What initial sign should the nurse recognize as indicating hypoglycemia in a neonate?

The initial sign that indicates hypoglycemia in a neonate is typically lethargy. In newborns, low blood sugar levels can lead to a variety of symptoms, and lethargy is a key indicator that the baby is not getting enough glucose to maintain energy levels. This decreased level of alertness and responsiveness can be alarming and is clinically significant because the neonate's brain depends heavily on glucose for energy.

While acrocyanosis, bradycardia, and jaundice can occur in neonates, they are not specific indicators of hypoglycemia. Acrocyanosis reflects a temporary condition of peripheral circulation and not a direct indication of glucose levels. Bradycardia can denote a variety of underlying issues, not solely linked to hypoglycemia, and jaundice pertains to bilirubin levels rather than glucose levels. Understanding that lethargy is associated with insufficient energy supply emphasizes the critical nature of monitoring blood sugar levels in neonatal care.