A nurse is assessing a full-term newborn upon admission to the nursery.
Which of the following clinical findings should the nurse report to the provider?
A.
Rust-stained urine.
B.
Subconjunctival hemorrhage.
C.
Single palmar creases.
D.
Transient circumoral cyanosis.
The Correct answer and Explanation is:
The correct answer is C. Single palmar creases.
Explanation:
A single palmar crease, also known as a simian crease, is a single line that runs across the palm of the hand instead of the usual two creases. While it can be seen in healthy newborns, it is also associated with certain genetic conditions, including Down syndrome and other chromosomal abnormalities. When a nurse observes this finding, it should be reported to the provider, as further assessment and testing may be required to rule out any underlying conditions. This finding can indicate developmental anomalies that could affect the infant’s health, growth, and development.
Other Answer Options:
- Rust-stained urine (A): Rust-stained urine in newborns is typically due to the presence of uric acid crystals, which are commonly seen in the first few days of life. Uric acid crystals appear as red or rust-colored stains in the diaper and are considered normal, particularly during the early days when the baby is breastfeeding and may have low urine output. This condition usually resolves as the newborn begins to intake more fluids, and the kidneys mature.
- Subconjunctival hemorrhage (B): Subconjunctival hemorrhages are small blood vessels that break in the eye during delivery, causing a red spot in the white part of the eye. This is a common and benign finding in newborns that usually resolves on its own within a few weeks without intervention.
- Transient circumoral cyanosis (D): Transient circumoral cyanosis, or a bluish tint around the mouth, can occur in newborns due to cold exposure or normal circulatory adaptation after birth. It typically resolves within a short period and does not indicate a pathological condition unless it persists or is accompanied by central cyanosis (bluish discoloration of the lips, tongue, or trunk), which would be a more concerning finding.
In summary, while rust-stained urine, subconjunctival hemorrhage, and transient circumoral cyanosis are generally considered normal findings in newborns, the presence of a single palmar crease should raise suspicion for genetic conditions, necessitating further evaluation. Therefore, this finding should be reported to the provider for follow-up testing.