You deliver two bottles of breastmilk for Tyler to the NICU. When you arrive, the nurse is assessing Tyler. You are watching and note that the nurse has documented the following: Temp 97.6F, HR 158, RR 42, CBG 42mg/dL. Which of the findings is most concerning?

In a NICU (Neonatal Intensive Care Unit) setting, it is crucial to closely monitor newborn vital signs to ensure their stability and health. In this scenario, four key vital signs are provided for Tyler:

Temperature (Temp): 97.6°F
Heart Rate (HR): 158 beats per minute
Respiratory Rate (RR): 42 breaths per minute
Capillary Blood Glucose (CBG): 42 mg/dL

Let's analyze each of these findings:

Temperature (Temp): A normal body temperature for a newborn ranges approximately from 97.7°F to 99.5°F. Tyler's temperature is slightly below the normal range, which indicates mild hypothermia, but this alone isn't the most concerning.
Heart Rate (HR): For newborns, a normal heart rate typically ranges from 120 to 160 beats per minute. Tyler's heart rate of 158 is within the normal range.
Respiratory Rate (RR): A normal respiratory rate for a newborn is usually between 30 and 60 breaths per minute. With a respiratory rate of 42, Tyler's breathing rate is also within the normal limits.
Capillary Blood Glucose (CBG): A normal blood glucose level for newborns is often above 45 mg/dL. Levels below this threshold are considered low and require urgent attention as they can lead to hypoglycemia, which is a potentially dangerous condition if not addressed promptly.

Among these findings, the Capillary Blood Glucose (CBG) level of 42 mg/dL is the most concerning. Hypoglycemia in newborns can result in harmful effects on the brain and other body organs, and it requires immediate intervention, often involving feeding and possibly intravenous glucose administration to normalize the blood sugar levels.

Therefore, the low blood glucose level is the critical finding that needs to be addressed to ensure Tyler's safety and well-being.