A nurse in the newborn nursery is caring for a group of newborns. Which of the following newborns requires immediate intervention?
A newborn who is 12 hours post-delivery and has a temperature of 37.0°C (98.6°F).
A newborn who is 27 hours post-delivery and has not voided.
A newborn who is 18 hours post-delivery and has not passed meconium.
A newborn who is 18 hours post-delivery and has acrocyanosis.
The Correct Answer is B
Choice A rationale
A newborn with a temperature of 37.0°C (98.6°F) is within the normal range for newborns and does not require immediate intervention.
Choice B rationale
A newborn who has not voided within 27 hours post-delivery requires immediate intervention. Newborns should void within the first 24 hours of life. Failure to void may indicate dehydration, urinary tract obstruction, or renal issues.
Choice C rationale
A newborn who has not passed meconium within 18 hours post-delivery is concerning but not as urgent as not voiding. Newborns typically pass meconium within the first 24-48 hours.
Choice D rationale
Acrocyanosis, or bluish discoloration of the hands and feet, is common in newborns and usually resolves on its own. It does not require immediate intervention.
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Correct Answer is D
Explanation
Choice A rationale
Microcephaly is not typically associated with an increased risk of unconjugated bilirubin and jaundice.
Choice B rationale
Polydactyly is a congenital condition involving extra fingers or toes and is not associated with an increased risk of unconjugated bilirubin and jaundice.
Choice C rationale
Caput succedaneum is a condition involving swelling of the scalp in a newborn and is not typically associated with an increased risk of unconjugated bilirubin and jaundice.
Choice D rationale
Cephalohematoma is a collection of blood between a baby’s scalp and the skull bone. It is associated with an increased risk of unconjugated bilirubin and jaundice due to the breakdown of red blood cells in the hematoma. .
Correct Answer is D
Explanation
Choice A rationale
Newborns are not born with fully developed immune responses. Their immune system is immature and continues to develop after birth. They rely on maternal antibodies for initial protection.
Choice B rationale
Newborns do not have a mature gut microbiome immediately after birth. The gut microbiome develops over time and is influenced by factors such as breastfeeding and exposure to the environment.
Choice C rationale
Newborns do not rely solely on their innate immune system. They receive passive immunity from maternal antibodies transferred through the placenta and colostrum, which provides initial protection against infections.
Choice D rationale
Newborns receive passive immunity through the placenta and colostrum, but their own immune system is not fully functional until several months of age. This passive immunity helps protect them from infections during the early months of life.