When assessing a preterm newborn for cold stress, a graduate nurse in the newborn nursery needs further teaching when stating the need to assess for which finding?

Question

Quizplus · Accepted Answer

Neonates are unable to generate heat by shivering due to their lack of muscle tissue and immature nervous systems; they therefore produce heat by increasing their metabolic rates through nonshivering thermogenesis. Brown adipose tissue (BAT), developed during the third trimester, is metabolized for thermogenesis when available. Once BAT is depleted, nonshivering thermogenesis is less effective and the neonate may experience cold stress, possibly leading to death. Preterm neonates have fewer stores of BAT and are at higher risk for cold stress. Frequent temperature monitoring is the best method to assess if an infant is cold. In cold stress, metabolism increases to generate heat, causing a greater demand for oxygen and glucose and the release of norepinephrine. If adequate oxygenation is not maintained, hypoxia and acidemia occur. Hypoglycemia develops when available glucose is depleted, and repletion of glucose is impaired by gastrointestinal immotility and poor oral intake. Clinical manifestations of cold stress include: Neurological - altered mental status (irritability or lethargy) (Option A) Cardiovascular - bradycardia Respiratory - tachypnea early, followed by apnea and hypoxia Gastrointestinal - high gastric residuals, emesis, hypoglycemia (Option B) Musculoskeletal - hypotonia, weak suck and cry (Option D) Educational objective: Premature infants are at high risk for cold stress due to decreased brown adipose tissue and inability to generate heat by shivering. The nurse should carefully assess for signs of cold stress, which include decreased temperature, altered mental status, bradycardia, hypoxia, hypotonia, and a weak cry and/or suck.

When Assessing a Preterm Newborn for Cold Stress, a Graduate