# A nurse is assessing a postterm newborn who was born at 42 weeks gestation. Which assessment finding would be most characteristic of postterm infants? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543225 > language: ko > subject: Maternal Newborn Health ## 문제 A nurse is assessing a postterm newborn who was born at 42 weeks gestation. Which assessment finding would be most characteristic of postterm infants? ## 보기 1. Abundant vernix caseosa covering the skin 2. Dry, cracked, and peeling skin with minimal subcutaneous fat **✔ 정답** 3. Fine, downy lanugo hair covering the body 4. Soft, pliable ear cartilage that folds easily **정답: 2** ## 해설 Postterm infants have dry, cracked, peeling skin with minimal subcutaneous fat due to prolonged amniotic fluid exposure and placental insufficiency. Other options describe typical findings in preterm or term infants. ## 심화 해설 Understanding Postterm Newborn Assessment When a pregnancy extends beyond 42 weeks gestation, the intrauterine environment begins to deteriorate, leading to a characteristic set of physical findings in the newborn. The placenta, which serves as the lifeline for fetal oxygenation and nutrition, undergoes aging and calcification, progressively compromising its function. This pathophysiological process directly shapes the clinical presentation of a postterm infant. The most characteristic finding is dry, cracked, and peeling skin with minimal subcutaneous fat. Here is why this occurs: Loss of Protective Barrier Vernix caseosa, the thick, cheesy protective coating that shields fetal skin from amniotic fluid, begins to diminish and disappear after 40 weeks. Without this barrier, the skin is directly exposed to amniotic fluid for a prolonged period, resulting in a macerated then desiccated appearance. Upon delivery, this manifests as peeling, parchment-like skin. Depletion of Energy Reserves The aging placenta becomes less efficient at transferring oxygen and nutrients. In response, the fetus begins to catabolize its own glycogen and subcutaneous fat stores for energy. This leads to the classic wasted appearance of a postterm infant: loose, wrinkled skin with a notable absence of the plump, well-hydrated look seen in term newborns. The loss of subcutaneous tissue is a hallmark of placental insufficiency. Why the Other Options Are Incorrect - Option 1 (Abundant vernix caseosa): This is a finding typical of a preterm infant. Vernix production peaks around the third trimester and is abundant in babies born before 38 weeks. A postterm infant will have little to none. - Option 3 (Fine, downy lanugo hair): Lanugo is the fine hair that covers the fetal body, appearing around 20 weeks and beginning to shed around 36 weeks. A postterm newborn will have very little lanugo remaining, as most has been shed into the amniotic fluid. - Option 4 (Soft, pliable ear cartilage): Ear cartilage develops and becomes more rigid with increasing gestational age. Soft, easily folded ears are a sign of prematurity. A postterm infant’s ear cartilage is typically firm with a well-defined shape and instant recoil when folded. Clinical Implications The assessment of a postterm newborn requires vigilance for complications linked to placental insufficiency, such as meconium aspiration syndrome, hypoglycemia due to depleted glycogen stores, and polycythemia from chronic intrauterine hypoxia. The physical findings of a wrinkled, peeling appearance with reduced subcutaneous tissue are the direct visual cues that alert the nurse to these underlying risks. ## 임상 시나리오 Clinical Assessment of the Postterm Newborn A 42-week gestation newborn is admitted to the well-baby nursery. The nurse notes dry, cracked, peeling skin with an absence of vernix caseosa and loose skin folds indicating minimal subcutaneous fat. The infant appears alert with a "worried" facial expression, long nails, and abundant hair. Priority Nursing Actions: - Monitor blood glucose immediately and per protocol due to depleted glycogen stores and high risk for hypoglycemia. - Assess for meconium staining of skin, nails, and umbilical cord, which may indicate meconium aspiration syndrome. - Maintain thermoregulation using a radiant warmer or skin-to-skin contact, as the loss of subcutaneous fat and increased surface area predispose to hypothermia. - Provide meticulous skin care: avoid harsh soaps, apply emollients to prevent further transepidermal water loss, and monitor for cracks or fissures that could serve as portals for infection. - Initiate early feeding to replenish energy stores, monitoring for polycythemia (which can occur with chronic placental insufficiency) and associated feeding intolerance. ## 핵심 개념 - **Vernix Caseosa** — A protective, cheese-like coating on fetal skin that diminishes and disappears after 40 weeks gestation, leaving postterm skin exposed. - **Placental Insufficiency** — The progressive decline in placental function due to aging and calcification, leading to reduced oxygen and nutrient transfer to the fetus. - **Lanugo** — Fine, downy hair covering the fetus that appears around 20 weeks and is usually shed before term; its presence suggests prematurity. - **Subcutaneous Fat** — Adipose tissue deposited in the third trimester that provides insulation and energy; depleted in postterm infants due to catabolism from placental insufficiency. ## 같은 주제 문제 - [A nurse is assessing a preterm newborn (32 weeks gestation) in the NICU. 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