A nurse is assessing a newborn whose mother had a positive cytomegalovirus (CMV) titer during pregnancy. Which assessment finding would be most concerning and require immediate intervention?

A newborn presenting with petechiae and purpura in the context of maternal positive CMV titer requires urgent evaluation for severe thrombocytopenia. The primary concern is the risk of spontaneous intracranial hemorrhage. Immediate nursing actions include:

• Stabilization & Monitoring: Place the newborn on a cardiorespiratory monitor. Perform frequent neurological assessments (level of consciousness, fontanel fullness, pupillary response) to detect early signs of increased intracranial pressure. Handle the infant gently using a minimal stimulation protocol to avoid trauma.
• Diagnostic Workup: Anticipate orders for a STAT complete blood count with platelet count. A platelet count below 50,000/mcL significantly increases bleeding risk. Additional labs should include liver function tests, bilirubin levels, and a confirmatory CMV PCR from urine or saliva.
• Hemorrhage Precautions: Institute bleeding precautions immediately. Avoid intramuscular injections, rectal temperatures, and use of adhesive tape. Apply gentle, prolonged pressure to any puncture sites. Prepare for platelet transfusion if the count is critically low or active bleeding is present.
• Multisystem Assessment: Beyond the skin, assess for other signs of symptomatic congenital CMV, including microcephaly, hepatosplenomegaly, and chorioretinitis. A thorough head-to-toe exam will guide further targeted interventions and specialist consultations.