The newborn experienced fetal distress.Meconium staining is often caused by fetal hypoxia or other physiologic stress that triggers the fetus to pass meconium into the amniotic fluid before delivery.If the fetus aspirates the meconium, it can cause lung injury and respiratory distress, termed meconium aspiration syndrome.

Choice A is wrong because a bowel obstruction would not cause meconium staining of the nails and umbilical cord.

Choice B is wrong because a congenital anomaly would not necessarily cause meconium passage or staining.

Choice D is wrong because an infection may cause fetal distress, but it is not the direct cause of meconium staining.Meconium staining may be a sign of infection in the newborn.

Oligohydramnios is a condition where there is too little amniotic fluid surrounding the fetus.

This can cause the umbilical cord to become compressed by the fetal body parts or the uterine wall, reducing blood flow and oxygen to the fetus.

This can lead to fetal distress, hypoxia, and acidosis.

Choice B is wrong because fetal malposition is not directly caused by oligohydramnios.

Fetal malposition is when the fetus is in an abnormal position for delivery, such as breech, transverse, or face presentation.

This can increase the risk of complications during labor and delivery, such as cord prolapse, dystocia, or birth trauma.

Choice C is wrong because placental abruption is not directly caused by oligohydramnios.

Placental abruption is when the placenta separates from the uterine wall before delivery, causing bleeding and reduced blood flow to the fetus.

This can be triggered by trauma, hypertension, or cocaine use.

Choice D is wrong because premature rupture of membranes (PROM) is not directly caused by oligohydramnios.

PROM is when the amniotic sac breaks before the onset of labor, causing leakage of fluid and increased risk of infection.

This can be caused by infection, cervical incompetence, or mechanical factors.

A post-term newborn who has macrosomia is at risk of hypoglycemia because the fetus produces more insulin in response to the high glucose levels from the mother.

After birth, the glucose supply from the mother is cut off, but the newborn still has high insulin levels, which can cause low blood glucose.

A heel stick blood glucose test is done to monitor the newborn’s blood glucose level and prevent complications from hypoglycemia.

Choice B is wrong because hyperglycemia is not a common problem for post-term newborns with macrosomia.

Hyperglycemia occurs when there is too much glucose and not enough insulin in the blood.

This is more likely to happen in infants of diabetic mothers who have poor glycemic control during pregnancy.

Choice C is wrong because polycythemia is not related to insulin or glucose levels.

Polycythemia is a condition where there are too many red blood cells in the blood, which can cause increased blood viscosity and clotting.

This can happen in post-term newborns due to chronic hypoxia in utero, which stimulates erythropoietin secretion.

Choice D is wrong because anemia is not related to insulin or glucose levels.

Anemia is a condition where there are not enough red blood cells or hemoglobin in the blood, which can cause decreased oxygen delivery to the tissues.

This can happen in newborns due to blood loss, hemolysis, or decreased production of red blood cells.

The normal range for blood glucose in newborns is 40 to 80 mg/dL (2.2 to 4.4 mmol/L).

A heel stick blood glucose test should be done within the first hour of life and repeated as needed based on the results and clinical signs of hypoglycemia.

This is because phototherapy exposes the newborn to intense light that can damage the eyes and skin, and also increases water loss through the skin.

Eye shields protect the eyes from the light and a diaper prevents overexposure of the genital area.The newborn should also be turned frequently to expose different parts of the body to light.

Choice A is wrong because exposing the newborn to sunlight is not an effective treatment for hyperbilirubinemia and can cause sunburn.Choice C is wrong because breast milk does not interfere with phototherapy and breastfeeding should be continued as normal.Choice D is wrong because blood tests are not needed every 12 hours, but only when indicated by the bilirubin level or risk factors.

Normal bilirubin levels vary by age, gestational age, and risk factors.The American Academy of Pediatrics provides hour-specific nomograms for initiating phototherapy based on these factors.

A hematocrit value of 65% indicates polycythemia, which is an abnormally high number of red blood cells.

Polycythemia can occur in post-term newborns who have hypoxemia, which is a low level of oxygen in the blood.Hypoxemia stimulates the production of erythropoietin, a hormone that increases red blood cell formation.

Choice A.35% is wrong because it is below the normal range for newborns, which is 45% to 61%.

A hematocrit value of 35% would indicate anemia, which is a low number of red blood cells.

Choice B.45% is wrong because it is at the lower end of the normal range for newborns.

A hematocrit value of 45% would not indicate polycythemia or hypoxemia.

Choice C.55% is wrong because it is within the normal range for newborns.

A hematocrit value of 55% would not indicate polycythemia or hypoxemia.