bluuebunny/crossref_metadata_2025 huggingface dataset:
A Case Study of Antenatal Distress and Consequent Neonatal Respiratory Distress
Authors: Uebel Patsy
Published: May 2012

CS, A 42-YEAR-OLD, GRAVIDA 2, para 1 Caucasian woman, presented at her private obstetrician’s office at 36 weeks gestation with a complaint of decreased fetal movement for 24 hours. Fetal heart tones were present, membranes were intact, and there were no contractions. The first pregnancy had resulted in preterm labor at 36 weeks with no neonatal complications. CS’s blood work indicated that she was type AB+, rubella immune, nonreactive rapid plasmin reagin (RPR) for venereal disease, hepatitis B surface antigen negative, and unknown group B streptococci status. Previous history was significant for herpes simplex, with no active disease during this pregnancy. CS was referred for a biophysical profile (BPP) and an oxytocin challenge test.
L. Joseph Butterfield: The Death of the Multidisciplinary Man
Authors: Karp Tracy
Published: May 2012

IT IS WITH GREAT SADNESS THAT WE CONTEMPLATE THE death of L. Joseph Butterfield, MD, who died on June 1, 1999, of a massive heart attack. Neonatal care, medicine, and especially neonatal nursing lost a great man.
Efficacy of Saline vs Heparin in Maintaining 24-Gauge Intermittent Intravenous Catheters in a Rabbit Model
Authors: Kyle Leigh , Turner Barbara
Published: May 2012

Purpose: The purpose of this study was to compare saline and heparin flushes in 24-gauge IV catheters.

Design: A double-blind experiment in four recorded trials was conducted using a rabbit model. Twenty-four-gauge catheters were placed in both auricle veins, and all catheters were secured in the same manner. Ampicillin was infused into each ear at the same interval, with each ear randomized to receive either the heparin solution or the saline solution.

Sample: The subjects were ten white New Zealand rabbits. Data were collected on 76 catheter sites.

Main Outcome Variable: Patency for each catheter was measured in hours and evaluated based on presence of warmth, erythema, induration, leakage, or occlusion.

Results: There was no significant difference in the duration of patency of the catheters between the two groups.
Problem-Based Learning in the NICU
Authors: Sudia-Robinson Tanya , Walden Marlene
Published: May 2012

PROBLEM-BASED LEARNING (PBL) is an excellent method for developing continuing-education activities for health care professionals. It provides a means of looking at a common clinical situation while examining current literature on the topic and thinking through possible courses of action and their consequences. PBL can be beneficial for new staff nurses and for nurses with years of experience in the NICU. This column examines the application of PBL in the NICU and includes a case study presented in PBL format.
African American Mothers’ Responses to Hospitalization of an Infant with Serious Health Problems
Authors: Shandor Miles Margaret , Wilson Sonja , Docherty Sharron
Published: May 2012

Purpose:To describe African American mothers’ experiences related to the hospitalization of an infant with serious health problems.

Design:Retrospective descriptive.

Sample:19 African American mothers with premature and term infants who were hospitalized at birth for serious health problems related to sequelae of prematurity or birth defect.

Main Outcome Variable:African American mothers’ recollections about the hospitalization of their seriously ill infant.

Results:The mothers worried primarily about when the baby could go home. Their greatest source of stress was separation from the infant. Seeing their sick infant was also stressful and evoked shock, fear, denial, guilt, and helplessness. Mothers sought hope by seeking information and cues from the infant and by praying to God. Mothers established a relationship with their infant by visiting regularly and by learning how to care for him. Some mothers feared getting attached to an infant who might die. Mothers’ highest source of satisfaction was support from the health care team.
Drug-of-Abuse Testing in the Neonate
Authors: Reinarz Susan , Ecord Jenny
Published: May 2012

DRUG ABUSE I S A MAJOR psychiatric problem in the U.S.1The American Academy of Pediatrics (AAP) Committee on Substance Abuse notes that increasing numbers of women are reported to use licit and illicit substances during pregnancy.2Statistical data are insufficient because of the difficulty in obtaining accurate information from a medical history, but as many as one in ten infants has been estimated to have been exposed to illicit drugsin utero. The reported incidence is higher in inner-city hospitals.3Some of these infants are known to be experiencing complications related to drug exposure during the neonatal period. Others may be sent home with undetected problems. Long-term health and well-being of the infant and family may be negatively influenced by the lack of identification of drug exposure. This concern has prompted increased efforts to identify the exposed infant and the substance to which the infant was exposed.
The Pineal Gland
Authors: Paquette Heidi
Published: May 2012

The pineal gland is located posterior to the midbrain and is the site of melatonin production. Research on pineal gland function in neonates is very limited. This article will discuss pineal gland development and the possible relationship between melatonin production and sudden infant death syndrome. Further research on pineal gland function is needed in order to establish its significance for the neonate.
Gentamicin Dosing Recommendations
Authors: Noerr Barbara
Published: May 2012

CONCURRENT ADMINISTRATION of an aminoglycoside (e.g., gentamicin) and a β-lactam antibiotic (e.g., ampicillin) is often the cornerstone of empiric therapy for neonatal infection. Once the determination is made to begin gentamicin therapy, how much to give (the dose) and how often to give it (the dosing interval) are the next decision points. Traditional neonatal gentamicin dosing schedules of 2.5 mg/kg/dose at intervals of every 12–24 hours (or longer in very premature neonates) are based on postnatal age and body weight.
Effects of Family Coping and Resources on Family Adjustment and Parental Stress in the Acute Phase of the NICU Experience
Authors: Pinelli Janet
Published: May 2012

Purpose:To determine the relationship between family coping and resources and family adjustment and parental stress in the acute phase of the NICU experience.

Design:Correlational study based on the Resiliency Model of Family Stress, Adjustment, and Adaptation. Main study instruments included the State Anxiety scale of the State-Trait Anxiety Inventory, the Family Inventory of Resources for Management, the Family Crisis Oriented Personal Evaluation Scales, and the General Functioning subscale of the McMaster Family Assessment Device.

Sample:Data collected from 124 mother and father pairs within two to four days of their infant’s admission to the NICU.

Main Outcome Variables:Family adjustment and parental stress.

Results:Adequate resources were more strongly related to positive adjustment and decreased stress than were either coping or being a first-time parent. The relationships among the variables were generally the same for both parents. Mothers utilized more coping strategies than did fathers.

Practice Recommendations:Families with limited resources should be identified early to facilitate their adjustment to the NICU.
Intraventricular Hemorrhage in the Term Infant
Authors: Fink Stacy
Published: May 2012

Intraventricular hemorrhage (IVH) in the term infant is an uncommon and unexpected diagnosis. This article examines the frequency of IVH in the term newborn; the pathogenesis behind IVH; the presentation according to the location, extent, and cause of the hemorrhage; the diagnosis, associated complications, management, and outcomes of infants with IVH; and nursing responsibilities. A case study is offered of a term infant who presented with seizures after a normal labor and delivery, was found to have bilateral Grade III hemorrhages, and proceeded to develop posthemorrhagic hydrocephalus. Her management and outcome to date are discussed.
Radiology Basics, Part VI: Pulmonary Sequestration, Periventricular/Intraventricular Hemorrhage, Embolization of Percutaneous Central Venous Catheters
Authors: Carey Barbara , Trotter Carol
Published: May 2012

THE CLINICIAN FREQUENTLY DEALS WITH INFANTS WHO present with respiratory distress and/or abnormal chest x-ray findings of undetermined etiology. One of the essential components in the process of patient evaluation is consideration of differential diagnosis with correlation to radiologic findings and clinical presentation. Sequestrations are estimated to account for 0.15–1.7 percent of all congenital pulmonary malformations.1Although rare, often asymptomatic, and frequently not presenting in the neonatal period, pulmonary sequestrations or bronchovascular foregut malformation anomalies (with or without respiratory distress) can result in abnormal radiographic findings and should be considered in the differential diagnosis.
Mother-Bingo Bonding: Screening for Gambling Addiction in the Neonatal Intensive Care Unit
Authors: Christensen Margaret , Patsdaughter Carol , St. Germain Monique
Published: May 2012

As the prevalence of gambling increases in society, problem or pathologic gambling in new mothers may interfere with the bonding process as well as with infant and child care. Although neonatal nurses routinely screen for maternal addictions to substances such as alcohol, cocaine, and heroin, they are less likely to be alerted to signs of gambling addiction in new parents. This article presents a case study of a mother with a bingo preoccupation, provides neonatal nurses with an overview of problem and pathologic gambling, presents brief interview questions and a standardized screening tool for assessing gambling problems in parents, and suggests areas for intervention.
Ethical Dilemmas and the Nurse Practitioner in the NICU
Authors: Juretschke Linda
Published: May 2012

With the emergence of advanced practice roles for nurses, including the role of the neonatal nurse practitioner (NNP), nurses are increasingly being placed in the position of making difficult decisions, especially in acute or emergency situations. NNPs, therefore, must have a working knowledge of the ethical decision-making process in order to make appropriate decisions at the bedside.
Parental Visits and Infant Care: Understanding Parents’ Needs
Authors: Griffin Terry
Published: May 2012

CONTINUING OUR DISCUSSION OF family visits to the NICU, this column focuses on parents who visit but do not actively provide care for their infant. An example might be parents who spend the night while their infant is in the intermediate care area of the NICU. The infant feeds orally and is close to discharge. The parents spend the night at the bedside, sleeping in chairs. Much to the nurses’ surprise, they do not offer to care for him. When the infant cries, the parents stir in their chairs but do not awaken and provide care to the infant. The parents are physically present and are capable of providing basic infant care, and yet they are not taking an active role in this process.
Neonatal Thermal Care, Part II: Microbial Growth Under Temperature Probe Covers
Authors: Blackburn Susan , DePaul Debra , Loan Lori , Marbut Kristie , Taquino Lauren , Thomas Karen , Wilson Suzanne
Published: May 2012

Purpose: To determine if temperature probe covers contribute to nosocomial infections by providing an environment for skin microbe colonization.

Design: Descriptive, comparative design with infants randomized into two groups: foam probe cover and hydrogel probe cover. Skin cultures were obtained 72 hours after cover placement. Bacterial growth was quantified after 24 and 48 hours. Skin integrity was assessed using visual irritations scores (VIS) every 5 minutes for 30 minutes following cover removal. ANOVA and ANOVA-RM were used to compare amounts of microbes and VIS scores between groups.

Sample: Twenty-six medically stable infants, 29 to 34 weeks gestational age, less than 10 days postbirth, and in an incubator.

Main Outcome Variable: Microbial growth and VIS.

Results: There were no statistically significant differences in microbial growth and VIS scores between groups (p >.05). Clinical significance was noted in VIS scores. Infants who had foam covers had more sustained irritation scores.
Neonatal Thermal Care, Part III: The Effect of Infant Position and Temperature Probe Placement
Authors: Blackburn Susan , DePaul Debra , Loan Lori , Marbut Kristie , Taquino Lauren , Thomas Karen , Wilson Suzanne
Published: May 2012

Purpose: Accurate management of infant temperature requires appropriate placement of temperature monitoring probes. Currently, there is a lack of consensus regarding placement of skin temperature probes and the effect on temperature monitoring of the infant’s lying on the probe. The objective of this study was to compare abdomen and back skin temperatures when infants were positioned supine and prone.

Design: A quasi-experimental design was used to randomize infants to prone or supine position. Infant back, abdomen, and axillary temperatures were measured at oneminute intervals with small disposable thermocouples over a one-hour period.

Sample: Twenty-three infants, weight 820–2,400 gm, gestational age 27–37 weeks, postnatal age three to ten days.

Main Outcome Variable: Gradient between abdomen and back temperature.

Results: Both mean abdomen and mean back temperatures differed significantly by position (t-test, p = .003 and .028, respectively). Weight and postnatal age did not have an effect on the mean difference between abdomen and back temperature. Results indicate that probe placement and infant positioning are important factors altering measurement of skin temperature.
What Every Nurse Needs to Know about Breast Pumping: Instructing and Supporting Mothers of Premature Infants in the NICU
Authors: Spicer Karen
Published: May 2012

Research has established that breast milk is the best source of nutrition for the premature infant. Because the infant is born prematurely, the mother will need support in expressing breast milk for her infant’s use. The clinical nurse has the opportunity to educate the mother on the importance of breast milk for the premature infant and to support the mother through the course of pumping. However, many nurses are not sufficiently educated in the physiology of lactation to adequately support the mother. The purpose of this article is to educate the bedside nurse in the physiology of lactation so that the mother is adequately assisted in expressing breast milk for her vulnerable infant.
Congenital Stridor
Authors: Gatz Joan
Published: May 2012

AHARSH, VIBRATING SOUND OF variable pitch, stridor implies partial airway obstruction resulting in turbulent airflow through a narrowed segment of airway.1 Stridor is characteristically heard on inspiration, suggesting airway obstruction above the glottis in either the larynx or the pharynx.2 Infants with upper-airway obstruction typically demonstrate prolonged inspiration.3 Expiratory stridor suggests lower-airway obstruction in the intrathoracic tracheobronchial tree.2 Stridor may also manifest as biphasic (both inspiratory and expiratory), usually indicating midtracheal lesions.4
Anemia of Prematurity
Authors: Salsbury Debra
Published: May 2012

Physiologic anemia is a common and normal finding in newborn infants. In preterm infants, anemia of prematurity is the result of this normal physiologic process compounded by the morbidity of prematurity. Premature infants reach their nadir hematocrit sooner and at a lower level than term infants do.

This article reviews the physiology of stem cell differentiation and the structure and function of the red blood cell, as well as examining red blood cell indices. It also addresses the etiology, symptomatology, diagnostic workup, and treatment/prevention modalities of anemia of prematurity. Treatment for and prevention of anemia of prematurity remain controversial, and specific criteria are lacking.
Ice Cream, Anyone?
Authors: Maguire Denise
Published: May 2012

THE REGARD AN ORGANIZATION holds toward its staff nurses is reflected in its organizational chart. In most hospitals, each service holds an equal position on the chart somewhere under the president. In turn, each of these services has its own chart, which, in part, illustrates the chain of command. The organizational chart often identifies lines of promotion and indicates how positions report directly and indirectly to others. A typical organizational chart in nursing has the chief of the department (vice president) at the top and directors underneath, followed by managers (Figure 1). The managers may have one or more departments listed under them, depicting the position of staff nurses in the organization.
Use of Methylene Blue to Treat Methemoglobinemia in Infancy
Authors: Zenk Karin
Published: May 2012

AN ABNORMALLY INCREASED concentration of methemoglobin in the blood (methemoglobinemia) occurs whenever there is an imbalance between oxidation and reduction of heme iron. Methemoglobin is a form of hemoglobin (the oxygen-carrying pigment of the red blood cells) in which heme iron has been oxidized to the ferric state, making it unable to transport oxygen (Table 1). Normally, methemoglobin is continuously formed at a slow rate by the oxidation of heme iron to the ferric state and is then enzymatically reduced back to hemoglobin. The enzyme NADH-methemoglobin reductase accounts for nearly all methemoglobin reduction. Other mechanisms for methemoglobin reduction include antioxidants such as vitamin C and glutathione. Methemoglobinemia occurs when more than 1 percent of hemoglobin is oxidized to methemoglobin; cyanosis occurs with methemoglobin levels of approximately 1.5 gm/dl.1 Table 2 shows the normal methemoglobin concentrations for infants of various ages.
Supplemental Oxygen Delivery to the Nonventilated Neonate
Authors: St. Clair Nancy , Touch Suzanne
Published: May 2012

Oxygen is one of the most commonly administered drugs in the neonatal intensive care unit. A variety of techniques exists to deliver oxygen to infants who are not on a ventilator or who are not receiving positive pressure. These techniques include oxygen hood, nasal cannula, face mask delivery or “free flow,” and “flooding” the incubator with oxygen. Because each technique has unique advantages and disadvantages, the choice is frequently dependent on style. Recent advances in incubator technology have improved the delivery of supplemental oxygen by incubator flooding. This technique is generally underutilized, but it has some advantages over the other modalities in certain clinical scenarios. The neonatal nurse needs to be aware of the characteristics of the various oxygen delivery technologies and the tools needed to optimally care for infants who are dependent on supplemental oxygen.
Twentieth Anniversary Times Two: Gifts for Our Readers
Authors: Rait Charles
Published: May 2012

IT MAY BE UNUSUAL, BUT NEONATAL NETWORK® IS GOING to celebrate two 20th anniversaries. The first 20th anniversary is next month. Just twenty years ago in October of 1981, the very first issue of Neonatal Network:® The Newsletter for Neonatal Nurses appeared. “Networking” was the hot topic of the day, and as we quoted at the time from the book, Networking,1 “It’s building a community of working women across professional and occupational lines....It’s helping each other to become more effective in the work world—with more clout, more money, more know-how, more self-confidence....It’s giving help, too, serving as a resource for other women.” Our goal in starting the newsletter was simple, and was simply stated: “By working together we can improve patient care and our own satisfaction as professional nurses.”
Making the Most of E-Mail
Authors: Fraser Askin Debbie
Published: May 2012

PERHAPS NOTHING HAS CHANGED THE face of communication more in the past ten years than the widespread use of electronic mail, or e-mail. More than 80 million Americans use e-mail, sending more than nine billion messages each day.1 Imagine sending a message to 2, 10, or 200 colleagues down the hall, across the country, or around the world. The message is transmitted instantly and received within seconds—all without postage or long-distance charges. No more telephone tag!
Sucrose for Neonatal Procedural Pain
Authors: Noerr Barbara
Published: May 2012

EFFECTIVE JANUARY 1, 2001, ALL hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) must comply with newly approved pain management standards.1Although such standards present us with an important opportunity to improve pain assessment and interventions for neonates, it is unfortunate that an accrediting body mandate provided the momentum for the now widespread interest in the management of neonatal pain.
Recognizing and Understanding the Cold-Stressed Term Infant
Authors: Hackman Pamela
Published: May 2012

Hypothermia is an important cause of morbidity—and occasionally mortality—in the newborn. This article explains the physiology of thermoregulation and thermogenesis in term infants. Subjects include the role of the hypothalamus in heat production, causes of and ways to prevent heat loss, and establishment of a neutral thermal environment. Complications associated with cold stress and their etiologies, as well as methods for rewarming an infant, are also addressed.
The Thymus Gland
Authors: Fraser Askin Debbie , Young Sandra
Published: May 2012

This article reviews the embryology, physiology, and pathophysiology of the thymus. The anatomy of this lymphoid organ, the significance of the presence or absence of the thymus radiographically, and the role of the thymus in immunity are also reviewed. Finally, the pathologic presentation of thymic hypoplasia (DiGeorge syndrome) is discussed. Despite advances in modern science, little was known about the thymus, one of the body’s key organs in the immune system, until 1961, when Dr. Jacques Miller performed thymectomies in mice. Then it became evident that the thymus played a key role in the body’s defense against infection. Since that time, researchers have continued to examine the role of the thymus from fetal life through adulthood.
Reference Accuracy in Neonatal-Maternal Nursing Literature
Authors: Oermann Marilyn , Wilmes Nancy , Braski Patricia
Published: May 2012

Purpose:To identify the frequency and types of reference errors in neonatal-maternal nursing literature. This study was an extension of earlier research on reference accuracy in pediatric and critical care nursing journals.

Design:A random sample was selected of references in three nursing journals:Neonatal Network: The Journal of Neonatal Nursing; Journal of Obstetric, Gynecologic, and Neonatal Nursing; and The American Journal of Maternal/Child Nursing.References were compared against original publications, and errors were classified as major or minor based on criteria used in earlier studies.

Results:Fifty-four of the 221 references had errors, for an overall error rate of 24.4 percent. Major errors were found in 21.3 percent of the references, and minor errors were calculated at 3.2 percent. Errors in the author’s name were most common, followed by errors in titles of articles and books. The rates of reference errors in this study were lower than those reported previously in the nursing and medical literature.
Posthemorrhagic Hydrocephalus: A Complication of Intraventricular Hemorrhage
Authors: Kirby Cindy
Published: May 2012

SURVIVAL OF PREMATURE AND LOW birth weight (LBW) neonates has increased in the past decade, and it continues to improve with recent advances in neonatal care. The use of antenatal corticosteroids and surfactant has played a major role in the improved survival of these LBW infants. Stevenson and colleagues documented survival-to-discharge rates of 49 percent for infants weighing 501–750 gm at birth, 85 percent for those 751–1,000 gm, 93 percent for those 1,001–1,250 gm, and 96 percent for those 1,251–1500 gm. With increasing survival rates, developmental outcome remains a concern, particularly in the lowest birth weight groups. Approximately 32 percent of very low birth weight (VLBW) infants (defined as weighing 501–1,500 gm) show evidence of intracrenial hemorrhage.
Infant Crying: Nature, Physiologic Consequences, and Select Interventions
Authors: Ludington-Hoe Susan , Cong Xiaomei , Hashemi Fariba
Published: May 2012

This article describes the nature of infant crying, the physiologic events and changes associated with it, and appropriate nursing interventions for infant crying. A cry is a series of four movements that basically resembles a Valsalva maneuver. Documented immediate and long-term sequelae of crying include increased heart rate and blood pressure, reduced oxygen level, elevated cerebral blood pressure, initiation of the stress response, depleted energy reserves and oxygen, interrupted mother-infant interaction, brain injury, and cardiac dysfunction. Caregivers are encouraged to answer infant cries swiftly, consistently, and comprehensively. Kangaroo care is an efficient method for preventing, minimizing, and halting crying. Other interventions for crying include swaddled holding, a pacifier, sugar water, a sweet-tasting nonsucrose solution, heartbeat sounds, distraction by lullabies or mother’s voice, rhythmic movement, and reduction of external stimuli.
Dysphagia and Oral Feeding Problems in the Premature Infant
Authors: Wilson Jones Martha , Morgan Elaine , Shelton Jean
Published: May 2012

FEEDING DISORDERS AND dysphagia are common problems seen in premature infants following their discharge from the NICU. A major factor in the growing incidence of these problems is the number of infants born and surviving between 23 and 25 weeks gestational age, which has increased dramatically over the past decade. These infants experience both a lengthier exposure to noxious oral stimuli and a longer time until they develop the suck/swallow coordination that makes oral feeding safe.1 Oral feeding is generally not offered before 32–34 weeks gestational age, when the preterm infant’s sucking pattern begins to resemble that of a term infant.2,3 Therefore, there may be an 8- to 9-week lag between birth and oral feedings in a 23- or 24-week gestational age infant.
Profound Early-Onset Neonatal Anemia: A Case Study
Authors: McArthur Amy
Published: May 2012

B.G. WAS A 38 6/7-WEEK GESTATIONAL age female born to a 29-year-old G2 P0, O+ (antibody negative), rubella immune, RPR nonreactive, GC negative, HepBsAg negative, GBS negative, HIV negative mother. The pregnancy was uncomplicated. The mother had received prenatal care starting in the first trimester. There was no reported history of hydrops fetalis. Thick meconium was noted on artificial rupture of the membranes six hours prior to delivery.
Congenital Cystic Adenomatoid Malformation of the Lung
Authors: Pittman Liz
Published: May 2012

CONGENITAL CYSTIC ADENOMATOID malformation (CCAM) of the lung is a rare, multicystic lesion with embryonic origins. Approximately 421 cases have been documented since the lesion was first described in 1949.1Usually, only one lobe is affected, most often the lower lobe.2CCAM represents 25 percent of all congenital lung lesions.3There is no race predominance, nor is there a left- or right-side trend.4Males may be at greater risk than females for CCAM development.5
Developmental Considerations for Resuscitation of the VLBW Infant
Authors: Thigpen Janet
Published: May 2012

The survival rates for very low birth weight (VLBW) infants continue to increase while the morbidity rates show little improvement. Negative outcomes have been associated with hypoxia, hyperoxia, hypocarbia, barotrauma, intraventricular hemmorhages, metabolic acidosis, cold stress, and overwhelming stimuli. Protection from iatrogenic harm must always be provided for the extremely fragile infant. Standards for resuscitation of the VLBW infant in the delivery room need to be expanded to reflect the physiologic and developmental care requirements. In this article, guidelines are proposed to address these needs.
The History of Neonatal Resuscitation
Authors: Zaichkin Jeanette , Wiswell Thomas
Published: May 2012

Attempts at human resuscitation date back to ancient times. Most strategies for resuscitation focused on adults until the early 1800s, when newborn resuscitation captured the interest of noted practitioners. The most promising techniques and strategies for neonatal resuscitation were developed during the latter part of the twentieth century. This article examines the key components of neonatal resuscitation and the discoveries that stimulated the development of current neonatal resuscitation practices.
Discussion Groups: Staying in Touch
Authors: Fraser Askin Debbie
Published: May 2012

IN THE PREVIOUS COLUMN OF THIS series (October 2001), we reviewed the ins and outs of e-mail. An e-mail address is essential for staying in touch with colleagues around the world. An email address also opens the door to discussion groups, another avenue for keeping up with changing clinical trends. This column examines the workings of a discussion group and provides you with the addresses of several perinatal and neonatal groups.
Perinatal Brain Injury in the Premature Infant
Authors: Wilson Jones Martha , Bass W. Thomas
Published: May 2012

APPROXIMATELY 85 PERCENT OF infants with birth weights ≤1,500 gm now survive.1 Infants with birth weights <1,000 gm—the group contributing most to this increase in survival—have the greatest incidence of brain injury. Overall, the rates of neurologic disability have remained the same; therefore, the survival of more high-risk infants has increased the absolute number of NICU graduates with neurologic deficits.2–4 This concerns all involved in the care and lives of premature infants.
Mean Noise Amounts in Level II vs Level III Neonatal Intensive Care Units
Authors: Levy Gary , Woolston Dixie , Browne Joy
Published: May 2012

Purpose:To compare mean noise amounts in Level II NICUs with those in Level III NICUs after controlling statistically for the number of infants per unit.

Study design:A between-group design was used in measuring noise amounts.

Sample:Noise amounts were sampled using a central site procedure during two time periods of approximately 25 minutes each (total time approximately 50 minutes) in five Level II NICUs and seven Level III NICUs in Colorado.

Main outcome variable:Average noise amounts (in dB) from two time periods of approximately 25 minutes each (total time approximately 50 minutes).

Results:Mean noise amounts were significantly higher in Level III NICUs (mean = 54.89 dB) than in Level II NICUs (mean = 49.07 dB). This result remained statistically significant even after correcting statistically for total number of babies present in each NICU during noise measurements.
The Latest in the Literature
Authors: Rasmussen Lynn
Published: May 2012

This column presents abstracts of recently published research studies and evidence-based practice guidelines of interest to those who care for neonates. These abstracts, printed as written by the authors, have been chosen from peer-reviewed journals in order to provide readers of Neonatal Network:®The Journal of Neonatal Nursing with a timely glimpse at the state of the science. A short commentary regarding the studies and topics is provided.
Fetal Alcohol Syndrome
Authors: Wilson Jones Martha , Thomas Bass W.
Published: May 2012

FETAL ALCOHOL SYNDROME (FAS) is the leading known cause of mental retardation and birth defects in the world.1,2 It is caused by in utero exposure to alcohol and is entirely preventable. Because alcohol is a known teratogen and the damage done to a fetus by alcohol exposure is permanent, public education about the dangers of prenatal alcohol exposure has been extensive. Nevertheless, alcohol is a widely accepted and legal social drug, and many pregnant mothers continue to drink it while pregnant. Other mothers drink before they are aware of their pregnancy. This column provides information regarding the incidence of FAS, its etiology, spectrum of effects, and diagnosis. We also discuss potential disabilities that these infants may face as they grow and suggest how to work effectively with the families.
VATER Association
Authors: Spoon Janie
Published: May 2012

VATER ASSOCIATION WAS FIRST described in 1973 as a nonrandom group of related defects, as follows: V = vertebral defects, A = anal atresia, TE = tracheoesophageal fistula, R = radial limb dysplasia.1Since that time, various expansions of the acronym have been suggested in an effort to further define the scope of the VATER association. Temtamy and Miller expanded the V in VATER to include vascular anomalies, specifically, ventricular septal defect and single umbilical artery.2An expansion of the acronym to VACTERL has been suggested, with theCdenoting cardiovascular anomalies and theLdenoting limb anomalies.3The designation of VATER or VACTERL association can be made for infants with at least three of the defects designated in the acronym.4
Single-Room Infant Care: Future Trends in Special Care Nursery Planning and Design
Authors: Henry Bowie Bonnie , Hall Richard , Faulkner Janet , Anderson Barbara
Published: May 2012

For the past several years, health care providers specializing in the treatment of neonates have been working steadily to improve the environment for premature and sick neonates in order to optimize outcomes. They have also begun to recognize that involving the family in every aspect of care not only has positive value for the family, but can improve outcomes for neonates as well. This article examines how the staff at one hospital closely utilized and married these two concepts, developmentally supportive care and family-centered care, to design a Level II special care nursery that embraces parents as partners in treatment. Each phase of design development is described, including space programming, schematic design, environmental design, and design development, as well as the successful use of a multidisciplinary team.
Gastroschisis: Etiology, Diagnosis, Delivery Options, and Care
Authors: King John , Fraser Askin Debbie
Published: May 2012

Gastroschisis, one of the more common congenital abdominal wall defects, results in herniation of fetal abdominal viscera into the amniotic cavity. This article discusses theories about gastroschisis etiology,in uterodiagnostic tools, delivery options, and postdelivery care. Included are detailed considerations regarding immediate interventions after delivery to support the infant’s thermal and fluid management needs and to protect the exposed bowel. Surgical options and postoperative care issues and complications are reviewed, as are respiratory distress and vena cava compression from increased abdominal pressure, nutritional support, and interventions related to the prevention of infection. Giving birth to an infant with gastroschisis is an upsetting experience for parents. Evidence suggests, however, that with today’s advances in neonatal care and nutrition and with meticulous attention, the survival rate for infants born with gastroschisis can be excellent.
Early Recognition of Infant Malignancy: The Five Most Common Infant Cancers
Authors: Lin Yi-Chih
Published: May 2012

The incidence of cancer in children is rising in the U.S. Although cancer in the first year of life is relatively rare, understanding the early signs and symptoms of and the historical factors associated with most common infant cancers is essential for providing optimal care to these infants and their families. Neonatal nurses and nurse practitioners play a pivotal role in early recognition and detection of infant malignancy. This article reviews the incidence of and historical factors associated with infant cancers and discusses clinical presentations and available diagnostic images as well as screening tools for the five most common types of infant malignancy.
The Best NICU in America 2003 White Plains Hospital Center, White Plains, New York
Authors: Juretschke Linda
Published: May 2012

TOGETHER WITH THE NURSING STAFF OF THE NEONATAL ICU at White Plains Hospital Center, I would like to pay tribute to a very special physician, Dr. Jesus Jaile-Marti, the Director of our NICU. It is because of Dr. Jaile-Marti and the compassion he has for both his nursing family and his babies, that we are blessed to work in the ‘Best NICU in America!!’
Kangaroo (Skin-to-Skin) Care with a Preterm Infant Before, During, and After Mechanical Ventilation
Authors: Swinth Joan , Cranston Anderson Gene , Hadeed Anthony
Published: May 2012

Using kangaroo care (KC) with unstable and/or ventilated infants remains controversial. In this article, potential advantages for ventilated infants and their mothers are discussed. The 33-week-gestation infant in this case study presented with mild respiratory distress at birth, requiring supplemental oxygen at hour 2. With no improvement by hour 18, KC was also begun, first for 1.25 hours and then, 2 hours later, for 3.5 hours. The infant was intubated at hour 45 for increasing respiratory distress, and KC resumed 24 hours later for 1 hour and 3 hours after that for an additional 3 hours. Extubation occurred at hour 90. Kangaroo care resumed 2 hours later for periods of 1.5, 1.5, and 1 hour over the next 8 hours, 2.5 hours more later that day (day 5, the last day of data collection). Thereafter, KC was done intermittently until discharge on day 9. Total KC times for pre-vent, vent, and immediate post-vent periods were 4.75, 4, and 6.5 hours, respectively. The data from this study suggest that KC may assist in, rather than retard, recovery from respiratory distress. KC may also foster maternal relaxation and minimize maternal stress.
Physiologic Effects of CPAP: Application and Monitoring
Authors: Irwin Sherman Tami , Blackson Thomas , Touch Suzanne , Greenspan Jay , Shaffer Thomas
Published: May 2012

Although a wide array of respiratory care modalities has been employed to manage neonatal respiratory distress syndrome (RDS), the recent focus has emphasized strategies that correct lung pathophysiology while protecting the lung from further insult. Continuous positive airway pressure (CPAP) has remained a viable option for NICU infants since its introduction in 1971. Current methods of monitoring allow clinicians to troubleshoot and better understand the physiologic and clinical impact of administering CPAP to neonates with RDS. This article highlights the renewed interest in CPAP therapy and current methods of monitoring.
A Christmas Story
Authors: Norris Burkes Chaplain
Published: May 2012

OUR CHRISTMAS TREE IS CROOKED. It’s one of those halfpriced jobs you buy at those after-Christmas sales. You know the kind: Everything that was marked up 200 percent before Christmas is cut by 50 percent the day after so that you pay only half again what the item is really worth. Actually, because of its pronounced tendency to lean, our tree is nearly worthless. And my wife doesn’t help matters when she wraps the tree in more lights than Mickey puts in Disney’s Magical Light Parade.
Narratives and Embodied Knowing in the NICU
Authors: Ringham Catherine
Published: May 2012

The author draws on narratives as an illustration of embodied knowledge and argues for the importance of using embodied knowing to inform ethical decisions in the neonatal setting. Nurses have a unique perspective of the complex care associated with neonatal intensive care (NIC). NIC nurses listen to parent’s stories and share their own practice stories, leading to an intimate appreciation of a family’s particular response to their health care experience. These narratives can deepen understanding of how nurses go about doing their everyday work, describe experiences in everyday practice, and help the writer come to terms with traumatic events. Moreover, nurses’ narratives provide a voice, an expression of their embodied knowledge. By telling and listening to nurses’ stories, we can better understand how embodied knowledge supports families in crisis. The narratives in this article are examples of the challenges neonatal nurses face in using embodied knowing to enhance relationships with families. These narratives may help nurses to reflect on their practice and cultivate relationships with families in the NICU.
Pain Management, Morphine Administration, and Outcomes in Preterm Infants: A Review of the Literature
Authors: Kaneyasu Maya
Published: May 2012

Infants in the Neonatal Intensive Care Unit may experience a myriad of painful procedures and stressful experiences. Pain management for infants requiring mechanical ventilation is complex and challenging especially in the preterm population. Many infants may not receive analgesia, primarily due to the unknown long-term neurodevelopmental effects of morphine exposure on the developing brain. Currently, there is no consensus on how to treat pain related to mechanical ventilation due to conflicting scientific evidence lacks clarity and certainty about the role of morphine in pain in preterm infants. The Advance Practice Neonatal Nurse must make the best use of available information about morphine analgesia for the preterm infant, and use it to guide policy and practice for infants. The Advance Practice Neonatal Nurse must use his/her clinical expertise to judicially balance the risks and benefits of morphine analgesia, when used, and tailor the treatment plan to each infant’s specific needs.
Quality Improvement for Neonatal Nurses, Part I: A Framework for Advancing the Quality and Safety of Care
Authors: Marcellus Lenora , Harrison Adele
Published: May 2012

Quality improvement (QI) and patient safety are becoming increasingly powerful drivers for health care planning and delivery. In this two-part series, the concept of QI will be introduced and implications for neonatal nursing care will be discussed. Part I reviews trends in the fields of QI and patient safety and introduces how neonatal practitioners are currently taking up QI and patient safety in their practice. Part II, to come, is titled “Using a Plan-Do-Study-Act Process to Introduce a Step-wise Framework for Establishing Oral Feeds in Premature Infants” will present the QI process “in action” by describing a QI project conducted in a Level III NICU on introducing and testing a new process for improving the transition from tube to oral feeding for preterm infants.
Oral Feeding Readiness in the Neonatal Intensive Care Unit
Authors: Jones Luann R.
Published: May 2012

Oral feeding is a complex sensorimotor process that is influenced by many variables, making the introduction and management of oral feeding a challenge for many health care providers. Feeding practice guided by tradition or a trial-and-error approach may be inconsistent and has the potential to delay the progression of oral feeding skills. Oral feeding initiation and management should be based on careful, individualized assessment of the NICU infant and requires an understanding of neonatal physiology and neurodevelopment. The purpose of this article is to help the health care provider with this complex process by (a) defining oral feeding readiness, (b) describing the importance of oral feeding in the NICU and the physiology of feeding, and © providing a review of the literature regarding the transition from gavage to oral feeding in the NICU.
Adsorption of crystal violet from aqueous solution onto sugarcane bagasse: central composite design for optimization of process variables
Authors: Chakraborty Sagnik , Chowdhury Shamik , Saha Papita Das
Published: May 2012

The adsorption of crystal violet (CV) from aqueous solution by sugarcane bagasse (SCB), an agro-industrial residue, was investigated in a batch experimental setup. A two level four factor (24) full factorial central composite design (CCD) with the help of Design Expert Version 7.1.6 (Stat-Ease, USA) was used for adsorption process optimization and evaluation of interaction effects of different operating parameters: agitation speed (80–180 rpm), initial solution pH (4.0–8.0), initial dye concentration (100–200 mg L–1), and adsorbent dose (2–5 g L–1). A multiple coefficient of determination (R2) value of 0.98, model F value of 266.36 and its low P-value (<0.0001) along with lower value of coefficient of variation (2.70%) indicated the fitness of the response surface quadratic model developed during the present study. Numerical optimization applying desirability function was used to identify the optimum conditions for maximum removal of CV. The optimum conditions were found to be agitation speed = 165 rpm, initial solution pH = 8.0, initial dye concentration = 200 mg L–1 and adsorbent dose = 2.0 g L–1. A confirmatory experiment was performed to evaluate the accuracy of the optimization procedure and maximum CV removal of 93.21% was achieved under the optimized conditions.
Cork industry wastewater characterization: assessment of the biodegradability, reuse and of the relationship between BOD, COD and tannins with TOC
Authors: Santos Ana , Bernardo Marisa , Vespeira Carla , Cantinho Paula , Minhalma Miguel
Published: May 2012

Cork processing involves a boiling step to make the cork softer, which consumes a high volume of water and generates a wastewater with a high organic content, rich in tannins. An assessment of the final wastewater characteristics and of the boiling water composition along the boiling process was performed. The parameters studied were pH, color, total organic carbon (TOC), chemical and biochemical oxygen demands (COD, BOD5, BOD20), total suspended solids (TSS), total phenols and tannins (TP, TT). It was observed that the water solutes extraction power is significantly reduced for higher quantities of cork processed. Valid relationships between parameters were established not only envisaging wastewater characterization but also to provide an important tool for wastewater monitoring and for process control/optimization. Boiling water biodegradability presented decreasing values with the increase of cork processed and for the final wastewater its value is always lower than 0.5, indicating that these wastewaters are very difficult to treat by biological processes. The biodegradability was associated with the increase of tannin content that can rise up to 0.7 g/L. These compounds can be used by other industries when concentrated and the clarified wastewater can be reused, which is a potential asset in this wastewater treatment.
Liberating Intercultural Technical Communication from “Large Culture” Ideologies: Constructing Culture Discursively
Authors: Agboka Godwin
Published: May 2012

Although contemporary writers on culture have argued for more dynamic approaches to culture in intercultural technical communication scholarship, much of the theoretical position on culture is still heavily based on “large culture” ideologies. Yet, not only do these ideologies fail to account for cultural practices and values within less comprehensive groups within culture, but they do not accommodate the inputs individuals make in specific communication contexts. This article draws from the existing body of work and the critical cultural perspectives on culture advocated by contemporary anthropologists and sociologists, mainly Arjun Appadurai (1996), to argue that we construct culture discursively to address cultural issues in intercultural technical communication. A discursive paradigm of culture sees culture as “socially constructed” in which culture is under construction and reconstruction by active cultural actors, who construct their identities and negotiate systems of knowledge and meaning that come to play during intercultural contacts.