The nurse caring for a 4479 g (9 lbs, 14 oz) infant of a diabetic ...

[pane00]

The nurse caring for a 4479 g (9 lbs, 14 oz) infant of a diabetic mother who was born by cesarean delivery 3 hours ago observes a respiratory rate of 90 breaths/minute, nasal flaring, and expiratory grunting.
 
  She reports the findings and recognizes that the newborn most likely has:
  a. Hypothyroidism
  b. Hypoglycemia
  c. Transient tachypnea of the newborn
  d. Neonatal sepsis

Question 2

A pregnant woman at 38 weeks' gestation has had ruptured membranes for 30 hours. A cesarean delivery is performed due to failure to progress. After birth, the newborn is noted to be pale and tachypneic.
 
  Based on maternal history, the cause of the newborn's distress is most likely to be:
  a. Hypoglycemia
  b. Respiratory distress syndrome
  c. Phrenic nerve injury
  d. Sepsis

[IRincones]

Answer to Question 1

ANS: C
Large infants of diabetic mothers and those born by cesarean delivery are at risk for transient tachypnea of the newborn (TTN), a self-limiting disorder caused by a slight lack of surfactant and/or a delayed reabsorption of fetal lung fluid.

Answer to Question 2

ANS: D
Prolonged rupture of membranes (greater than 24 hours) predisposes a newborn to infection from pathogens ascending from the vagina or cutaneous transmission as the fetus passes through the birth canal. Pallor, tachypnea, hypothermia, and lethargy may be noted at birth.