bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Acculturation and Distance From Cardiac Center on Congenital Heart Disease Mortality
Authors: Fixler David E. , Nembhard Wendy N. , Xu Ping , Ethen Mary K. , Canfield Mark A.
Published: May 2012

BACKGROUND AND OBJECTIVE:

Despite improvements in congenital heart disease (CHD) survival over the past 4 decades, ethnic disparities persist. Several studies have shown higher postoperative CHD adjusted mortality in black and Hispanic children. Others noted that non–English-speaking language at home was associated with appointment noncompliance, which the parents attributed to misunderstanding and living too far from a health center. The purpose of this study was to determine the effect of home distance to a cardiac center, or having a Latin American–born parent, on first-year mortality in infants with severe CHD.

METHODS:

Infants with severe CHD, having an estimated first-year mortality >25%, born 1996–2003, were identified from the Texas Birth Defects Registry and linked to state and national vital records. We examined the effects of defect type; birth weight; gestational age; extracardiac anomalies; infant gender; maternal race/ethnicity, marital status, and education; residence in a Texas county bordering Mexico; home distance to cardiac center; and parental birth country on first-year survival.

RESULTS:

Overall first-year survival was 59.9%, and no race/ethnic differences were noted; however, survival was significantly (P < .05) lower for Hispanic infants with hypoplastic left heart syndrome. Neither home distance to a cardiac center nor parental birth country was related to first-year survival; however, survival was noted to be lower in Texas counties bordering Mexico, counties that have high rates of poverty.

CONCLUSIONS:

Further studies are needed to determine if these disparities in survival of infants with severe CHD are attributable to delays in referral to a cardiac center.
Introduction of the demoralization scale in Hungary, a study on demoralization and depression among hospice patients
Authors: Hadnagy Zsolt , Csikós Ágnes , Nagy Lajos
Published: May 2012

Depression is a common problem among hospice patients. In the past few years, the international literature has dealt with demoralization, which is a new phenomenon. According to clinical studies, it give a better description of the patients’ state in palliative care than depression. In Hungary there has been no research performed on demoralization yet. Aims: The aim of the authors was to introduce the demoralization scale in Hungary, learn about its practical use, as well as to study and compare demoralization and depression. Methods: The Hungarian translation of the demoralization scale and the short form of the Beck depression inventory were applied in the institutional and home hospice service in Pécs. Results: The rate of the patients with severe demoralization but no depression was 10.5–21%. According to the severity of the demoralization, the rate of severely demoralized patients was 37–53%. Patients who suffered from pain or severe physical problems were significantly more demoralized and depressed. Discussion: In hospice patients, demoralization occurs in a higher rate than depression. The demoralization scale is suitable for describing patients’ feelings and thoughts. The relief of their physical symptoms affects their emotional state. The authors introduced the demoralization scale in Hungary which can be a good tool for psychological management in palliative care. Orv. Hetil., 2012, 153, 737–743.
Complications of systemic cytomegalovirus infection in therapy refracter Hodgkin’s lymphoma
Authors: Irsai Gábor , Tampu-Kiss Tatjana , Dezső Balázs , Miltényi Zsófia , Illés Árpád , Méhes Gábor
Published: May 2012

Cytomegalovirus infection related changes frequently remain masked by local symptoms of tumor invasion or therapeutic side effects in cancer patients. The spectrum of cytomegalovirus manifestations, however, can be highly varied and may contribute to the failure of different organs with fatal outcome. The case of a 29-year-old female patient is presented who obtained polychemotherapy and allogenic stem cell transplantation following the diagnosis of classical Hodgkin’s disease. Despite intensified treatment, only partial response could be achieved and the outcome of the disease was death. Postmortem examination revealed regressive lymph node infiltration as well as nodular liver and spleen manifestations of classical Hodgkin’s disease. In addition, parenchymal tissues (lung, kidneys, small intestine, liver, pancreas and ovaries) showed the classical morphology of widespread cytomegalovirus infection. Bilateral enlargement of the ovaries was caused by a partially necrotic giant cell proliferation in the subepithelial cortex. CD30-negativity and cytomegalovirus antigen positivity of the large atypical cell infiltrate supported the diagnosis of cytomegalia oophoritis with morphological overlap between cytomegalovirus-infected giant cells and residual Hodgkin-Reed-Sternberg cells. Further to the cytopathic effect in multiple organs, significant hemophagocytosis was also observed in the spleen, liver and bone marrow. In summary, active cytomegalovirus infection may be a major cause of multi-organ failure in the immunosuppressed oncohematological patient. Careful postmortem analysis demonstrated both the activity of the viral infection and the efficacy of the anti-viral treatment, when applied. Orv. Hetil., 2012, 153, 751–755.
Proteasome Inhibition and Combination Therapy for Non-Hodgkin's Lymphoma: From Bench to Bedside
Authors: Mato Anthony R. , Feldman Tatyana , Goy André
Published: May 2012

Although patients with B-cell non-Hodgkin's lymphoma (NHL) usually respond to initial conventional chemotherapy, they often relapse and mortality has continued to increase over the last three decades in spite of salvage therapy or high dose therapy and stem cell transplantation. Outcomes vary by subtype, but there continues to be a need for novel options that can help overcome chemotherapy resistance, offer new options as consolidation or maintenance therapy postinduction, and offer potentially less toxic combinations, especially in the elderly population. The bulk of these emerging novel agents for cancer treatment target important biological cellular processes. Bortezomib is the first in the class of proteasome inhibitors (PIs), which target the critical process of intracellular protein degradation or recycling and editing through the proteasome. Bortezomib is approved for the treatment of relapsed or refractory mantle cell lymphoma. The mechanisms of proteasome inhibition are very complex by nature (because they affect many pathways) and not fully understood. However, mechanisms of action shared by bortezomib and investigational PIs such as carfilzomib, marizomib, ONX-0912, and MLN9708 are distinct from those of other NHL treatments, making them attractive options for combination therapy. Preclinical evidence suggests that the PIs have additive and/or synergistic activity with a large number of agents both in vitro and in vivo, from cytotoxics to new biologicals, supporting a growing number of combination studies currently underway in NHL patients, as reviewed in this article. The results of these studies will help our understanding about how to best integrate proteasome inhibition in the management of NHL and continue to improve patient outcomes.
Spatiotemporal patterns of mountain pine beetle activity in the southern Rocky Mountains
Authors: Chapman Teresa B. , Veblen Thomas T. , Schoennagel Tania
Published: May 2012

The current mountain pine beetle (MPB; Dendroctonus ponderosae) outbreak in the southern Rocky Mountains has impacted ∼750 000 ha of forest. Weather and habitat heterogeneity influence forest insect population dynamics at multiple spatial and temporal scales. Comparison of forest insect population dynamics in two principal host species may elucidate the relative contribution of weather and landscape factors in initiating and driving extensive outbreaks. To investigate potential drivers of the current MPB outbreak, we compared broadscale spatiotemporal patterns of MPB activity in lodgepole pine (Pinus contorta) and ponderosa pine (Pinus ponderosa) from 1996 to 2010 in Colorado and southern Wyoming with regional weather fluctuations, and then tracked the annual meso‐scale progression of the epidemic in lodgepole pine with respect to weather, topographic, previous MPB activity, and forest stand attributes. MPB activity in lodgepole pine compared to ponderosa pine showed higher magnitude and extent of spatial synchrony. Warm temperatures and low annual precipitation favorable to beetle populations showed high regional synchrony across areas of both pine species, suggesting that habitat interacts with weather in synchronizing MPB populations. Cluster analysis of time series patterns identified multiple, disjunct locations of incipient MPB activity (epicenters) in lodgepole pine, which overlapped an earlier 1980s MPB outbreak, and suggests a regional trigger (drought) across this homogenous forest type. Negative departures from mean annual precipitation played a key role in subsequent spread of MPB outbreak. Development of the outbreak was also associated with lower elevations, greater dominance by lodgepole pine, stands of larger tree size, and stands with higher percentage canopy cover. After epidemic levels of MPB activity were attained, MPB activity was less strongly associated with stand and weather variables. These results emphasize the importance of considering differences in patterns of MPB dynamics for different host pine species even under similar regional‐scale weather variation and the nonstationarity of outbreak dynamics over time.
What to Tell Parents about the Developmental Needs of Their Baby at Discharǵe
Authors: VandenBerg Kathleen
Published: May 2012

THESE ARE THE WORDS OF A parent whose infant had been discharged from the intensive care nursery to home: “I was thrilled that she was finally coming home, and I thought I was ready. But I wasn’t prepared for what really happened.”
The Economic Impact of Drug Therapy
Authors: Noerr Barbara
Published: May 2012

INCREASINGLY, HEALTH CARE PROVIDERS at all levels are being forced to weigh the economic impact of treatment. Davey and colleagues state that health care economics depends on two basic assumptions.1 These assumptions are, first, that resources are limited and, second, that resources should be allocated to produce as much good as possible. On an intellectual basis it is hard to disagree with these assumptions. But in the day-to-day care of at-risk neonates it may be difficult to implement them.
Retinopathy of Prematurity in the 1990s
Authors: Lee Sharon
Published: May 2012

Infants diagnosed with retinopathy of prematurity (ROP) are at risk for developing visual impairments. The International Classification of ROP (ICROP) developed the most useful tool available for communicating the location and extent of the condition, with three zones to describe the location and five stages to describe the extent.

Despite current knowledge and treatment, however, 500 infants are blinded each year by ROP. Infants at highest risk are the smallest and most immature. The nurse must understand why and how ROP occurs and the forms of management used to treat ROP. This article reports on the incidence, pathophysiology, risk factors, screening, treatment, and long-term complications of ROP in the 1990s.
Perinatal Substance Abuse: Working with Neonates and Families
Authors: Sudia Robinson Tanya
Published: May 2012

ACCORDING TO A NATIONAL survey on drug use during pregnancy, more than 5 percent of all neonates are exposed to illicit substancesin utero.1Five percent of births may not seem significant, but it represents 221,000 affected neonates each year. Cocaine and marijuana are the most frequently used illicit substances. In addition to illegal substances, we must also be concerned about the use of legal substances that can adversely affect the fetus—specifically, alcohol and tobacco. Annually, about 20 percent of fetuses are exposed to tobacco, which can adversely affect growth and result in an increased risk for low birth weight.1,2Additionally, approximately 20 percent of neonates are exposed to alcohol, a known teratogen.1,3
An Introduction to Hemoglobin Physiology
Authors: Givens Bell Susan
Published: May 2012

Hemoglobin plays an important physiologic role, one that begins early in fetal development. The focus of this article is hemoglobin physiology. Developmental erythropoiesis, developmental stages of hemoglobin, and postnatal erythropoiesis and hemoglobin production are discussed. The function of hemoglobin, its affinity for oxygen, and the clinical significance of the oxyhemoglobin dissociation curve are also explored.
Neonatal Skin Care: The Scientific Basis for Practice
Authors: Lund Carolyn , Kuller Joanne , Lane Alfred , Wright Lott Judy , Raines Deborah
Published: May 2012

Objective:To review the literature addressing the care of neonatal skin.

Data Sources:Computerized searches in MEDLINE and CINAHL, as well as references cited in articles reviewed. Key concepts in the searches included neonatal skin differences; neonatal skin and care practices for skin integrity; neonatal skin and toxicity; permeability; and contact irritant sensitization.

Study Selection:Articles and comprehensive works relevant to key concepts and published after 1963, with an emphasis on new findings from 1993 to 1999. One hundred two citations were identified as useful to this review.

Data Extraction:Data were extracted and organized under the following headings: anatomy and physiology of the skin; physiologic and anatomic differences in neonatal skin; nutritional deficiencies; skin care practices; and care of skin breakdown.

Data Synthesis:Newborns’ skin is at risk for disruption of normal barrier function because of trauma. In light of available evidence about differences in neonatal skin development, clinical practice guidelines are suggested for baths, lubrication, antimicrobial skin disinfection, and adhesive removal. In addition, basic care practices are suggested for maintaining skin integrity, reducing exposure to potentially toxic substances, and promoting skin health beyond the neonatal period. Preventive care recommendations are made for reducing trauma, protecting the skin’s immature barrier function, and promoting skin integrity.

Conclusions:This review generated evidence with which to create a new and comprehensive practice guideline for clinicians. Evaluation of the guideline is under way at 58 U.S. sites.
Development of a Resource Manual for Returning Neonates to Community Hospitals
Authors: Lofgren Maria
Published: May 2012

To facilitate the transfer of an infant from a tertiary NICU to a community Level II hospital for convalescing follow-up care, the tertiary staff must know the referral center’s capabilities. This will help to establish a trusting relationship between hospitals, will enable the tertiary staff to send infants back to the referral center in a timely manner, will enable them to reassure the patient’s parents concerning the transfer, and will facilitate communication between the hospitals and the patient’s family. This article describes the development of a referring hospital resource manual designed to facilitate the transfer process.
Neonatal Thermoregulation: Bed Surface Transfers
Authors: Altimier Leslie , Warner Barbara , Amlung Stephanie , Kenner Carole
Published: May 2012

Purpose:To describe temperature changes that occur in preterm infants following bed surface transfers.

Design:The design was descriptive.

Sample:The convenience sample was comprised of 20 preterm infants (<1,500 gm birth weight).

Main outcome variable:Temperature stability after a bed transfer (i.e., radiant warmer to incubator) was the main outcome variable.

Results:There were no significant differences in temperatures after bed surface transfer. However, the temperatures one hour after bed surface transfer were lower than baseline temperature before bed surface transfer.
Sharing the Vision of NICU Nursing Practice
Authors: Maguire Denise
Published: May 2012

NURSES WHO READILY AND consistently describe their vision of professional practice help to move nursing toward the future. A vision is a philosophy that determines how we conduct the business of neonatal nursing in our NICU. It is how we hope nursing practice will evolve; it helps to direct our efforts toward our goals. Personal vision is a powerful motivator, fueling commitment and energy toward great achievements. Creators of the vision assume an ideal world, where nurses are fully prepared to engage in collegial relationships with physicians and other health care professionals to make a significant difference in the lives of patients and their families. Keepers of the vision are often managers, but staff nurses have vision also. The key to success is developing a shared vision that all members of the staff embrace.
Genetics and the World Wide Web: An Introduction
Authors: Hetteberg Carol , Trangenstein Patricia
Published: May 2012

Nurses cannot escape the impact that new genetics discoveries and the World Wide Web (WWW) have on nursing practice. This article presents an overview of the WWW, offers examples of genetics-related WWW sites, and illustrates their applicability to neonatal nursing.
Beyond Pierre Robin Sequence
Authors: Prows Cynthia , Bender Patricia
Published: May 2012

The labelPierre Robin sequenceis given to infants presenting with a triad of specific congenital anomalies: micrognathia, glossoptosis, and cleft palate. However, this label should be considered the first, not the final, step in the diagnostic process. In approximately 80 percent of newborns with Pierre Robin sequence, the triad of anomalies is part of an underlying genetic condition. This article reviews the variable etiologies of and general clinical considerations for Pierre Robin sequence. To illustrate how clinical management might vary based on the identification of an underlying condition, three case examples of neonates with Pierre Robin sequence and different underlying genetic conditions are presented.
Percutaneously Inserted Polyurethane Central Catheters in the NICU: One Unit’s Experience
Authors: Evans Martha , Lentsch Donna
Published: May 2012

This article describes the authors’ experiences with using polyurethane percutaneously inserted central catheters from June 1993, when these catheters were introduced in the NICU at Children’s Hospital, Omaha, Nebraska, through September 1997. Indications for line placement and anatomy are reviewed. Patient demographics, success rates, and complications are analyzed. Line cares, including dressing changes, management of infusions, and troubleshooting, are also discussed.
Newborn Genetic Screening: Blessing or Curse?
Authors: Kenner Carole , Amlung Stephanie
Published: May 2012

Newly discovered genes and advances in genetic screening programs prompt many questions reflecting the kinds of ethical dilemmas that go hand in hand with life-changing discoveries. Neonatal genetic screening has been a standard of care for some time, but as our knowledge in the field of genetics expands, should we continue with the same approach? What newborn genetic screening tests should be mandatory, and what are the long-range consequences associated with testing? This article reviews genetic modes of inheritance, outlines and explains the most common newborn screening tests, and enumerates the ethical issues associated with these screening procedures. The role of the neonatal nurse in the newborn genetic screening process is discussed.
Newborn Percutaneous Absorption: Hazards and Therapeutic Uses
Authors: Benis Marilyn
Published: May 2012

THE SKIN ACTS AS A VITAL BARRIER between an individual and the environment by limiting water loss and by protecting against the entry of harmful substances. Various material can pass through the skin barrier, a process called percutaneous absorption. Although the skin’s permeability can lead to harmful effects, it can be beneficial in making the skin a possible route for the delivery of therapeutic drugs. Differences between adult and neonatal skin, especially preterm skin, expose the neonate to a greater potential for percutaneous absorption.1 Neonatal nurses need to be familiar with the characteristics of newborn skin, principles for maintaining skin integrity, and the risks and benefits of percutaneous absorption.
Autosomal Trisomies: What Neonatal Nurses Need to Know
Authors: Cox Ann
Published: May 2012

Autosomal trisomies are associated with major congenital malformations that may result in prolonged hospitalization of the newborn. Knowledge about these chromosomal abnormalities is important for nurses in neonatal practice. This article identifies the causes and manifestations of most of these trisomies: trisomy 13 (Patau syndrome), trisomy 18 (Edwards syndrome), and trisomy 21 (Down syndrome). More detailed description of the manifestations, associated abnormalities, and outcomes of the most common of these, trisomy 21, is provided.
Neonatal Air Leaks: Pneumothorax, Pneumomediastinum, Pulmonary Interstitial Emphysema, Pneumopericardium
Authors: Carey Barbara
Published: May 2012

NEONATAL AIR LEAKS INCLUDE a spectrum of conditions—pneumothorax, pulmonary interstitial emphysema, pneumomediastinum, pneumopericardium, and (rarely) pneumoperitoneum. Pneumothorax is the most common of these conditions; it occurs spontaneously in 1 to 2 percent of term neonates without pulmonary disease.1 The rate of occurrence increases in ventilated neonates, where it ranges from 20 to 30 percent. 2,3 With the increased use of surfactant, less barotrauma and a lower rate of air leaks (9 to 15 percent) have been reported among low birth weight neonates requiring mechanical ventilation.4 Pneumothorax represents the most commonly occurring air leak.
Apgar Scoring: Its Use and Meaning for Today’s Newborn
Authors: Juretschke Linda
Published: May 2012

Apgar scoring is a common and accepted practice used for evaluating newborns immediately after delivery. After its development by Dr. Virginia Apgar in the late 1940s/early 1950s, its use and meaning have evolved over the past five decades. Today, every baby born in a U.S. hospital is given an Apgar score. With advances in neonatology and improved survival rates for infants with lower gestational ages, a new or revised scoring system may be warranted in order to more appropriately evaluate the extremely preterm infant. In addition, the predictive capabilities of Apgar scoring must be considered with caution for all gestational age groups.
Lasers in Medicine: Treatment of Retinopathy of Prematurity
Authors: De Roo-Merritt Linda
Published: May 2012

Lasers are a unique surgical tool, but what actually are they? This article answers that question and describes how lasers work and how they are being used in medicine. Retinopathy of prematurity (ROP) then is defined. Cryotherapy, a surgical procedure often performed on ROP patients, is reviewed and compared to photocoagulation, a form of laser therapy. Photocoagulation and its complications are then discussed.
Neonatal Laboratory Blood Sampling: Comparison of Results from Arterial Catheters with Those from an Automated Capillary Device
Authors: Johnson Karen , Cress Gretchen , Connolly Natalie , Burmeister Leon , Widness John
Published: May 2012

Purpose:To compare neonatal laboratory results from capillary blood samples drawn using the Tenderfoot automated capillary sampling device with those drawn through arterial catheters.

Design:Prospective, paired comparisons of laboratory results from capillary and arterial blood.

Sample:Twenty-one infants being cared for in an NICU and having indwelling arterial catheters through which a variety of predominantly glucose-containing fluids were being administered.

Main Outcome Variables:Statistical comparisons of paired capillary and arterial results of pH, PO2, PCO2, lactate, sodium, potassium, ionized calcium, and hematocrit.

Results:No capillary-arterial differences were observed for pH, PCO2, lactate, or sodium. Although capillary results were slightly, but significantly (p<.01), higher for potassium (+0.4 mEq/liter), ionized calcium (+0.47 mg/dl), and hematocrit (+4 percent), these differences fell within acceptable Clinical Laboratories Improvement Act (CLIA) performance criteria. Markedly lower PO2 (−30.2 mmHg) and glucose (−61 mg/dl) values were observed with capillary sampling. With the exception of results for PaO2and plasma glucose, capillary blood drawn using the Tenderfoot automated device yields laboratory results comparable to those from blood drawn from arterial catheters as assessed by CLIA performance criteria.
Considerations for Touch and Massage in the Neonatal Intensive Care Unit
Authors: Browne Joy
Published: May 2012

AN EXPANDING BODY OF research has documented the short-term advantages of gentle touch and massage for healthy term infants and some growing and medically stable preterm infants. These findings have provided the impetus for extension of massage techniques to very small, fragile newborns, promoting the utilization of new personnel in NICUs specifically to provide massage therapy for newborns. It is important, before engaging in these approaches, for professionals in the NICU to consider the potential impact of massage on the infant and the family. It is also imperative that professionals in the NICU take into account the current growing knowledge base regarding developmental care and the implications for decision making regarding provision of stimuli of any sort to fragile, sick newborns in the NICU.
Newborn Auditory Follow-Up
Authors: Purdy Isabell
Published: May 2012

Because hearing is a key component in the infant’s development of speech, language, and cognition, early detection of infant hearing loss is critically important. The routine evaluation of hearing should include the identification of parental concerns regarding infant hearing as well as the assessment and diagnosis of infants with potential hearing impairment. Identification of hearing loss should be followed by early interventions to prevent developmental delays. This article promotes universal screening of newborn hearing. The article also provides a review of the embryogenesis of hearing and includes a breakdown of risks for hearing loss, recommendations for auditory testing, and suggestions for follow-up, early intervention, and support for families of infants with hearing impairment.
The Pituitary Gland: Embryology, Physiology, and Pathophysiology
Authors: Dorton Angela
Published: May 2012

The pituitary gland, the “master gland” of the body, is composed of endocrine cells, which secrete hormones essential for homeostasis. The gland consists of the adenohypophysis (anterior pituitary) and the neurohypophysis (posterior pituitary), two unique structures that differ anatomically and functionally.

The neurohypophysis is innervated by nerve cells in the hypothalamus and forms the connection between it and the pituitary gland. The hypothalamus stimulates release and inhibition of pituitary hormones. The neurohypophysis secretes oxytocin and antidiuretic hormone.

The adenohypophysis is composed of three structures: the pars distalis, the pars intermedia, and the pars tuberalis. The anterior pituitary (pars distalis) is responsible for the release of hormones that include growth hormone, prolactin, thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, adrenocorticotropic hormone, and melanocyte-stimulating hormone.

Disorders of the pituitary are predominately those of insufficient hormone release and may have profound effects on the neonate. The potential causes of and clinical symptomatology that may accompany pituitary hormone insufficiency in the neonatal period are explored.
Physicians’ Neonatal Resuscitation of Extremely Low-Birth-Weight Preterm Infants
Authors: Joy Catlin Anita
Published: May 2012

Purpose:To examine the perceptions of physicians who make delivery room decisions to resuscitate extremely low-birthweight (ELBW) neonates at marginal viability. Nurses, parents, economists, and ethicists have questioned resuscitation of ELBW neonates, many of whom experience high levels of morbidity and mortality. Yet no systematic studies were found that addressed physicians’ perceptions and delivery room decisions.

Design:Descriptive, using naturalistic inquiry. A national U.S. convenience sample was obtained in 1996–1997 of 54 physicians in five perinatal subspecialties who resuscitated ELBW neonates.

Methods:Tape-recorded and transcribed interviews were analyzed using NUD*IST software and line-by-line constant comparison.

Findings:Despite awareness of the high morbidity and mortality, 96 percent of the physicians offered resuscitation to all ELBW neonates in the delivery room. The main factors affecting their decisions were “the role of the physician;” having been “trained to save lives;” the belief that “if called, I resuscitate;” the inability to determine gestational age; requests from parents to “do everything;” and the need to move from a “chaotic” delivery room to a controlled neonatal intensive care unit. Six major themes were: role expectation, uncertainty, awareness, internal and external forces, burden, and continuing quandaries. Physicians were burdened by the devastated and dying babies, by their inability to predict which neonates had a chance for intact survival, and by conflicts with colleagues about viability. Statistical probability of survival, legal constraints, and cost of care did not appear to affect greatly their decisions. Physicians asked that society and national policy makers set parameters for resuscitation.

Conclusions:The American Academy of Pediatrics’ Neonatal Resuscitation Protocol needs revision to delineate the ethical criteria for resuscitation. Early prenatal education for families which clearly teaches the margins of viability and outcomes of early deliveries is also recommended. Physicians must be supported in changing the resuscitation paradigm.
Radiology Basics, Part II: RDS and BPD
Authors: Trotter Carol , Carey Barbara
Published: May 2012

ASSESSMENT OF ADEQUACY OF INSPIRATORY EFFORT IS essential in the evaluation of a chest roentgenogram. Underinflation of the chest may suggest serious cardiac or pulmonary disease or worsening of the existing condition.1Therefore it is essential that adequacy of inspiration is provided for when chest x-ray films are taken.
A Comparison of Kangaroo Mother Care and Conventional Cuddling Care
Authors: Roberts Kathryn , Paynter Christine , McEwan Beryl
Published: May 2012

Purpose: To compare kangaroo mother care (KMC) and conventional cuddling care (CCC) in premature and smallfor-gestational-age infants.

Design and Sample: Thirty mother-infant dyads in two Australian neonatal nurseries were randomly assigned to the KMC group or the CCC group. Both groups of mothers cuddled their babies for a minimum of two hours a day, five days a week while in the study, with the KMC group having skin-to-skin contact while the CCC group had contact through normal clothing.

Main Outcome Variable: The main outcome variables were infant weight gain, temperature maintenance during KMC and CCC, and length of hospital stay.

Results: The results showed no difference between groups on the Parental Stress Scale (NICU) or the Parental Expectations Survey. Infants in both groups experienced equivalent maintenance of or rise in temperature while out of the incubators, equal weight gain, equal length of stay in the hospital, and equal duration of breastfeeding.
Correlates of Anxiety, Hostility, Depression, and Psychosocial Adjustment in Parents of NICU Infants
Authors: Doering Lynn , Moser Debra , Dracup Kathleen
Published: May 2012

Purpose: The birth of a premature or critically ill infant can result in debilitating parental responses. This study identifies correlates of parental anxiety, hostility, depression, and psychosocial adjustment so that nurses can identify parents likely to need special attention or intervention.

Design: An explanatory, correlational design was used.

Sample: The study involved 469 parents (mothers = 299, 65 percent; mean age 29.1 ± 6.8 years) of infants hospitalized in five Level III NICUs.

Main Outcome Variable: The main outcomes were those variables which correlated with the independent variables and included: parent status (mother or father), ethnicity, employment status, and education.

Results: Parents experienced high levels of anxiety, hostility, and depression. Poorer family functioning, lower levels of social support, and lower perceived control were associated with higher levels of anxiety, hostility, and depression and with poorer adjustment. Parental status (mother or father), ethnicity, employment status, and education were significantly related to parental responses.
Radiology Basics, Part IV: Cardiac Assessment
Authors: Carey Barbara , Trotter Carol
Published: May 2012

THE EVALUATION OF THE NEONATAL HEART ON CHEST x-ray film, although generally similar to the adult, is unique in many ways. The clinician must take into account the unique cardiovascular aspects of the fetal heart, the dramatic changes that occur at birth, and other aspects peculiar to neonatal physiology.
Parasitic Conjoined Twins: A Case Report
Authors: Juretschke Linda
Published: May 2012

Parasitic twins are a rare phenomenon and a challenge for caregivers. Occurring as a result of abnormal processes in the first several weeks of embryologic development, this condition is oftentimes diagnosed by prenatal ultrasound. This unusual condition may go undiagnosed until the time of delivery, however, despite the availability and use of advanced ultrasound techniques. The challenges presented by this condition are multiple and complex. The following case report demonstrates some of these challenges.
Apnea of Prematurity: Diagnosis, Implications for Care, and Pharmacologic Management
Authors: Theobald Karen , Botwinski Carol , Albanna Stephanie , Mc William Paula
Published: May 2012

Apnea is a disorder of respiratory control commonly seen in premature infants. Several mechanisms have been proposed to explain apnea, and many clinical conditions have been associated with its development. Apnea of prematurity is seen in infants less than 37 weeks gestation, with the incidence increasing as gestational age decreases. Expert and consistent nursing care is essential for management of premature infants with apnea. This article reviews the differential diagnosis, pathogenesis, and implications for care of apnea of prematurity.
The Hypothalamus
Authors: Settle Mary
Published: May 2012

The hypothalamus is an integral part of the neuroendocrine system. The anatomy, embryologic development, and normal function of the hypothalamus are described here. Pathophysiology of congenital abnormalities and brain injury is discussed and a case study examined. In addition, nursing implications of caring for such an infant are addressed.
From Breast to Baby: Quality Assurance for Breast Milk Management
Authors: Dougherty Dorothy , Giles Valerie
Published: May 2012

Breast milk is a body fluid capable of transmitting blood-borne pathogens when ingested. High-risk infants are frequently fed mother’s expressed breast milk and may be at risk if they receive the wrong mother’s milk. A multidisciplinary team at this 42-bed Level III regional NICU developed a quality assurance program and audit aimed at reducing the risk of feeding expressed breast milk (EBM) to the wrong high-risk infant in the unit. Changes to the old system included modernizing the handling, storing, and distribution of EBM. Elimination of feeding errors was the priority. A specific protocol to minimize EBM feeding errors became part of the quality assurance program and is consistent with the recommendations of the NICU multidisciplinary team.
The Thyroid Gland: Physiology and Pathophysiology
Authors: Kirsten Denise
Published: May 2012

The thyroid gland contains many follicular cells that store the thyroid hormones within the thyroglobulin molecule until they are needed by the body. The thyroid hormones, often referred to as the major metabolic hormones, affect virtually every cell in the body. Synthesis and secretion of the thyroid hormones depend on the presence of iodine and tyrosine as well as maturation of the hypothalamic-pituitary-thyroid system. Interruption of this development, as occurs with premature delivery, results in inadequate production of thyroid-stimulating hormone and thyroxine, leading to a variety of physiologic conditions. Pathologic conditions occur in the presence of insufficient thyroid production or a defect in the thyroid gland. Laboratory tests are important in diagnosing conditions of the thyroid gland. A thorough history in combination with clinical manifestations and radiologic findings are also useful in diagnosing specific thyroid conditions. Nurses play an important role in identifying and managing thyroid disorders and in providing supportive care to infants and their families.
The Use of Inhaled Glucocorticosteroids and Recovery from Adrenal Suppression after Systemic Steroid Use in a VLBW Premature Infant with BPD: Case Report and Literature Discussion
Authors: Karinski Debra , Balkundi Dhruv , Rubin Lewis , Padbury James
Published: May 2012

Despite development of many prevention and treatment modalities for bronchopulmonary dysplasia (BPD), a form of chronic respiratory insufficiency in premature infants recovering from respiratory distress syndrome, BPD remains a treatment challenge and a significant cause of long-term morbidity. A ventilator-dependent very low birth weight infant in our newborn special care unit was receiving multiple courses of systemic dexamethasone for severe respiratory failure. The infant demonstrated adrenal suppression manifested by a baseline cortisol concentration below reported levels in infants of similar birth weight and postnatal age. We hypothesized that he had developed adrenal insufficiency as a result of the prolonged systemic steroid administration used to treat his respiratory problems. We further hypothesized that inhaled beclomethasone therapy would aid in the infant’s recovery phase during relative adrenal insufficiency—and so substituted inhaled for systemic steroids. Inhaled corticosteroid treatment improved the clinical respiratory course and postnatal growth of this premature infant with BPD without inhibiting his recovery from adrenal insufficiency.
How Rewarding Can a Pacifier Be? A Systematic Review of Nonnutritive Sucking in Preterm Infants
Authors: Pinelli Janet , Symington Amanda
Published: May 2012

Purpose:To determine whether nonnutritive sucking (NNS) in preterm infants influences selected outcome variables.

Design:A systematic review, based on the Cochrane Collaboration format, of trials utilizing experimental or quasi-experimental designs in which NNS (by pacifier) was compared to no provision of NNS; related to naso/orogastric tube feedings, bottle feedings, or not assoicated with feeding.

Sample:All infants born at <37 weeks gestation. This review consisted of 19 studies; 13 were randomized controlled trials. Sample sizes ranged from 10 to 59 infants and totaled 518 infants.

Main Outcome Variable:Weight gain, energy intake, heart rate, oxygen saturation, length of hospital stay, intestinal transit time, and postconceptional age at full oral feedings.

Results:NNS significantly decreased the length of hospital stay in preterm infants. The review did not reveal a consistent benefit of NNS with respect to other major clinical variables. No negative outcomes were reported in any of the studies.
Challenges Mothers Identify in Bottle Feeding Their Preterm Infants
Authors: Thoyre Suzanne
Published: May 2012

Purpose:To describe the challenges mothers identify in bottle feeding their preterm infants prior to discharge from the NICU.

Design:Mothers bottle fed their infants in the NICU while being videotaped. Following the feeding, a semifocused interview was conducted with the mother using playback of the videotaped feeding to enhance exploration of the experience of feeding.

Sample:The participants were 22 mothers of preterm infants (≤1,500 grams).

Main Outcome Variable:Mothers’ challenges in feeding preterm infants.

Results:Mothers identified three major categories of challenge: ensuring safety during the feeding, ensuring adequate intake of calories, and advancing the feeding plan once home. Mothers described strategies they used to meet these challenges and discussed the implications some of these strategies held for them.
Evaluation of a Program to Promote Positive Parenting in the Neonatal Intensive Care Unit
Authors: Pearson Jolene , Andersen Kate
Published: May 2012

Purpose:To describe and evaluate a parent education program to promote positive parenting in the NICU.

Design:Program evaluations completed by parent participants and staff members.

Sample:104 parents (59 mothers and 45 fathers) who attended the Parent’s Circle; also 44 NICU or SCN staff members.

Main Outcome Variable:Family and staff evaluations of the Parent’s Circle program.

Results:Families reported that attending Parent’s Circle helped them gain perspective on their situation, feel supported, learn key developmental concepts, locate hospital and community resources, and optimize interactions with their fragile infant. Staff reported that the knowledge parents gained from Parent’s Circle influenced their interactions and behaviors in the NICU.
Neonatal Nurses’ Guide to the Internet
Authors: Fraser Askin Debbie
Published: May 2012

SINCE ITS INCEPTION IN 1969, THE Internet has grown beyond all expectations, and today it plays a major role in our daily lives. In order to make the best use of limited time and resources, all members of your health care team should understand the strengths and weaknesses of the information superhighway.
Elimination of Bleeding Associated with Urinary Catheterization in Neonates
Authors: Portell Elizondo Arleen , Gilbert Janice , Wearden Mary , Lanclos Debby , Adams James
Published: May 2012

Three cases of hematuria associated with urinary catheterization in infant males in this NICU over a year prompted an investigation by the health care team. The team tracked catheterizations in the unit, conducted a national survey, and did a literature review. Based on their findings, the team revised the unit policy and procedure and evaluated new products. After changes were implemented, the incidence of hematuria—originally at 20.7 percent— dropped to 5.5 percent during the first evaluation period and to zero during a second follow-up period.
Neonatal Corneal Opacity: A Case Study of Peters’ Anomaly
Authors: Yoon Grace
Published: May 2012

W.Y. IS A FEMALE INFANT born at 38 5/7 weeks gestation to a 25-year-old gravida 3, para 2, O+, RPR: nonreactive, rubella: nonimmune, HbsAg: negative, Class A2 diabetic African American mother. The obstetric history was significant for one seven-year-old healthy male offspring and another male infant who died of carnitine transferase type 1 deficiency at three months of age. W.Y. was delivered via SVD. Her Apgar scores were 8 and 9. Her birth weight was 4,085 gm, making her large for gestational age (LGA).
Sedation for Nonemergent Neonatal Intubation
Authors: DeBoer Scott , Peterson Lisa
Published: May 2012

A newborn lies wide-awake, about to be intubated. The infant is able to feel everything, to hear everything—but cannot do anything to change the situation. Big people hold down the newborn and place a laryngoscope blade into the mouth, then a large endotracheal tube into the trachea. As the baby struggles, coughs, chokes, gags, and cries, blood pressure and intracranial pressure increase dramatically, and the heart rate plummets.

Infants, like adults, do feel pain and anxiety. Yet recent studies show that NICU staff continue neonatal intubation utilizing only force. In pediatric emergency/critical care settings, rapid-sequence intubation (RSI), once confined to the environment of the operating room, is now the standard of care. An understanding of commonly administered RSI medications is essential to bring this practice to standard use in the NICU as well.

In the pediatric and adult critical care population, rapidsequence intubation (RSI)—the use of sedatives and chemical paralytics to facilitate tracheal intubation—is considered the standard of care. Use of these medications optimizes intubating conditions and helps to minimize the adverse physiologic effects of intubation. Neonatology has yet to embrace this trend, however. This article addresses the issue of sedation for intubation in the neonatal population.
In the Absence of God: Ethics in the Modern Hospital
Authors: Rogoff Marianne
Published: May 2012

0n February 6 of 1988 Marianne and Dan Rogoff became parents of a daughter who was severely brain damaged. In response to her child’s life and death, Marianne authored the book Silvie’s Life (available through bookstores, amazon.com or from the publisher, 510-595-0595). In this article, Marianne writes her thoughts twelve years later. Hopefully work in neonatal ethics has progressed so that parents such as the Rogoffs are not placed in such untenable positions.
Leadership for Dummies
Authors: Maguire Denise
Published: May 2012

OUR CATCHY TITLE ASIDE, LET’S BE clear: Leadership is not for dummies. Although leadership skills are different from those needed to care for critically ill newborns in the neonatal intensive care unit, the job of managing nurses is just as hard as the job of nursing, if not more so. Leadership in the NICU focuses less on technical and patient care skills than on social skills such as coaching and supervising learned from experience in dealing with people.1 As a manager, the nurse leader takes on priorities and goals that are different from the priorities and goals of the nursing staff. Instead of using their sharp assessment skills to avoid fluid overload, for instance, managers must use their assessment skills to recognize nursing skills in candidates they meet once in a 30-minute interview. Instead of prioritizing nursing care interventions for her own two-patient assignment, the manager prioritizes staffing patterns based on the skills needed by the entire patient population. Whereas staff members use every resource available to meet patient needs, nurse managers must allocate resources to keep within a tight budget. Strong fiscal skills have become extremely important for today’s manager.2 But rarely do new managers have the formal training in financial skills needed to manage a budget. Managers must also be keenly aware of the relationships among staff, physicians, and other support staff, and they must continually work at keeping the environment productive for staff. They must know what motivates the NICU staff to achieve the goals of the unit. Perhaps the most difficult task that managers have is conveying and making operational the administrative goals in a clinical setting that is intense, detail oriented, and entirely focused on the work of patient care. At every promotion, interpersonal skills become more important and technical skills become less important.1 No, leadership is certainly not for dummies.
Accidental Administration of Oxytocin to a Premature Infant
Authors: Hoff David , Maynard Roy
Published: May 2012

Oxytocin has been used for several decades in close proximity to newborns, yet no published information is available regarding complications associated with its accidental administration to a newborn. We describe a case where oxytocin instead of vitamin K was accidentally administered intramuscularly to a premature infant shortly after birth. The patient described remained hemodynamically stable but developed transient hyponatremia as the sole biochemical abnormality.