bluuebunny/crossref_metadata_2025 huggingface dataset:
Carbon/carbon implants in oral and maxillofacial surgery – Part 2
Authors: Sebők Béla , Kiss Gábor , Szabó Péter János , Rigler Dániel , Molnár László Milán , Dobos Gábor , Réti Ferenc , Szőcs Hajnal , Joób F. Árpád , Körmöczi Kinga , Szabó György
Published: May 2012

In their previous report, the authors presented observations regarding the long-term application of carbon/carbon implants. After evaluating the good functional and aesthetic results, the effect of the human body on the structure and morphology of the implants was investigated with state of the art methods. An implant retrieved from the body after eight years was compared to implants which were sterilized but not implanted (reference). Carbon and oxygen were the main components of both implants, however, as a result of the interaction with the human body the amount of oxygen increased 3–4 times and phosphorus, sulphur, calcium and iron were detectable as trace elements on the surface. The width of the carbon fibres (5–7 µm) building up the implants was not changed during the interaction with the human body. The surface of the implant retrieved from the human body was covered with a 15–17 µm thick layer, not present on the reference implant, having a similar composition to that of the carbon fibres (high amount of calcium that is typical to bone tissue was not detected). According to these results, the structure and the morphology of the implants were not altered notably by the human body. Orv. Hetil., 2012, 153, 744–750.
Traditional Chinese medicine: theoretical background and its use in China
Authors: Oravecz Márk , Mészáros Judit
Published: May 2012

This paper aims to define the concept of traditional Chinese medicine. Chinese medicine has its own unique system of knowledge, which fundamentally defines all of its therapeutic procedures (acupuncture, manual therapy, and Chinese herbal medicine). The authors offer a detailed description of the theoretical basics of Chinese medicine: classification of the normal and pathological processes of the human body based on functional models and a high degree of therapeutic individualization. The authors describe the current practice of Chinese medicine based on the Chinese model, without which modern Chinese medicine cannot exist. This concept pervades the education, clinical practice and research of Chinese medicine. If we hope to adequately satisfy scientific inquiry about Chinese medicine, we must first define its theoretical background and get acquainted with its scope of usage in modern China. The clarification of these basic issues will be beneficial to scientific research and legislative procedures. Orv. Hetil., 2012, 153, 723–731.
Evaluating the predictive abilities of community occupancy models using AUC while accounting for imperfect detection
Authors: Zipkin Elise F. , Grant Evan H. Campbell , Fagan William F.
Published: May 2012

The ability to accurately predict patterns of species' occurrences is fundamental to the successful management of animal communities. To determine optimal management strategies, it is essential to understand species–habitat relationships and how species habitat use is related to natural or human‐induced environmental changes. Using five years of monitoring data in the Chesapeake and Ohio Canal National Historical Park, Maryland, USA, we developed four multispecies hierarchical models for estimating amphibian wetland use that account for imperfect detection during sampling. The models were designed to determine which factors (wetland habitat characteristics, annual trend effects, spring/summer precipitation, and previous wetland occupancy) were most important for predicting future habitat use. We used the models to make predictions about species occurrences in sampled and unsampled wetlands and evaluated model projections using additional data. Using a Bayesian approach, we calculated a posterior distribution of receiver operating characteristic area under the curve (ROC AUC) values, which allowed us to explicitly quantify the uncertainty in the quality of our predictions and to account for false negatives in the evaluation data set. We found that wetland hydroperiod (the length of time that a wetland holds water), as well as the occurrence state in the prior year, were generally the most important factors in determining occupancy. The model with habitat‐only covariates predicted species occurrences well; however, knowledge of wetland use in the previous year significantly improved predictive ability at the community level and for two of 12 species/species complexes. Our results demonstrate the utility of multispecies models for understanding which factors affect species habitat use of an entire community (of species) and provide an improved methodology using AUC that is helpful for quantifying the uncertainty in model predictions while explicitly accounting for detection biases.
The Influence of Equipment Weights on Neonatal Daily Weight Measurements
Authors: Goetz Hermansen Mary , Hermansen Marcus
Published: May 2012

Purpose: To determine the weight of commonly used pieces of neonatal equipment that can affect the accuracy of daily weight measurements.

Design and sample: Twenty-one pieces of equipment commonly attached to the neonate at the time of daily weight measurement were selected for analysis. Three examples of each piece of equipment were weighed; each one was weighed three times. All weights were obtained using a digital electronic diaper scale calibrated to 1 gm accuracy and precision.

Main outcome variable: Average weights for pieces of routine nursery equipment.

Results: Equipment weights ranged from 1 gm for an umbilical catheter to 23 gm for a pulse oximeter probe. There was no variation among the individual examples for 19 of the 21 pieces of equipment. There was a small variation in weight for the pulse oximeter probe and the arm board, but these variations were of no clinical significance.
Assessment of the Newborn with Dysmorphic Features
Authors: Bodurtha Joann
Published: May 2012

Accurate assessment of all newborns is essential for identifying those who will need more thorough examination, medical or support services, or family counseling. External assessment of dysmorphic features offers clues to the presence of internal anomalies. This article describes a systematic approach to the assessment of dysmorphic features in the newborn.
A Survey of Skin Care Practices for Premature Low Birth Weight Infants
Authors: Ann Munson Karen , Bare Diane , Hoath Steven , Visscher Marty
Published: May 2012

Purpose:To provide baseline information about current skin care practices in premature low birth weight infants (<1,000 gm birth weight) in typical NICUs within the U.S.

Design:Descriptive survey.

Sample:104 hospitals with at least 2,500 deliveries per year and at least 20 Level III NICU beds.

Main Outcome Variables:Environmental conditions, bathing practices and products, adhesive products used to secure IVs and endotracheal tubes, skin protectants used with diaper rash, treatment systems for fragile preterm skin, and treatment systems for denuded skin.

Results:Most units surveyed based their premature low birth weight skin care protocols on a combination of gestational age and birth weight criteria. One-quarter of the units had no skin care protocols at all. Among the units, there was considerable practice variation with respect to common nursing procedures such as bathing, adhesive application, and wound care.
Complete Congenital Heart Block: A Review and Case Study
Authors: Reneé Klassen Lisa
Published: May 2012

Complete congenital heart block (CCHB) is a rare disease of the newborn that carries significant morbidity and mortality. It generally occurs as a result of the presence of maternal autoantibodies that are transferred to the fetus and affect the fetal heart, or it may be associated with a congenital structural abnormality of the heart.

Infants with CCHB are at risk for diminished cardiac output and the subsequent development of congestive heart failure. Many infants require the placement of a cardiac pacemaker.

It is essential that the nurse caring for these infants have a good understanding of the disease process and be familiar with the unique problems that these infants and their families may encounter.
Spironolactone
Authors: Noerr Barbara
Published: May 2012

DIURETICS ARE COMMONLY USED IN the neonatal intensive care unit (NICU) to remove excess extracellular fluid secondary to various diseases, such as chronic lung disease (CLD) and congestive heart failure (CHF). Diuretics are among the most used of all medications across age groups. They are also among the most abused medications, with the potential for many untoward side effects.3,4Thus, NICU nurses must understand their appropriate use, their possible consequences, and the monitoring required when using them. Furosemide and chlorothiazide have been reviewed previously (see Neonatal Network, 1991, 9(7): 65–67, and 1993, 12(7): 69–70, respectively). This column focuses on spironolactone use.
Implications for Nursing of the Human Genome Project
Authors: Munro Cindy
Published: May 2012

Information obtained from the Human Genome Project, initiated in 1990 and targeted for completion in 2005, will influence both health care and nursing practice. It will substantially revise our understanding of disease susceptibility and causation. Additional genetic tests will be developed and gene therapies explored. The project has implications for both nursing research and nursing practice. This article reviews the establishment of the Human Genome Project, reports on current progress of the project, and identifies some implications of the project for health care generally and nursing specifically.
Notes from England
Authors: Gras Lynn
Published: May 2012

“Bowels opened?”
Fragile X Syndrome
Authors: Welch Judy , Williams Janet
Published: May 2012

Fragile X syndrome is the most common inherited condition causing mental retardation in males. Females with the full mutation expansion can have milder signs of the disorder. Families with members who have been diagnosed with fragile X syndrome face concerns about the health of their newborn infant, decisions regarding family planning, and questions about the possibility that other family members could have this disorder. Neonatal nurses participate in assessment, health care management, counseling, and referral of the families regarding this syndrome.
Visitation Patterns: Parents Who Visit “Too Little”
Authors: Griffin Terry
Published: May 2012

PARENTAL PRESENCE IN THE NICU is the foundation for parent-infant attachment. It is also essential if parents are to learn how to care for their child. Therefore, nurses are justifiably concerned when parents do not visit frequently. This column identifies the reasons why nurses are concerned, the reasons why some parents may visit less frequently than others, and interventions that nurses can use to facilitate parental visitation.
Erythromycin
Authors: Noerr Barbara
Published: May 2012

ERYTHROMYCIN, A MACROLIDE ANTIBIOTIC, HAS BEEN USED widely in pediatrics to treat a number of infections. Initially given as an alternative to penicillin because of that drug’s potential for allergic reactions, erythromycin was first introduced in 1952.1 Erythromycin is currently used in neonatal settings for treatment of infections caused by Chlamydia, Ureaplasma, and Mycoplasma.1,2 Prophylaxis for ophthalmia neonatorum and treatment of otitis media are often managed with erythromycin. Erythromycin is the only drug currently proven effective for both prophylaxis and treatment of Bordetella pertussis (not a common pathogen in neonatal intensive care units, however).
Cisapride: The Problem of the Heart
Authors: Premji Shahirose , Paes Bosco
Published: May 2012

Cisapride has been used in the neonatal population as a first-line gastrointestinal prokinetic agent for managing feeding intolerance secondary to decreased gastrointestinal motility. Cisapride acts specifically at many levels of the gastrointestinal tract and has no central nervous system side effects. Recently, prolonged QT interval has been reported secondary to high-dose cisapride, and concerns regarding its use in premature infants have been raised. In response, Janssen-Ortho Inc. and Janssen Pharmaceutica, the manufacturers of cisapride in Canada and the U.S., have released safety information prohibiting the use of cisapride in premature infants. In light of the present evidence, it is imperative that NICUs that continue to prescribe cisapride for the management of feeding intolerance exercise vigilance in cardiac monitoring and recognize the importance of drug interactions that lead to elevated cisapride levels.
Playing the Team-building Game
Authors: Bono Barbara
Published: May 2012

THERE IS AN OLD SAYING THAT politics makes strange bedfellows. With all the changes brought about by managed care, the same thing could be said of health care today. Nurses, especially in an NICU, recognize and value the concept of teamwork. We have always worked closely with a variety of medical professionals and often lead discussions related to a patient’s plan of care. But lately, it seems that members of our “teams” are diversifying, and we find ourselves working with people, groups, or organizations in a manner not previously envisioned. Although we have always worked collaboratively with other departments within the hospital, now we are also building relationships with community agencies and organizations, suppliers of durable medical equipment for home care use, and other nonhospital-based sources of support for patients and families.
Neonatal Ethical Decision Making: Where Does the NNP Fit In?
Authors: Waltman Patricia , Schenk Laura
Published: May 2012

Neonatal nurse practitioners are frequently confronted with ethical dilemmas in the NICU. This article reflects on the historical basis of ethical decision making and the issues some novice NNPs face today regarding their participation in the decision-making process. It examines various educational strategies that can be used to help NNPs to develop the skills they need to participate collaboratively in ethical decision making in the NICU. It concludes with recommendations for further research.
Developing Leadership Skills in Staff Nurses
Authors: Maguire Denise , Colangelo Ann , Peters Jacqueline
Published: May 2012

Jessica was two weeks old and weighed almost 1,500 gm. Michelle, her nurse, had practiced in the NICU for one year and was struggling to gain self-confidence in this new setting. She was easily disorganized and was unable to prioritize complex patient issues. As I walked through the unit one day, I noticed how flustered Michelle appeared as a crowd of nurses stood at the baby’s bedside. It was immediately apparent to me that she needed guidance and support to care for this patient. I understood the difficulty this peer was experiencing in her struggle to gain self-confidence, and my goal was to provide clinical leadership without taking over the situation.
Parathyroids: The Forgotten Glands
Authors: Steffensrud Shari
Published: May 2012

Symptomatic calcium disorders—most notably, hypocalcemia— are common problems in preterm and certain term infants. Many factors predispose susceptible neonates to hypo- or hypercalcemia, but in many cases, the root of the problem is altered function of the parathyroid glands. Parathyroid gland dysfunction may affect calcium homeostasis and alter physiologic functioning, resulting in significant clinical symptoms. A review of how the parathyroid glands and parathyroid hormone affect calcium balance and of the problems that result from altered function promotes a better appreciation of the important role played by these sometimes “forgotten” glands in maintaining normal neonatal physiologic functioning.
Radiology Basics: Overview and Concepts
Authors: Trotter Carol , Carey Barbara
Published: May 2012

WHILE I WAS GROWING UP, THERE WAS A PERIOD OF time when I was no longer interested in fictional characters, but in real life heros. Certainly one of the books that influenced me was Microbe Hunters by Paul De Kruif. I was spellbound as these scientific heros discovered the unseen universe of bacteria that was all around us. No less thrilling or useful was the discovery of a new force that allowed us to see within the human body, x-rays.
Transdermal Clonidine
Authors: Noerr Barbara
Published: May 2012

TO PROVIDE OPTIMAL CARE FOR selected neonates in a neonatal intensive care unit (NICU), opioid sedation and analgesia may be required. Not only is this a caring approach, but there is mounting evidence that biochemical and physiologic stress responses to acute disease may directly influence the neonate’s outcome.1Opioid analgesia and sedation decrease pulmonary vascular responsiveness and help to prevent movement that may dislodge extracorporeal membrane oxygenation cannulas.2Appropriate opioid analgesia has been associated with improved survival of neonates with congenital diaphragmatic hernia, as well as with reduced frequency of postoperative complications in preterm neonates after ligation for patent ductus arteriosus and in those infants with more complicated cardiac surgery.1
Instituting Developmental Care: One Unit’s Success Story
Authors: Turnage Carrier Carol
Published: May 2012

CARE IN THE NEONATAL INTENSIVE care unit (NICU) is traditionally based on medical and nursing tasks that may not include responding to the behavioral cues of infants. Over the past 20 years, support for relationship-based, individualized developmental care has been growing, along with randomized, controlled trials demonstrating both the medical and the neurobehavioral benefits of this type of care. In preparing to educate staff about developmentally supportive care at a large, tertiary pediatric hospital with 120 neonatal beds, strategies for success had to be implemented early in the planning process.
Mothers’ Stories about Their Experiences in the Neonatal Intensive Care Unit
Authors: Holditch-Davis Diane , Shandor Miles Margaret
Published: May 2012

The purpose of this article is to let mothers tell the stories of their neonatal intensive care unit (NICU) experiences and to determine how well these experiences fit the Preterm Parental Distress Model. Interviews were conducted with 31 mothers when their infants were six months of age corrected for prematurity and were analyzed using the conceptual model as a framework. The analysis verified the presence in the data of the six major sources of stress indicated in the Preterm Parental Distress Model: (1) pre-existing and concurrent personal and family factors, (2) prenatal and perinatal experiences, (3) infant illness, treatments, and appearance in the NICU, (4) concerns about the infant’s outcomes, (5) loss of the parental role, and (6) health care providers. The study indicates that health care providers, and especially nurses, can have a major role in reducing parental distress by maintaining ongoing communication with parents and providing competent care for their infants.
Pancreatic Disorders in the Newborn
Authors: McKenna Laura
Published: May 2012

Except for the hyperinsulinism associated with the infant of a diabetic mother (accounting for about 5 percent of NICU admissions annually), pancreatic disorders of the newborn are rare. Congenital anomalies (such as annular pancreas) and endocrine disorders (such as hyperinsulinism of nesidioblastosis or hyperglycemia of neonatal diabetes mellitus) present many challenges to the personnel caring for these infants and their families. The potential mortality and morbidity of these disorders make it imperative for nurses and nurse practitioners working with infants to recognize and understand pancreatic dysfunction so that appropriate and timely intervention can prevent complications of brain injury and developmental delay. The home care needs of these infants and the extensive teaching needs of their parents require skilled nursing care to ensure a safe discharge.
Nurses’ Experiences Working with Families in an NICU During Implementation of Family-Focused Developmental Care
Authors: Heermann Judith , Wilson Margaret
Published: May 2012

Purpose:To explore and describe nurses’ experiences while working with parents and infants receiving family-focused developmental care (FFDC), to gain insight into the process of changing from a traditional model of care to FFDC.

Design:The qualitative design was based on Spradley’s method.

Sample:Data were collected by interviewing ten nurses who worked in an NICU during a pilot study of FFDC. Transcripts were analyzed using Spradley’s domain analysis.

Findings:Four themes describe aspects of the transition from traditional care to FFDC: (1) negative experiences of FFDC, (2) transitions central to partnering with parents, (3) positive experiences of parental participation, and (4) organizational transitions necessary for the move to a family-centered model of care.

Conclusion:Learning to share responsibility with families will require change in the NICU culture as well as in nurses’ role identity.
Radiology Basics, Part III: TTN, Meconium Aspiration, and Neonatal Pneumonia
Authors: Carey Barbara , Trotter Carol
Published: May 2012

RETAINED LUNG FLUID, ALSO KNOWN AS TRANSIENT tachypnea of the newborn, was first described as a syndrome by Mary Ellen Avery in 1966.1Other names that have been applied to this problem are wet lung syndrome and respiratory distress syndrome Type II. It is a diagnosis of exclusion and is generally a benign, self-limiting condition of the term or near-term neonate lasting 24 to 48 hours and occasionally up to 72 hours. The most prominent findings are tachypnea with respiratory rates as high as 120 per minute, grunting, nasal flaring, minimal to no retractions, minimal cyanosis, and mild hypoxemia. The onset of clinical findings appears soon after birth or at birth. Both the clinical and x-ray findings resolve within 72 hours.
Caring One Day at a Time
Authors: Gannon Barbara
Published: May 2012

This article describes the use and development of a three-ring binder book titledCaring One Day at a Time. The book is an organizational tool in which the family keeps the medical, developmental, and financial records of their child from birth until adolescence or beyond. Pertinent, accurate, and accessible information empowers the family to take an active and vital role in the development and implementation of their child’s plan of care. This book provides a record that can be accessed by the family and the multidisciplinary team and supports the transition from family-centered care in the hospital to family-directed care at home. Parent-held records likeCaring One Day at a Timeare used in other countries, and studies have shown them to be valuable to both families and professionals. Both one parent who has used the book and the book’s developer provide their perspectives.
Radiology Basics, Part V: Congenital Anomalies of the Gastrointestinal Tract
Authors: Carey Barbara , Trotter Carol
Published: May 2012

CONGENITAL ANOMALIES OF THE GASTROINTESTINAL (GI) tract may involve any part of the primitive tube from the hypopharynx to the anus. Stenoses, atresias, duplications, and obstructions are among the common lesions of the gastrointestinal tract.1,2 These lesions can be differentiated on the basis of data from the history along with physical examination, clinical presentation, and radiographic imaging. Findings from the history and physical examination significant in making the diagnosis of GI obstruction may include: (1) polyhydramnios, (2) large gastric aspirates, (3) abdominal distention, (4) bilious or nonbilious emesis, and (5) failure to stool.1
Pharmaceutical Excipients
Authors: Noerr Barbara
Published: May 2012

WHY IS THE USE OF SINGLE-DOSE vials the norm in the NICU? Why is preservative-free parenteral solution standard care in the NICU? The simple response is that neonates are not just small adults. Children, especially neonates, differ from adults in their drug pharmacokinetics (absorption, distribution, metabolism, elimination). This explanation only hints at the rationale.
Neonatal Tachyarrhythmias
Authors: Watson Margaret
Published: May 2012

CARDIAC ARRHYTHMIAS CAN BE found in the fetus and the neonate. Arrhythmias that are seen in the neonate include sinus bradycardia and tachycardia, premature atrial and ventricular contractions, supraventricular tachycardia, atrial flutter, ventricular arrhythmias, and heart block. Although infants with structural or functional anomalies can have arrhythmias, many arrhythmias result from noncardiac causes, such as hypoxemia and acidosis.1
Neonatal Cortical Hyperostosis
Authors: Carey Barbara
Published: May 2012

PROSTAGLANDIN THERAPY FOR neonates with ductal-dependent heart defects is a lifesaving intervention that permits optimal stabilization, diagnostic imaging, and timing of surgery. However, this therapy is not without complications (Table 1).1–3 When longterm (weeks or months) prostaglandin therapy is required because of neonatal immaturity or for optimal timing of procedures, one complication that may occur is bone changes: cortical hyperostosis/ periosteal new-bone formation.2,4
Supporting Parents in the NICU: Guidelines for Promoting Parent Confidence and Competence
Authors: Vanden Berg Kathleen
Published: May 2012

AS INTENSIVE CARE NURSERIES move toward implementation of family-centered and developmentally supportive care practices, we are encouraged to focus on the relationship between parents and their infants and recognize the essential role that parents play in promoting the health and recovery of their infant. Supporting parents and facilitating a closer, more intimate relationship with their fragile, sick newborn is often a challenge. Yet these first weeks and months can lay a foundation either of positive feelings or of ambivalence and negativity, which can have consequences for the future stability of the attachment relationship so important to the infant’s development.
Enhanced-Calorie Formulas: Considerations and Options
Authors: Nevin-Folino Nancy , Loughead Jeffrey , Loughead Melinda
Published: May 2012

The long-term developmental impact of nutrition on the preterm newborn has recently been shown to be of even greater importance than previously recognized. Very immature or ill infants are challenged by the need for a high caloric intake, but are unable to tolerate large fluid volumes. These patients may require enhanced-calorie formulas to achieve the desired growth goals. Formula enhancement has traditionally been performed by uniquely developed recipes of base formula concentration with the addition of powdered formula or single components such as medium-chain triglycerides oil, protein, or polycose. These mixtures have been largely unstudied for bioavailability, long-term outcomes, and tolerance. Deviation from recommended protein, fat, carbohydrate, mineral, and vitamin delivery limits may impair growth or lead to undesirable side effects. The practitioner must have an understanding of when and how to use an enhanced formula and the important monitoring and assessment needs of the patient receiving enhanced-calorie formula.
Continuous Insulin Infusion: Promoting Growth in Low Birth Weight Infants
Authors: Zylberberg Rachel , Pepper Mel
Published: May 2012

Development of improved technologies in neonatal care has yielded increasing numbers of surviving low birth weight (LBW) infants who have challenged methods of supportive care. As researchers and practitioners have focused on respiratory, cardiac, and other body system requirements, nutritional support has been low on the priority list. Support for growth and maximized neurologic development, rather than simply for survival, has been the challenge in care of small and sick newborns. Use of insulin to enhance glucose tolerance in LBW infants, and thereby maximize growth, is a management modality that can be initiated early in the infant’s course and is facilitated by implementation of clear and consistent policies and procedures. Continuous insulin infusions have been demonstrated to enhance glucose uptake and utilization—facilitating neonatal growth and in turn enhancing brain growth and developmental outcome.
SIADH: A Case Review
Authors: Shirland Lee
Published: May 2012

Because the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) can cause neurologic sequelae with the potential to affect long-term outcomes, its prompt recognition and treatment are essential. Normally, antidiuretic hormone (ADH) is secreted when effective circulating blood volume is decreased. SIADH is marked by secretion of ADH in the presence of effective or normal circulating blood volume. This causes plasma hyponatremia simultaneously with plasma hypo-osmolality and inappropriate hyperosmolality of the urine. This article explains the pathophysiology of the syndrome; describes its diagnosis, clinical course, and treatment; and exemplifies the syndrome with a case study.
Situs Inversus Totalis
Authors: Spoon Janie
Published: May 2012

EXTERNALLY, THE HUMAN BODY appears symmetric; if a line is drawn down the middle of the body, each side appears identical. However, this is not true of the internal anatomy. For example, there is one heart, which lies in the left chest, one liver, in the right abdomen, and one stomach, in the left abdomen. The term situs refers to the position or location of an organ, specifically, the position of the atria and abdominal viscera in relation to the midline of the body.1 There are three types of situs: solitus, inversus, and ambiguous. Situs solitus refers to the normal arrangement of organs, with the right atrium, liver, gallbladder, trilobed lung, and inferior vena cava on the right side and the left atrium, stomach, spleen, bilobed lung, and descending aorta on the left side (Figures 1–3). Situs inversus totalis refers to a mirror image reversal of the normal position of the internal organs (Figures 4 and 5). 1 The incidence of situs inversus totalis is 1 in every 8,000 to 25,000 births, and the condition is most often diagnosed by radiographic examination.2Situs ambiguous, often referred to as heterotaxia, is the random arrangement of the internal organs and is associated with splenic abnormalities and congenital heart disease.3 The purpose of this column is to discuss the embryology, pathophysiology, and diagnosis of situs inversus totalis and to review a case study with radiographic findings.
Protecting TPN and Lipid Infusions from Light: Reducing Hydroperoxides in NICU Patients
Authors: Baird Lisa
Published: May 2012

The use of total parenteral nutrition (TPN) and intravenous fat emulsions in sick or preterm infants is often required to maintain adequate nutrition, yet recent research has shown that when exposed to light these nutrients are altered and deliver a high load of exogenous toxic hydroperoxides to already compromised infants. Hydroperoxides cause damage at the cellular level unless mediated by the body’s antioxidant systems. NICU patients are, by definition, patients at risk. Preterm infants have low antioxidant reserves and, like sick term infants, typically suffer significant oxidative stress. Endogenous hydroperoxides alone may overwhelm defenses. The addition of hyperperoxides from light-exposed TPN or fat emulsions increases the risk of tissue damage. Hydroperoxides have been associated with hypoxicischemic encephalopathy, intraventricular hemorrhage, periventricular leukomalacia, chronic lung disease, retinopathy of prematurity, and necrotizing enterocolitis. By protecting these infusates from light, bedside nurses can reduce the amount of hydroperoxides infused and protect NICU patients from the associated risks.
An Effective Approach for Preventing and Treating Gastrostomy Tube Complications in Newborns
Authors: Bordewick Angela , Bildner Judy , Burd Randall
Published: May 2012

Gastrostomy tube site complications can be difficult to manage and may temporarily prevent use of the tube for feeding. Such complications are especially common in premature newborns. Leakage is the usual cause of tube-site complications. This makes maintenance of effective intragastric and transabdominal tube seals the most effective approach for preventing and treating tube-site complications in newborns. This article explains how to use balloon volume and transabdominal segment length to recognize problems that can lead to leakage and how to correct these problems before they cause complications. It also addresses skin care at the site.
How Parents of Premature Infants Gather Information and Obtain Support
Authors: Brazy Jane , H. Anderson Barbara , Becker Patricia , Becker Marion
Published: May 2012

Purpose:To identify the process by which parents of premature infants seek information, the kinds of information they seek, and the resources they use to meet their educational and support needs.

Design/Sample:Descriptive study using 19 parent interviews and 64 questionnaires.

Main Outcome Variable:The process parents use to obtain information and support.

Results:Parents of premature infants make a transition from being passive recipients of information to actively seeking it. They spend 10–20 hours a week gathering information during the first month of the baby’s hospitalization. They desire more information than is provided, particularly in the areas of infant health, infant care, and coping. Family is the primary source of support prior to birth and after discharge, but during the infant’s convalescence, nurses are the main source of support and help for parents in understanding and adapting to their baby. Many parents would use a computer-based resource for information if it were available to them.
Neonatal Chylothorax
Authors: Carey Barbara
Published: May 2012

ACHYLOTHORAX IS AN ACCUMULATION of lymphatic fluid that collects in the pleural space. It is the most common cause of a large pleural effusion in the newborn.1,2 Estimated incidences vary from 1 in 10,000 deliveries to 1 in 2,000 admissions to the NICU.2,3 Chylothorax may be unilateral or, infrequently, bilateral and can occur spontaneously or be acquired secondary to trauma or surgical procedures. The right lung is more commonly affected than the left.
Neonatal Thermal Care, Part I: Survey of Temperature Probe Practices
Authors: Blackburn Susan , DePaul Debra , Loan Lori , Marbut Kristie , Taquino Lauren , Thomas Karen , Wilson Suzanne
Published: May 2012

Purpose: To determine nurses’ practices regarding skin temperature probes.

Design: Data were collected using an anonymous questionnaire, which was returned by mail. Questionnaires were distributed by volunteer neonatal nurses. Items included frequency of probe change, position of probe, use of probes in skin and air servocontrolled incubators and radiant warmers, as well as demographic data.

Sample: Eighty-three neonatal nurses.

Results: Nurses reported that skin servocontrolled incubators are used widely, but generally only for infants less than 28 weeks gestational age; a high proportion of respondents reported using continuous monitoring of skin temperature in air servocontrol incubators. Although most nurses reported positioning infants to prevent their lying on the probe, 21 percent reported using the same probe site regardless of infant position. Routine changing of the probe cover was reported by a number of nurses. Practices were influenced by individual knowledge, beliefs, and experience as well as by unit protocols, which varied widely.
Perinatal Asphyxia: A Clinical Review, Including Research with Brain Hypothermia
Authors: Ellen Flavin Nancy
Published: May 2012

Perinatal asphyxia may occur in utero, during labor and delivery, or in the postnatal period. There are numerous causes, and the clinical manifestations vary. Infants who experience mild asphyxia may show no neurologic injury. Severe asphyxia may be fatal in utero, or immediately after birth, with survivors showing extensive neurologic sequelae, with or without cognitive deficits. Mild brain hypothermia appears promising in the prevention of further neurologic damage in encephalopathic infants following asphyxia. Recent research on newborn animal models has focused on the timing, duration, and depth of hypothermia. Promising new research is now under way in nurseries in the U.S. in an attempt to establish clinical protocols for use of hypothermia in human neonates.
From Gavage to Oral Feedings: Just a Matter of Time
Authors: Lemons Pamela
Published: May 2012

The ability to safely and efficiently feed by mouth is based on oral-motor competence, neurobehavioral organization, and gastrointestinal maturity. Although most infants successfully make the transition to oral feedings as they approach term gestation, infants who were very immature at birth have historically had the most difficulty achieving this milestone. Postnatal complications (chronic lung disease, intraventricular hemorrhage, seizures, and so on) are also associated with delays in the onset of the first feeding, as well as with delays in achieving full enteral intake.

Weaning the infant to breast is a slow and gradual process that may necessitate supplemental gavage or bottle feedings. A variety of measures—such as positioning, containment, reduced milk flow, and imposed rest breaks—may help to facilitate better oral intake, but infants probably benefit most from the passage of time. Frequently, the older the infant is at first feeding, the shorter the time required to make the transition to full oral feedings. Rather than attempting to accelerate the inherent maturational processes that form the basis for oral feeding, efforts might better be spent in providing adequate nutritional support while avoiding unnecessary stress and fatigue.
Congenital Toxoplasmosis
Authors: Martin Sara
Published: May 2012

Toxoplasma gondii, a parasite, has three modes of transmission: oral intake of raw or undercooked meat or contaminated fruits and vegetables, ingestion of materials contaminated with cat feces, and transplacental infection. The focus of this article is congenital toxoplasmosis, which is transmitted to the fetus across the placenta.

When primary infection of the mother occurs during pregnancy, there is a 40 percent chance of fetal infection; rate of transmission and severity of infection are related to gestational age at the time of infection. The brain and retina are often affected, and there can be a wide range of clinical disease. Amniocentesis or cordocentesis provides the most accurate diagnosis.

At birth, 80–90 percent of infants with congenital toxoplasmosis are asymptomatic. But further testing may reveal retinal and central nervous system abnormalities, and there is a risk of long-term sequelae. Chorioretinitis, hydrocephalus, intracranial calcifications, and convulsions are the typical presentation of classic congenital toxoplasmosis. Serology is the most common method of diagnosing neonatal infection, but more complex tests are also utilized. The prognosis for the untreated infant is poor; however, when antibiotic therapy is started early, the rate of sequelae is reduced significantly.
When It Is More than Transient Neonatal Hypoglycemia: Hyperinsulinemia— A Case Study Challenge
Authors: Shirland Lee
Published: May 2012

Persistent uncontrolled neonatal hypoglycemia may cause irreversible brain damage. Hyperinsulinemia is a rare cause of persistent hypoglycemia, diagnosed by excluding other etiologies. Inappropriately high fasting serum insulin levels with concurrent hypoglycemia confirm the diagnosis.

Initial interventions for hyperinsulinemia are conservative. The first line of therapy is administration of adequate intravenous (IV) glucose to maintain serum or whole blood glucose levels at or greater than 40 mg/dl. When enteral feedings are tolerated, schedules and caloric concentration are adjusted. Pharmacologic therapy is added to facilitate weaning from IV glucose. The drug of first choice is diazoxide. Octreotide is added if diazoxide therapy fails. Partial or complete pancreatectomy is the final treatment option.

Nursing care for infants with hyperinsulinemia must also focus on the support and education of families. Family education must be individualized and should cover feeding regimes, administration of medication, proper use of equipment, and care during illness.
The NICU Experience: A Parent’s Perspective
Authors: Owens Kim
Published: May 2012

MY FIRST GLIMPSE OF THE NEONATAL INTENSIVE CARE unit was from the side of a gurney as I was being wheeled to the bedside of my newborn baby girl, Emily. It was only six hours after her birth, and already she had suffered several heart failures and required multiple chest tubes to help inflate her badly infected lungs. Born at 26 weeks gestational age, Emily and her twin sister, Brooke, had been taken immediately to the NICU, where Emily was now dying and Brooke was fighting to live.
Systemic Inflammatory Response Syndrome
Authors: Botwinski Carol
Published: May 2012

Despite advances in perinatal care in the past decade, sepsis and its complications continue to present problems for the neonate, remaining a major cause of neonatal morbidity and mortality. Sepsis research is focusing on how the neonate (host) responds to bacteria. The newborn may develop a systemic reaction to bacteria that induces the release of substances known as inflammatory mediators. Termed the systemic inflammatory response syndrome (SIRS), this reaction is believed to be responsible for the signs and symptoms of sepsis. This article introduces the neonatal nurse to SIRS, providing an overview of various inflammatory mediators and cytokines, their clinical consequences, and potential new therapies in the management of SIRS.
Fat-Soluble Vitamin Supplements for Enterally Fed Preterm Infants
Authors: Greer Frank
Published: May 2012

Fat-soluble vitamin requirements for the enterally fed premature infant are an important concern, both before and after discharge from the neonatal intensive care unit. Because preterm infants fed unsupplemented human milk receive deficient quantities of these vitamins (A, D, E, and K), supplements are very important for this population. Vitamin intakes with special formulas for low birth weight infants and human milk fortifiers are also reviewed.
Nasopharyngeal CPAP: A Nursing Art
Authors: Berends Susan
Published: May 2012

CPAP, the use of continuous positive airway pressure as a means of providing respiratory support to the infant, has been studied since the early 1970s. A variety of delivery methods has been used. One method, that of providing CPAP through a single nasopharyngeal tube, is reviewed here. The process of delivering nasopharyngeal CPAP can be technically difficult, and requires careful attention to the infant and the CPAP system. The ability to anticipate and troubleshoot problems is essential. Done well, this process truly shows off the art of nursing.
Use of Translation Cards to Increase Communication with Non-English-Speaking Families in the NICU
Authors: Dye Eva
Published: May 2012

Parents of infants in the neonatal intensive care unit report that communication with staff helps to relieve the many stresses they face. Particularly challenging for NICU nurses, however, is communication with non-Englishspeaking families. To improve this communication at Vanderbilt Children’s Hospital in Nashville, illustrated cards have been developed to translate phrases commonly used in the nursery into foreign languages. Three different sets of cards provide translations in Spanish, Kurdish, and Serbo-Croatian (the languages most commonly encountered at this hospital), and a fourth set, in English, is used for individuals with hearing impairments. These cards aid the bedside nurse in giving a basic report and in encouraging parental participation in the infant’s care. Nurses who have used the cards report that parents respond to the questions and seem to appreciate the attempt to communicate.
Breast Milk and the Hospitalized Infant: Guideline for Practice
Authors: Lemons Pamela
Published: May 2012

BREAST MILK, THE MAINSTAY OF infant nutrition, provides the appropriate nutrients for optimal growth and development for most babies. Several conditions in women and infants preclude breastfeeding, however, and identifying these conditions early on is important. Women who are unable to breastfeed because their infants are ill and/or premature yet wish to establish lactation for their hospitalized newborns need instruction and support if they are to succeed. It is the responsibility of the discharging hospital to have personnel who are specifically trained to provide an individualized plan of care for each mother (Table 1). Written instructions for handling, storing, and preparing expressed breast milk are an essential part of such plans. The discharge plan for each mother should include specific recommendations related to the mother: medical/surgical history, expression techniques, and collection and storage procedures. Completion of the plan should incorporate the infant’s current medical condition and neurologic status, with particular emphasis placed on enhancing the quality of the maternalchild interaction.
Early Feeding Strategies in Preterm and Critically Ill Neonates
Authors: Evans Ruth , Thureen Patti
Published: May 2012

This two-part article presents feeding strategies for the NICU population over the first several weeks of life. It focuses primarily on the theory and approach to feeding extremely low birth weight (ELBW) infants, but also addresses some issues pertinent to larger, ill infants. The premise for these recommendations is that avoiding early malnutrition in ELBW and ill infants has both short- and long-term benefits. Many practitioners may consider our approach to be somewhat aggressive. In this strategy, total parenteral nutrition (TPN) is initiated in the first hours after birth and is given together with initially small, and then increasing, enteral feedings beginning on the first or second day of life. The role of the TPN is to provide rapid, maximal nutrition and that of the early enteral feedings is to “prime” the gut and stimulate normal gastrointestinal tract activity.
Behaviors of Very Preterm Neonates as Documented Using NIDCAP Observations
Authors: Pressler Jana , Helm James , Hepworth Joseph , Wells Nancy
Published: May 2012

Purpose:The purpose of this study was to describe the range and frequency of behaviors in neonates 24–30 weeks postconceptional age (PCA) using the Newborn Individualized Developmental Care Assessment Program (NIDCAP).

Design:A prospective design with convenience sampling was used.

Sample:Starting 24–72 hours postnatally and continuing through 30 weeks PCA, 8,144 two-minute observations of 85 NIDCAP behaviors were collected and analyzed from 42 neonates born at 24–29 weeks gestation.

Main Outcome Variable:The main outcome variables were the frequencies of the 85 neonatal behaviors measured by the NIDCAP. Frequencies were organized first by subsystem (autonomic, motor, or state) and were categorized further based on week of PCA. Comparisons of behavioral frequencies by number of weeks PCA were completed using correlation and regression analyses.

Results:The most frequently observed behaviors were irregular respirations, pink color, postured flexion of the extremities, immature light sleep, and drowsiness. Least frequently observed behaviors consisted of burps, bowel movement, grunting, smooth motor movements, cooing, and speech movement. Regression analysis illustrated that the pattern of behavior was significantly similar week to week.
Universal Newborn Hearing Screening Coming Soon: “Hear’s” Why
Authors: Knott, Carrie
Published: May 2012

Screening the hearing of all newborns, both NICU and well nursery, is rapidly becoming the standard of care. The impetus for universal newborn hearing screening (UNHS) has come from outside the domain of nursing and the newborn nursery. Because nursing will be involved in nearly all aspects of UNHS, nurses need a thorough knowledge base about permanent childhood hearing loss (PCHL) and UNHS. Technology exisits today that can objectively and physiologically screen for this condition at a cost comparable to metabolic screening. PCHL occurs more than twice as often as all the hemoglobinopathies and inborn errors of metabolism combined. Undiagnosed hearing loss often leads to permanent developmental delays. The ultimate goal of early diagnosis and intervention for a congenital hearing loss is to enable the child to develop language and communication skills that correspond to his chronological age and innate cognitive abilities.