Situation: A nurse in the delivery room and newborn nursery … | 마이메르시 MyMerci
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Nursing Practice II — Maternal and Child Health Nursing
문제

Situation: A nurse in the delivery room and newborn nursery of a provincial hospital receives newborns at birth and during the first days of life. A newborn born at 41 weeks weighs 2,350 g, below the 10th percentile for gestational age. At 6 hours of age she is jittery and sucks weakly at the breast. Her glucose is 38 mg/dL (2.1 mmol/L). Based on the American Academy of Pediatrics (AAP) guidance, what should the nurse do?

해설
Small-for-gestational-age infants have low glycogen stores and are screened for hypoglycemia. The AAP action value of 35 mg/dL (1.9 mmol/L) for 4–24 hours applies to asymptomatic infants; this infant has jitteriness and a weak suck, and a symptomatic infant with glucose below 40 mg/dL (2.2 mmol/L) receives intravenous glucose.
같은 주제 다음 문제Situation: A nurse works in the neonatal intensive care unit (NICU) of a tertiary hospital…이 문제가 수록된 문제집PLNE Question Bank 150014,000원 · 무료 체험 가능

심화 해설

Symptoms change the threshold
This newborn is small for gestational age (SGA), weighing 2,350 g at 41 weeks, below the 10th percentile. SGA infants have low glycogen stores and are routinely screened for hypoglycemia. At 6 hours she is jittery and sucks weakly, and her glucose is 38 mg/dL (2.1 mmol/L). Under American Academy of Pediatrics (AAP) guidance, a symptomatic infant with glucose below 40 mg/dL (2.2 mmol/L) receives intravenous glucose. Because she has symptoms and her glucose is below 40 mg/dL, the nurse reports her for intravenous glucose.

Asymptomatic versus symptomatic thresholds
The AAP guidance includes action values for at-risk infants who have no symptoms, such as 35 mg/dL (1.9 mmol/L) between 4 and 24 hours of age, at which feeding and rechecking may be tried. Those values apply only to asymptomatic infants. Once signs of hypoglycemia appear, the brain may already be short of glucose, and feeding alone is too slow and unreliable to correct it. Watch out! Her glucose of 38 mg/dL is above 35 mg/dL, which makes the feed-and-recheck option look correct, but that threshold does not apply to a symptomatic infant.

Recognizing symptoms of neonatal hypoglycemia
Signs are often subtle and nonspecific: jitteriness or tremors, poor or weak sucking, poor feeding, irritability, a high-pitched cry, lethargy, hypotonia, apnea, cyanosis, temperature instability, and seizures. A weak suck is especially important because it also means the infant cannot take enough milk to raise her own glucose.

Why the other options are wrong
Continuing routine care on the assumption that small babies normally have lower glucose is unsafe; SGA infants are at higher risk, and low glucose in them is a problem to treat, not a normal finding. Giving expressed milk by cup and rechecking before the next feeding delays definitive treatment. Feeding can continue alongside intravenous glucose when the infant is able, but it does not replace it in a symptomatic infant.

Exam takeaway
For at-risk newborns, first ask whether the infant has symptoms; a symptomatic infant with glucose below 40 mg/dL needs intravenous glucose. Key point! SGA, preterm, large-for-gestational-age, and infants of diabetic mothers are the main at-risk groups for early hypoglycemia screening.

임상 시나리오

Symptomatic Hypoglycemia in an SGA NewbornGlucose 38 mg/dL with jitteriness at 6 hours

Small-for-gestational-age infants have low glycogen stores and are screened for hypoglycemia.

The 35 mg/dL (1.9 mmol/L) action value for 4 to 24 hours applies to asymptomatic infants. A symptomatic infant below 40 mg/dL (2.2 mmol/L) receives intravenous glucose.

Watch for jitteriness, weak suck, poor feeding, lethargy, hypotonia, apnea, and seizures.

Caution

Do not treat a symptomatic infant with feeding and recheck alone, and do not assume low glucose is normal in a small baby.

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