The nurse is planning care for a newborn of a mother with Diabetes Mellitus. What is the priority health issue for nursing consideration for this newborn?

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

Explanation

Newborns of diabetic mothers are at high risk for hypoglycemia (low blood glucose) shortly after birth.
In utero, the mother's high blood sugar crosses the placenta, causing the baby's pancreas to produce extra insulin (fetal hyperinsulinemia).
After birth, the maternal glucose supply is abruptly cut off, but the newborn's high insulin levels persist, causing a rapid drop in blood glucose.
This condition requires immediate monitoring and intervention to prevent potential neurological damage.
The nadir (lowest point) of blood glucose in these infants is typically reached between 1 and 3 hours of age.

Option A: This is a potential long-term consequence, not an immediate, life-threatening priority at birth.
Option C: This is often a symptom of hypoglycemia, not the root cause. Treating the low blood glucose will typically resolve the poor feeding.
Option D: Hypoglycemia in a newborn is more commonly associated with hypothermia (low body temperature), not hyperthermia. An elevated temperature would suggest infection (sepsis).

Clinical Relevance

Nursing practice connection: Knowing Priority nursing care for a newborn of a diabetic mother (IDM) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses must anticipate hypoglycemia in all infants of diabetic mothers and implement a protocol for early feeding and glucose screening within the first hour of life.
A key nursing action is to check the baby's blood glucose 30 minutes after the first feed and then serially before subsequent feeds as per hospital protocol.
What if? If the newborn was also premature, the risk for both hypoglycemia and hypothermia would be even greater, requiring more intensive monitoring, likely in a Neonatal Intensive Care Unit (NICU).

How to Approach the Question

First, identify the key patient population in the question: a 'newborn of a mother with Diabetes Mellitus'.
Recall the primary pathophysiological consequence for this specific population. Maternal diabetes leads to fetal hyperinsulinemia.
Analyze the question's core demand: 'What is the priority health issue?'. This directs you to find the most immediate, life-threatening problem.
Evaluate each option based on urgency. Hypoglycemia is an acute metabolic crisis that occurs within hours of birth and can cause brain damage.
Systematically rule out the other options by assessing their timeline and relationship to the primary problem. Developmental delays are long-term, poor sucking is a secondary symptom, and elevated temperature is the opposite of the expected finding (hypothermia).

Concept Tested & Keywords

Concept Tested: Priority nursing care for a newborn of a diabetic mother (IDM)
Stem keywords: newborn, mother with Diabetes Mellitus, priority health issue
Lead-in keywords: priority
Clinical cues: The relationship between maternal diabetes and neonatal metabolic state is a classic concept in nursing.

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E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 2 (pp 239-476 of 713) pp. 5-7, 6-8

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1151-1153

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