications such as withdrawal syndrome or hypoxic-ischemic encephalopathy.

Rationale for incorrect answers
Heart rate (A) is important but was not reported abnormal; normal neonatal heart rate ranges from 120 to 160 beats per minute and the absence of murmurs suggests no cardiac compromise. Temperature (C) is less urgent as mucous membranes are moist and skin warm and dry, indicating stable thermoregulation; normal newborn temperature is 36.5–37.5°C. Feeding patterns (D) appear adequate with no difficulty reported, making this less immediately concerning.

Rationale for incorrect answers
Moro reflex (A) and Babinski reflex (B) are both present and exaggerated, which may be reactive but less specific for immediate concern than muscle tone abnormalities. Skin color (D) is normal without cyanosis or jaundice, reducing the likelihood of hypoxia or hemolytic issues.

Take home points

• Respiratory pattern irregularities in newborns may indicate neurological or respiratory dysfunction.
• Abnormal muscle tone and tremors are key signs of potential neurological complications.
• Normal heart rate, temperature, feeding, and skin color reduce likelihood of cardiac or systemic illness.
• Reflex exaggeration alone is less specific than muscle tone and respiratory changes for early complication detection.