# A nurse is caring for a newborn who is small for gestational age (SGA). Which nursing intervention should be the priority? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543232 > language: ko > subject: Maternal Newborn Health ## 문제 A nurse is caring for a newborn who is small for gestational age (SGA). Which nursing intervention should be the priority? ## 보기 1. Administer prophylactic antibiotics to prevent infection 2. Initiate phototherapy to prevent hyperbilirubinemia 3. Monitor blood glucose levels and provide early feeding **✔ 정답** 4. Place the newborn in a radiant warmer to maintain body temperature **정답: 3** ## 해설 SGA newborns are at high risk for hypoglycemia due to decreased glycogen stores and increased metabolic demands. Priority intervention is frequent blood glucose monitoring and early feeding to prevent complications like seizures and brain damage. ## 심화 해설 Understanding the Priority for an SGA Newborn When caring for a newborn who is small for gestational age (SGA), the nurse must prioritize interventions based on the most immediate physiological risks. SGA infants, often as a result of intrauterine growth restriction (IUGR), have experienced chronic nutritional deprivation in utero. This leads to depleted glycogen stores, reduced adipose tissue, and an immature metabolic regulatory system at birth [3]. Consequently, they are at an exceptionally high risk for neonatal hypoglycemia, a critical metabolic disturbance most common in the first 24 to 72 hours of life [2]. Why Monitoring Blood Glucose and Early Feeding is the Priority The primary goal is to prevent the neurodevelopmental sequelae associated with prolonged hypoglycemia. The metabolic profile of an IUGR neonate is characterized by depleted nutrient stores and dysregulated endocrine activity, which collectively compromise metabolic homeostasis [3]. Without a consistent exogenous glucose source, the newborn’s brain, which is dependent on glucose as its primary fuel, is vulnerable to injury. Clinical guidelines consistently emphasize early screening and nutritional intervention as the cornerstone of management [2]. The intervention of monitoring blood glucose levels provides the data needed to identify hypoglycemia, often defined as a blood glucose level < 2.6 mmol/L [1]. This assessment must be paired with early feeding to provide an immediate source of glucose, transitioning the newborn from a catabolic to an anabolic state. This proactive approach directly addresses the underlying pathophysiology of depleted nutrient reserves and prevents the cascade of complications associated with untreated hypoglycemia [1][3]. Why Other Options Are Not the Priority While the other interventions are important aspects of newborn care, they do not address the most acute and common metabolic threat for this specific population. - Administering prophylactic antibiotics (Option 1): Infection is a risk for all newborns, but it is not the primary, predictable metabolic consequence of being SGA. Antibiotic administration is not a standard prophylactic measure based solely on SGA status and would be reserved for cases with specific risk factors or clinical signs of sepsis. - Initiating phototherapy (Option 2): Hyperbilirubinemia is common in newborns, and SGA infants with polycythemia may be at increased risk. However, phototherapy is a treatment for a condition that develops over days, not the immediate, life-threatening metabolic emergency that hypoglycemia represents in the first hours of life [2]. - Placing in a radiant warmer (Option 4): Thermoregulation is crucial because SGA newborns have minimal subcutaneous fat and a high surface-area-to-body-weight ratio, predisposing them to hypothermia. Maintaining a neutral thermal environment prevents cold stress, which would increase metabolic rate and glucose consumption, thus worsening hypoglycemia. However, maintaining temperature is a supportive measure; the priority is directly identifying and correcting the hypoglycemia that cold stress would exacerbate. The foundational problem of depleted nutrient stores is most directly managed through glucose monitoring and feeding [3].References (research sources) - [1]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 - [2]Neonatal Hypoglycemia: A Systematic Review of International and Local Clinical Guidelines with Clinical Implications.GuidelineRusu C, Matyas M, Kramer BW, Dorobanțu FR, Bodog A. (2026) · DOI: 10.3390/jcm15103921 - [3]Umbilical Cord Biomarkers of Nutritional and Metabolic Status in Neonates with Intrauterine Growth Restriction.Research articleToth IH, Pantea MM, Enatescu I, Filimon AT, Kali FY, Belei O. (2026) · DOI: 10.3390/jcm15031043 ## 임상 시나리오 Clinical Practice Guide: Prioritizing Care for the SGA Newborn **Core Principle:** The immediate priority for a small for gestational age (SGA) newborn is prevention of hypoglycemic brain injury. This is achieved through proactive glucose monitoring and early nutritional support, not by waiting for symptoms to appear. Step-by-Step Clinical Actions - **Screen Immediately:** Obtain a point-of-care blood glucose level within the first hour of life, before the second feeding, and then per unit protocol (e.g., every 2-4 hours for the first 24 hours). A level < 2.6 mmol/L (45-47 mg/dL) requires intervention. - **Initiate Early Feeding:** Facilitate the first feeding within the first hour of life, ideally with breast milk or formula. This provides an immediate exogenous glucose source to compensate for depleted glycogen stores. - **Support Thermoregulation Concurrently:** While not the priority, place the newborn skin-to-skin with the mother or under a preheated radiant warmer during assessments and feeding to prevent cold stress, which increases metabolic demand and glucose consumption. - **Monitor for Secondary Risks:** After metabolic stability is addressed, conduct ongoing assessments for other common SGA complications, such as polycythemia, jaundice, and temperature instability. Key Clinical Reasoning An SGA newborn's physiology is defined by chronic intrauterine nutrient deprivation. This results in minimal glycogen and fat stores at birth, leaving the brain vulnerable to energy failure. A blood glucose check identifies the risk, and early feeding treats it. Delaying feeding to first address temperature or perform a full bath can precipitate a hypoglycemic crisis. Phototherapy for jaundice and prophylactic antibiotics for infection are secondary considerations, not immediate priorities in an asymptomatic SGA infant. ## 핵심 개념 - **Small for Gestational Age** — Newborn with birth weight below the 10th percentile for gestational age. This is associated with intrauterine growth restriction. - **Hypoglycemia** — Hypoglycemia. In newborns, this generally refers to a blood glucose level below 40-45 mg/dL, which can cause neurological damage. - **Glycogen Stores** — Glycogen stores. This is the form of glucose stored in the liver and muscles, and SGA newborns have insufficient amounts of these stores, leading to rapid depletion after birth. - **Metabolic Demands** — Metabolic demand. The amount of energy needed to adapt to the extrauterine environment, maintain body temperature, and grow. SGA newborns have relatively high metabolic demand. - **Early Feeding** — Early feeding. Feeding initiated within the first hour after birth, important for preventing hypoglycemia and stimulating bowel function. ## 같은 주제 문제 - [A nurse is assessing a newborn who was born at 38 weeks gestation and weighs 2,100 grams. …](https://mymerci.kr/pages/nclex_q.php?qn_id=543230) - [A nurse is assessing a newborn who was born at 38 weeks gestation and weighs 2,100 grams. …](https://mymerci.kr/pages/nclex_q.php?qn_id=543231) - [A nurse is caring for a newborn who is small for gestational age (SGA). Which nursing inte…](https://mymerci.kr/pages/nclex_q.php?qn_id=543233) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._