A nurse is assessing a 4200-gram newborn born at 38 weeks gestation to a mother with gestational diabetes who is large for gestational age (LGA). Which assessment finding would be the priority concern for this infant?

LGA infants are at high risk for hypoglycemia due to hyperinsulinemia from maternal glucose exposure in utero. A blood glucose level of 35 mg/dL at 2 hours of age requires immediate intervention to prevent neurological complications.

Core Nursing Explanation Key Concept Analysis: This question assesses the priority nursing concern for a Large for Gestational Age (LGA) infant born to a mother with Gestational Diabetes Mellitus (GDM). The core pathophysiology is neonatal hyperinsulinemia. During pregnancy, the fetus is exposed to high maternal glucose levels, which stimulates the fetal pancreas to produce excess insulin. After birth, when the maternal glucose supply is abruptly cut off, the infant's high insulin levels persist, leading to rapid hypoglycemia.

Answer Rationale: Key Point! A blood glucose level of 35 mg/dL at 2 hours of age is the priority finding. While the normal neonatal blood glucose range is typically 40-80 mg/dL, levels below 40-45 mg/dL in the first 24 hours are generally considered hypoglycemic and require intervention. For an LGA infant of a diabetic mother, this is an expected but urgent complication. Untreated hypoglycemia can lead to seizures, brain damage, and long-term neurological deficits, making it the top priority.

Distractor Analysis:

• Option 1 (Decreased muscle tone and weak cry): These are non-specific signs that could indicate various issues like sepsis, neurological problems, or late signs of hypoglycemia. However, the priority is to identify and treat the cause (hypoglycemia) before these symptoms manifest or worsen.
• Option 2 (Excessive weight loss in the first 24 hours): While some weight loss is normal, excessive loss is a concern for dehydration or feeding problems. However, it is not the most immediate, life-threatening risk for this specific infant population in the first few hours of life.
• Option 4 (Difficulty with initial feeding attempts): This is common in many newborns and can contribute to hypoglycemia. However, the abnormal lab value (35 mg/dL) provides objective, concrete evidence of an active metabolic crisis that takes precedence over a subjective feeding difficulty.

Related Concepts: Nurses must monitor LGA infants of diabetic mothers for hypoglycemia closely, typically checking blood glucose levels at 30 minutes, 1, 2, 4, 8, 12, and 24 hours of age. Early feeding (breastfeeding or formula) is a preventive measure, but if hypoglycemia persists despite feeding, intravenous (IV) dextrose is required.

Concept Summary

Concept	Description	Clinical Implication
Infant of Diabetic Mother (IDM)	Newborn exposed to maternal hyperglycemia in utero.	At risk for hypoglycemia, macrosomia (LGA), birth trauma, respiratory distress, polycythemia.
Neonatal Hyperinsulinemia	Fetal overproduction of insulin in response to high glucose.	Causes rapid postnatal drop in blood glucose (hypoglycemia).
Large for Gestational Age (LGA)	Birth weight >90th percentile for gestational age (>4000g is common cutoff).	Risk for shoulder dystocia, clavicle fracture, hypoglycemia, polycythemia.
Neonatal Hypoglycemia	Blood glucose 임상 시나리오 Nursing Clinical Practice Guide Clinical Scenario: You are the nurse in the well-baby nursery. A newborn, Baby Boy Smith, is admitted after a vaginal delivery at 38 weeks. He weighs 4200g (9 lbs, 4 oz). His mother had diet-controlled gestational diabetes. The pediatrician's order states: "Monitor blood glucose per protocol for LGA infant of diabetic mother." Nursing Intervention Strategy: Assessment: Obtain first blood glucose (heel stick) at 30 minutes of age, then per protocol (1, 2, 4, 8, 12, 24 hrs). Assess for signs of hypoglycemia: jitteriness, lethargy, poor feeding, apnea, temperature instability, high-pitched cry. Perform a thorough physical assessment, checking for birth injuries (e.g., Erb's palsy, clavicle fracture) common in LGA infants. Planning & Implementation: Primary Prevention: Initiate early feeding (breastfeeding or 10-20 mL formula) within the first hour of life. Refeed every 2-3 hours. If Hypoglycemic (Glucose 45 mg/dL. Evaluate feeding tolerance, weight trends, and absence of hypoglycemic symptoms. Patient Safety and Precautions: Heel Stick Technique: Use a warm pack on the heel to increase blood flow. Do not use the central area of the heel to avoid bone injury. Use appropriate lancet depth. Feeding Safety: Ensure proper positioning and latch to prevent aspiration. Monitor for signs of fatigue during feeding. IV Dextrose: If administering D10W IV, use an infusion pump. Rapid boluses can cause hyperglycemia and rebound hypoglycemia. Monitor the IV site closely for infiltration, as dextrose is hypertonic and can cause tissue necrosis. Nursing Procedure & Medication Flow Procedure: Managing Neonatal Hypoglycemia 1. Confirm hypoglycemia with a lab-quality point-of-care test. 2. If asymptomatic and glucose is 35-45 mg/dL: Feed (breastfeed or give 2-5 mL/kg of formula). Recheck in 1 hour. 3. If symptomatic (jittery, lethargic) OR glucose 마이메르시로 국가고시 완벽 대비 기출문제와 상세 해설을 무료로. 내 약점을 분석하고 진도를 관리하며 더 똑똑하게 공부하세요. 무료로 시작하기 App Store Google Play 학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요.