07-27-2006, 09:53 AM
An 8-hour-old neonate, who was born via cesarean delivery at 38 weeks' gestation, is in the neonatal unit. The cesarean delivery was done due to fetal distress. The mother is a healthy 25-year-old woman and this was her first pregnancy. There were no complications during the pregnancy, but bloody amniotic fluid was noted at the time of delivery. The neonate's Apgar score was 8 at 1 minute and 9 at 5 minutes; points were taken off for color only. At 30 minutes of age the infant was noted to have some mild grunting and tachypnea. These symptoms resolved spontaneously during approximately a 40-minute period, but the on-call physician ordered a complete blood count and blood culture for suspected sepsis. Because the symptoms resolved so quickly, no antibiotic therapy was started. You are now satisfied that further pursuit of infectious problems is not indicated. The neonate appears normal, and the mother's initial attempts at breast-feeding seem successful. Laboratory studies on the neonate return and are normal except for a hematocrit of 40% (N=4565). Maternal and infant blood type are both O, Rh-positive. The best course of action at this time is to do which of the following?
A
) Obtain hematology consultation
B
) Obtain serum iron studies, including total iron-binding capacity
C
) Order an Apt test on the neonate's stool
D
) Order hemoglobin electrophoresis
E
) Repeat the hematocrit determination
A
) Obtain hematology consultation
B
) Obtain serum iron studies, including total iron-binding capacity
C
) Order an Apt test on the neonate's stool
D
) Order hemoglobin electrophoresis
E
) Repeat the hematocrit determination