A baby is born at 42 weeks of gestation. Which of the following findings is most likely expected?

Appeared in: NORCET 10 Mains

Explanation

A baby born at 42 weeks is post-term, and a classic sign is dry, cracked, and peeling skin due to the loss of protective vernix caseosa and exposure to amniotic fluid.
Lethargy can be a sign of complications associated with postmaturity, such as hypoglycemia or hypoxia from placental insufficiency.
The combination of skin changes and potential lethargy makes this the most comprehensive and likely finding among the choices.

Option B: Excess lanugo (fine body hair) and soft skin are characteristic features of a preterm infant, not a post-term infant.
Option C: Poor muscle tone (hypotonia) and abundant vernix caseosa (waxy coating) are hallmark signs of prematurity.
Option D: Post-term infants typically have reduced, not increased, subcutaneous fat due to placental insufficiency, leading to a thin or wasted appearance. Their skin is wrinkled and peeling, not smooth.

Visual 1: Comparative Chart - A side-by-side chart showing the key physical differences between preterm, term, and post-term infants, highlighting skin, lanugo, plantar creases, and body fat.
Visual 2: Photograph - A picture of a post-term infant's skin, clearly showing the dry, peeling, and cracked 'parchment-like' texture.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Assessment of a post-term (postmature) infant as background academic context rather than a clinical decision trigger.
Nurses must promptly identify signs of postmaturity to anticipate and manage potential complications like hypoglycemia, meconium aspiration syndrome, and hypothermia.
Assessment of a post-term infant includes careful skin inspection, blood glucose monitoring, and a thorough respiratory assessment.
What if the baby was born at 36 weeks? In that case, the expected findings would be excess lanugo and abundant vernix, making options B and C more likely.

How to Approach the Question

First, identify the key clinical information in the stem: the gestational age is '42 weeks'.
Recognize that 42 weeks signifies a 'post-term' or 'postmature' infant.
Recall the classic physical characteristics of a post-term infant.
Evaluate each option against these characteristics. Eliminate options that describe preterm (abundant lanugo/vernix, poor tone) or healthy term infants.
Select the option that best matches the pathophysiology of postmaturity, which includes skin breakdown from loss of vernix and potential distress (lethargy) from placental insufficiency.

Concept Tested & Keywords

Concept Tested: Assessment of a post-term (postmature) infant
Stem keywords: baby, 42 weeks of gestation, findings
Lead-in keywords: most likely expected
Clinical cues: Gestational age of 42 weeks indicates a post-term pregnancy, which has specific physiological implications for the newborn.

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