Question

A client's gestational diabetes is poorly controlled throughout her pregnancy. She goes into labor at 38 weeks and gives birth. Which priority intervention should be included in the plan of care for the neonate during the first 24 hours?

1) Administer a bolus of dextrose IV.
2) Administer insulin subcutaneously.
3) Avoid oral feedings.
4) Provide frequent early feedings with formula.

Answer 1

The neonate born from a mother with poorly controlled gestational diabetes should receive frequent early feedings with formula or breast milk to prevent hypoglycemia, and may require a bolus of dextrose IV if blood sugar does not improve with initial feedings. Insulin administration is not recommended for these neonates.Hence, option 1 and 4 are the correct options.

Step-by-step explanation:

The priority intervention that should be included in the plan of care for a neonate born from a mother with poorly controlled gestational diabetes during the first 24 hours is to provide frequent early feedings with formula or breast milk, if available. The reason for this approach is due to the baby's increased risk of hypoglycemia after birth. The mother's high blood sugar levels can lead to the fetus producing extra insulin, which can make the baby's blood sugar drop too low once they are born and no longer receiving glucose via the placenta.

Those interventions like administering a bolus of dextrose IV may be necessary if the infant's blood sugar is critically low and does not respond to initial oral feedings. Administering insulin subcutaneously is generally not recommended for neonates with hypoglycemia, the excessive insulin as a response to maternal hyperglycemia is the issue, not deficiency. Avoiding oral feedings would not be beneficial and could lead to worsening hypoglycemia.