# A nurse is assessing a preterm newborn (32 weeks gestation) in the NICU. Which assessment finding would be the priority concern requiring immediate intervention? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543226 > language: ko > subject: Maternal Newborn Health ## 문제 A nurse is assessing a preterm newborn (32 weeks gestation) in the NICU. Which assessment finding would be the priority concern requiring immediate intervention? ## 보기 1. Blood glucose level of 35 mg/dL (1.9 mmol/L) **✔ 정답** 2. Dry, peeling skin with minimal vernix caseosa 3. Meconium-stained fingernails and umbilical cord 4. Weight at the 25th percentile for gestational age **정답: 1** ## 해설 Hypoglycemia (blood glucose ## 심화 해설 Priority Concern in a Preterm Newborn When assessing a preterm newborn at 32 weeks gestation, the nurse must prioritize findings that pose an immediate threat to neurological integrity. A blood glucose level of 35 mg/dL (1.9 mmol/L) represents neonatal hypoglycemia, a critical metabolic disturbance requiring prompt intervention to prevent long-term neurodevelopmental sequelae. The operational threshold for hypoglycemia in neonates is widely recognized as a blood glucose level < 2.6 mmol/L (47 mg/dL) [4]. The value of 1.9 mmol/L falls significantly below this cutoff, placing the newborn at immediate risk. Neonatal hypoglycemia is one of the most common metabolic disturbances in the first 24–72 hours of life , and preterm infants are an especially vulnerable population due to limited glycogen stores and immature gluconeogenic pathways . The clinical urgency is rooted in the brain's absolute dependence on glucose as a primary energy substrate. Untreated or prolonged hypoglycemia has been associated with potentially significant implications for neurodevelopment, including adverse long-term pediatric outcomes [2]. The systematic review by Abdelmonem Mahrous et al. underscores that the severity and timing of hypoglycemia are critical factors influencing subsequent neurodevelopmental trajectories [2]. Therefore, immediate intervention—typically a bolus of intravenous dextrose followed by a continuous infusion—is required to restore euglycemia and protect the developing brain. The other options, while relevant to preterm assessment, do not represent the same level of immediate physiological threat. Dry, peeling skin with minimal vernix caseosa is an expected integumentary finding in a preterm infant born at 32 weeks gestation, as vernix production peaks closer to term. Meconium-stained fingernails and umbilical cord indicate meconium passage in utero, which is a concern for meconium aspiration syndrome but is a finding that has already occurred; the priority shifts to respiratory monitoring rather than the staining itself. A weight at the 25th percentile for gestational age indicates the infant is appropriately grown and does not signal an acute, life-threatening condition. In the hierarchy of physiological stability, preserving neuronal function by correcting hypoglycemia takes precedence [2]. References (research sources) - [2]Neonatal Hypoglycemia and Long-Term Pediatric Neurodevelopmental Outcomes: A Systematic Review.Meta-analysis/systematic reviewAbdelmonem Mahrous RF, Ali Hassanin SH, Elemam Elbashir RE, Gasm Elseed H, Ahmed Elnour SE, Elsayid NN. (2025) · DOI: 10.7759/cureus.86183 - [4]Hypoglycemia on admission, associated factors, and early outcome among neonates admitted to the neonatal unit at Muhimbili National Hospital.Research articleMlawa ZA, Manji KP. (2026) · DOI: 10.1186/s12887-026-06519-w ## 임상 시나리오 Clinical Management of Neonatal Hypoglycemia **Operational Threshold:** Intervention is indicated for any blood glucose level < 47 mg/dL (2.6 mmol/L) in a symptomatic or high-risk neonate. A level of 35 mg/dL (1.9 mmol/L) mandates immediate treatment. Immediate Nursing Actions - Initiate an IV bolus of 10% dextrose in water (D10W) at 2 mL/kg over several minutes, as ordered. - Follow the bolus with a continuous IV infusion of D10W at a rate of 6-8 mg/kg/min to maintain euglycemia. - Recheck blood glucose 30 minutes after the bolus and then hourly until stable. - Ensure the newborn is in a thermoneutral environment to reduce metabolic demand. Pathophysiology in the Preterm Infant The 32-week preterm newborn is at high risk due to **limited hepatic glycogen stores** and **immature gluconeogenic enzyme systems**. These infants also have a high brain-to-body-mass ratio, increasing cerebral glucose demand. Without intervention, neuroglycopenia can lead to neuronal injury, seizures, and adverse long-term neurodevelopmental outcomes. Monitoring and Follow-Up - Maintain strict intake and output records during IV therapy. - Monitor for signs of hypoglycemia: jitteriness, lethargy, poor feeding, temperature instability, apnea, or seizures. - Once stable, transition to enteral feeds (breast milk or formula) while gradually weaning IV dextrose to prevent rebound hypoglycemia. - Document all glucose levels, interventions, and the infant's clinical response in the electronic health record. ## 핵심 개념 - **Neonatal Hypoglycemia** — A blood glucose level below 47 mg/dL (2.6 mmol/L) in a newborn, a metabolic emergency that can cause neurodevelopmental impairment if untreated. - **Preterm Neonate** — An infant born before 37 weeks of gestation, characterized by immature organ systems including limited glycogen stores and impaired gluconeogenesis. - **Glycogen Stores** — The body's reserve of stored glucose, primarily in the liver, which is rapidly depleted in preterm infants due to prematurity. - **Gluconeogenesis** — The metabolic pathway by which the liver produces glucose from non-carbohydrate substrates; this process is immature in preterm infants. - **Vernix Caseosa** — A white, cheesy protective coating on fetal skin that increases until about term; its absence is normal in a post-term but not a 32-week preterm infant. ## 같은 주제 문제 - [A nurse is assessing a postterm newborn who was born at 42 weeks gestation. 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