You are in the postpartum unit where a Day two G1P1 Mother is working hard at breastfeeding her baby. She is concerned that the baby is fussy between feedings. The advice you would give her is:

A) Axillary temp of 96.9F (36.0 C) after 30 minutes of skin-to-skin contact with the mother:
A temperature of 96.9°F (36.0°C) is lower than the expected normal range for a newborn, which is typically between 97.7°F (36.5°C) and 99.5°F (37.5°C). However, after 30 minutes of skin-to-skin contact with the mother, the temperature is likely to increase as the infant benefits from the warmth of the mother's body. If the temperature does not rise or if it continues to decrease, further intervention would be necessary.

B) Respiratory rate of 58 during assessment at beginning of shift:
Newborns may have slightly irregular and rapid breathing patterns, especially right after birth, but this is not a cause for concern unless accompanied by signs of respiratory distress, such as retractions, flaring, or grunting.

C) Heart rate of 162 while crying vigorously after a diaper change:
It is not uncommon for a newborn to have an elevated heart rate when upset or crying. A heart rate of 162 while crying is expected and does not indicate a problem. Once the baby calms down, the heart rate will likely return to its baseline.

D) No void after 8 hours of life:
The absence of a urine output within the first 8 hours of life is concerning and requires immediate follow-up. Newborns typically void within the first 24 hours, and if there is no urine output by 8 hours, it could indicate a potential problem such as dehydration, urinary tract obstruction, or renal dysfunction. A healthcare provider should be notified promptly for further assessment and intervention.

A) It could make respiratory distress syndrome worse:
The most critical reason to protect a preterm infant from cold stress is that hypothermia can exacerbate respiratory distress syndrome (RDS). Cold stress leads to an increased oxygen demand, which can worsen the infant’s already compromised respiratory function. In preterm infants, the immature lungs and underdeveloped surfactant production contribute to RDS, and hypothermia worsens the situation by increasing metabolic demands and impairing pulmonary function. Maintaining a stable body temperature is crucial for minimizing respiratory complications.

B) Shivering to produce heat may use up too many calories:
While it is true that preterm infants may not have the metabolic reserves to generate heat via shivering (as they lack significant brown fat), the primary concern is not shivering. Preterm infants generally do not shiver, and cold stress does not trigger this response. Instead, their body tries to conserve heat through vasoconstriction and increased metabolism, which can lead to hypoxia and worsening respiratory distress.

C) A low temperature may make the infant less able to digest nutrients:
Cold stress can affect a preterm infant’s gastrointestinal function by reducing blood flow to the digestive organs, which can impair nutrient absorption and digestion. However, the most immediate and serious consequence of cold stress is the increased metabolic demand and worsening of respiratory distress, rather than a direct impact on digestion. Protecting the infant from hypothermia helps prevent these secondary complications.

D) Cold decreases circulation to the extremities:
While cold stress can indeed lead to vasoconstriction and decreased circulation to the extremities, this is not the most significant concern. The primary issue with cold stress in preterm infants is the overall increase in metabolic demands, oxygen consumption, and exacerbation of respiratory problems, which can lead to more severe respiratory distress syndrome. The loss of peripheral circulation is a secondary concern.