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36. 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
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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
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E) Repeat the hematocrit determination
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why not c?
bloody amniotic fluid, had resp problems, grunting, Tachypnea etc
I am stuck <> C & E???
Pl. Discuss further!
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normal newborn hct 50-62%, hct is low but not very alarming. can repeat it.
this newborn had tachypnea and grunting but resolved spontaneuosly-can be transient tachypnea of newborn but no other sign of bleeding.
Apt test is done to find if blood of fetal or maternal origin.
What is the indication to evaluate that when newborn is now stable without any sign of distress/bleeding?
