Approach to prenatal teratogen exposure Quiz: Ace Your Exams
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A 4-hour-old newborn delivered at 38 weeks’ gestation is being evaluated in the nursery for irritability and jitteriness. The mother had poorly controlled gestational diabetes during pregnancy. There is no history of maternal fever, rash, or drug use. Delivery was uneventful, with rupture of membranes for 6 hours. Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. Birth weight is 4,200 grams, and the newborn is breastfed. Temperature is 37°C (98.6°F), pulse is 170/min, respirations are 37/min, blood pressure is 72/40 mmHg, and oxygen saturation is 98% on room air. On physical examination, no dysmorphic features are noted, and no rash is seen. Cardiopulmonary exam is unremarkable. A sacral dimple is seen on the back. Bedside glucose is 28 mg/dL. The neonate is breastfed three times, and repeated glucose measurements are 27, 25, and 26 mg/dL. Additional laboratory results are shown below. Which of the following is the most appropriate next step in management?
| Serum chemistries | |
| Hemoglobin | 24 g/dL |
| Hematocrit | 75% |
| Leukocyte count | 10,100/mm3 |
| Platelet count | 300,000/mm3 |
| Serum glucose | 30 mg/dL |
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