A nurse is caring for a newborn who is 70 hours old in the newborn nursery. Exhibits For each assessment finding, click to specify if the finding is consistent with hypoglycemia or neonatal abstinence syndrome (NAS). Each finding may support more than one disease process.

Rationales for Each Condition Neonatal Abstinence Syndrome (NAS) Temperature: Infants experiencing NAS often have difficulty regulating body temperature due to autonomic instability. While the newborn's temperature of 36.6°C (97.9°F) is within normal range, the use of a radiant warmer suggests challenges in maintaining thermoregulation, which is characteristic of NAS. Jitteriness: Jitteriness is observed in both hypoglycemia and NAS. In NAS, it is caused by neurological excitability due to opioid withdrawal, leading to tremors and hypertonia, which improve with soothing measures such as swaddling. Skin Color: Mottling is a frequent sign in neonates experiencing opioid withdrawal due to autonomic dysregulation. The absence of cyanosis or jaundice indicates that the mottling is due to withdrawal rather than an underlying pathology. GI Assessment: Loose stools and hyperactive bowel sounds are typical signs of NAS, caused by increased gastrointestinal motility due to withdrawal from opioids. Hypoglycemia Jitteriness: Hypoglycemia is characterized by neuromuscular instability, leading to jitteriness. However, in this case, the newborn’s blood glucose level of 45 mg/dL is within acceptable neonatal range, making NAS a more likely explanation. Temperature, Skin Color, and GI Assessment: Hypoglycemia does not typically cause mottled skin or loose stools, making these findings more consistent with NAS.