While working in the nursery, a nurse assesses a newborn born less than two hours ago. Which of the following findings by the nurse would necessitate further investigation?
While working in the nursery, a nurse assesses a newborn born less than two hours ago. Which of the following findings by the nurse would necessitate further investigation?
A. A diamond-shaped soft area present at the top of the newborn's head
[4%]
B. Greasy, white substance that resembles cheese on the newborn's neck, back, and thighs
[3%]
C. A single crease on the palm
[57%]
D. Acrocyanosis
[35%]
Statistics
Subject/Lesson
Subject
Maternal & Newborn Health
Lesson
Newborn
Client Need
Test Plan
Health Promotion and Maintenance
Related Topic
Development Stages and Transitions
Item Type
Item Type
Knowledge/Comprehension
Explanation
Choice C is correct. It is widely accepted that a finding of a single transverse palmar crease on the palm – often referred to as a simian line or simian crease – is often observed in a wide range of chromosomal defects, including, but not limited to, Down syndrome, congenital limb deficiency, trisomy 13/18/21, 4p, 18q, etc. Although this finding does not in and of itself render a diagnosis of a chromosomal disorder, this finding by the nurse would necessitate the need to alert the newborn's primary health care provider (HCP), as genetic and chromosomal testing will likely need to be performed.
Choice A is incorrect. Fontanels are one of a newborn's skull's most prominent anatomical features, helping to facilitate the movement and molding of the newborn's cranium through the birth canal during labor. The diamond-shaped soft area present at the top of the newborn's head is the anterior fontanel (also commonly referred to as a fontanelle), the largest of the six fontanels present at birth. The anterior fontanel typically fuses between 12 and 18 months of age.
Choice B is incorrect. This finding is indicative of vernix caseosa. At birth, a newborn's skin may be covered with vernix caseosa, a grayish-white, cheese-like substance composed of a mixture of sebum and desquamating cells. If it is not entirely removed during the post-birth bath, the newborn's skin will absorb any remaining vernix caseosa within 24 to 48 hours.
Choice D is incorrect. Acrocyanosis is often seen in healthy newborns and refers to the peripheral cyanosis around the mouth and the extremities (hands and feet). Unlike other causes of peripheral cyanosis with significant pathology (e.g., septic shock), acrocyanosis is a harmless condition caused by benign vasomotor changes that result in peripheral vasoconstriction and increased tissue oxygen extraction. Additionally, acrocyanosis is further differentiated from peripheral cyanosis as acrocyanosis occurs immediately after birth in healthy infants and is a common finding, at times persisting for 24 to 48 hours.
Learning Objective
While working as a nurse in a nursery, recognize that a single crease on the palm of a newborn would be the nursing assessment finding that would necessitate further investigation.
Additional Info
- Using simian creases to screen for certain known congenital chromosomal disorders and syndromes could be useful in conjunction with other diagnostic practices.
- Simian creases can be examined quickly without causing physical pain or incurring expensive medical bills.
- However, the detection of simian creases should not be used independently for diagnosing known associated chromosomal disorders and/or other disorders, but rather in combination with other diagnostic tests.
- A consensus statement based on the results of a study conducted by the National Association of Neonatal Nursing (NANN) and the Association of Women's Health Obstetrical and Neonatal Nursing (AWHONN) directed "removal of all vernix is not necessary for hygienic reasons" and "vernix may provide antibacterial promotion and wound healing."
