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The following essay is a personal story about a NICU experience in 1991 describing a high-risk pregnancy following uterine rupture. After 18 weeks of home and then in-patient monitoring, the infant was delivered by emergency cesarean section at 30 weeks' gestation. The story is written by a retired nurse, but is a first-hand parent narrative. [ABSTRACT FROM AUTHOR]

Amplitude-integrated electroencephalography (aEEG) is a bedside tool for continuous monitoring of brain activity with the possibility of real-time interpretation. Amplitude-integrated electroencephalography is routinely used in Canadian tertiary NICUs; however, its use in Level 2 NICUs has been limited. A bedside aEEG program was introduced in a Level 2 NICU in order to help facilitate the timely transfer of neurologically compromised infants and keep mother–infant dyads together where reassurance of appropriate neurological status could be attained. A monitoring guideline and educational program were developed. The introduction of aEEG monitoring enhanced the care provided to neurologically at-risk newborns. This experience can be used as a framework for other Level 2 NICUs who may wish to embark upon a similar initiative. [ABSTRACT FROM AUTHOR]

This piece was written as a letter of admiration for NICU parents from a NICU nurse. A NICU parent is a special person tasked with one of the most terrifying and burdensome paths possible. Allowing strangers to care for your vulnerable and miraculous child is asking a lot of a person. NICU nurses and staff know this and feel this. Parents should know that they are rock stars. They deserve so much credit. This letter is a small way to give that credit. [ABSTRACT FROM AUTHOR]

Purpose: To describe the use of developmental care (DC) rounds as an initiative to ensure the implementation of bedside DC. To measure the confidence of NICU nurses with participation in DC rounds. Design: Evidence-based practice/quality improvement initiative aimed to answer the following questions: What are the implementation rates of bedside DC nursing interventions used or discussed during DC rounds? Do NICU nurses report agreement with education about DC rounds prior to DC rounds starting? Do nurses in the NICU feel confident participating in DC rounds Do nurses with more years of NICU nursing experience feel more confident than nurses with fewer years of nursing experience? Sample: 513 DC rounds and 101 nursing surveys. Main Outcome Variable : Nursing survey Likert score response and implementation rate of DC nursing interventions. Results: Implementation of bedside DC nursing interventions was strong in the NICU. Areas of opportunity include developmental bath, oral care with breast milk, use of scent clothes, kangaroo care, breastfeeding, use of head plan when appropriate, assignment of a primary baby buddy when appropriate, and use of schedule when needed. Nurses reported their confidence in participation in DC during the implementation of this project. [ABSTRACT FROM AUTHOR]

Purpose: To characterize and quantify touch experienced by preterm infants in the NICU during essential nursing care, identify instances of skin-to-skin touch between infants and caregivers, and identify clinical/demographic variables associated with touch experiences. Design: Cross-sectional study. Sample: Preterm infants (N = 20) born 27–32 weeks post-menstrual age. Main Outcome Variable: Categories of touch during observations. Results: Touch experienced by infants during day and night shifts was primarily direct touch that was further categorized as general handling. During day shifts, 30 percent of direct touch was provided for comfort, but only 9.7 percent of touch was provided exclusively for comfort (i.e., without more intrusive touch). During night shifts, 10.6 percent of direct touch was provided for comfort, and 3 percent was categorized as exclusive comforting touch. Caregivers wore gloves for >89 percent of infant touch. Only the level of respiratory support was associated with touch categories during both shifts. [ABSTRACT FROM AUTHOR]

Aim: To review the literature relevant to palliative care educational programs for nursing staff and families in the NICU. Background: Few hospitals have a palliative care educational program that is in place despite the increasing need for one. Neonatal staff are not educated or prepared to provide end-of-life care (EOLC) and support to family members. There is a lack of literature that looks at parents' perception of EOLC and the potential benefit that proper education may have had on their experience. Methods: Sixteen articles were reviewed, including 7 cohort studies, 5 expert opinions, 1 experimental trail, 1 case-controlled study, 1 literature review, and 1 case study. Conclusion: Implementation of a palliative care education program can provide the necessary tools for neonatal staff to provide EOLC. This education can reduce the stress and anxiety that staff feel about EOLC. With proper education, the neonatal staff can then provide the necessary support for family members. Relevance to Clinical Practice: EOLC is part of all NICUs, and neonatal staff should receive proper education on how to handle such situations. [ABSTRACT FROM AUTHOR]

Family-centered care (FCC) in NICUs aims to support parents and children facing the distressing experience of a preterm infant's NICU hospitalization. Neonatal nurses must also have proper knowledge of the support interventions for parents' and siblings' adaptation during the NICU hospitalization. This paper describes comprehensive and innovative clinical tools which consist of a clinical reference guide for nurses, a website for parents, and a storybook for siblings to promote families' adaptation, and help parents support their older children during NICU hospitalization. Based on scientific evidence and the family systems nursing approach, these comprehensive and innovative clinical tools for nurses, parents, and siblings contribute, through their development and implementation, to enhancing FCC and the quality of nursing care to families. [ABSTRACT FROM AUTHOR]

Necrotizing enterocolitis (NEC) in the NICU does not stay in the NICU. Infants are often discharged with little concern long term, yet that is not true. Meet Linseigh, a former NICU patient who was full-term at birth and was ultimately diagnosed with NEC. In this article, we talk to Linseigh about what it was like growing up with the residual effects of NEC and even how it affects her today. This is a must-read for every NICU nurse so that families can better understand the long-term effects and know what resources to turn to for assistance. [ABSTRACT FROM AUTHOR]

The incidence of abdominal wall defects like gastroschisis and omphalocele are relatively rare. Gastroschisis occurs approximately in 2 to 3 births in every 5,000, and omphalocele occurs in fewer than 2 births in every 10,000. However, our Level III NICU was informed that we were going to receive 2 infants with gastroschisis and one infant with an omphalocele in the same year. Because of the infrequency of these defects, our novice NICU nurses expressed concern about their lack of exposure to and familiarity with these defects. It became apparent that a thorough review of the clinical care and emergency interventions was needed before the anticipated deliveries. The challenge, however, was to develop an innovative, interactive learning experience for the NICU nurse that would provide both a didactic review and hands-on education to care for these patients. We opted to employ simulation. Infant mannequins were used along with moulage to create realistic-looking loops of bowel, herniated bowel segments, and umbilical cord. Scenarios were created that covered the various unpredictable clinical directions these cases could take. These scenarios included the emergency equipment, maneuvers, and interventions that could be required for the anticipated deliveries. Ten sessions for each abdominal wall defect were held; 51 NICU nurses participated in each simulation. NICU nurses reported increased comfort and readiness to care for each infant. [ABSTRACT FROM AUTHOR]

In this review, we describe the near-infrared spectroscopy (NIRS) technology and its clinical use in high-risk neonates in critical care settings. We searched databases (e.g., PubMed, Google Scholar, EBSCOhost) to find studies describing the use of NIRS on critically ill and high-risk neonates. Near-infrared spectroscopy provides continuous noninvasive monitoring of venous oxygen saturation. It uses technology similar to pulse oximetry to measure the oxygen saturation of hemoglobin in a tissue bed to describe the relative delivery and extraction of oxygen. Near-infrared spectroscopy can be a valuable bedside tool to provide clinicians indirect evidence of perfusion. It may prompt early interventions that promote oxygen delivery, which can improve high-risk neonatal outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To assess the impact of a quality improvement (QI) project to increase nursing staff confidence in responding to neonatal emergencies. Design: Mandatory neonatal emergency in situ scenarios done quarterly. Sample: Bedside NICU nursing staff and the subset of NICU nurses that attend all high-risk deliveries and neonatal emergencies on the obstetrics unit. Outcome Measures: Confidence levels in responding to neonatal emergencies, demonstrating neonatal resuscitation skills, and communicating effectively during an emergency. Results: Sixty-eight NICU nurses completed the pre- and postintervention surveys. Self-reported confidence levels increased in all areas measured. Overall, the percentage of nursing staff that reported confidence in being able to participate in a neonatal emergency increased from 48 percent to 77 percent. [ABSTRACT FROM AUTHOR]

Medical technology has rapidly decreased the time and cost required to sequence, visualize, and analyze an individual's genome since the Human Genome Project (HGP) ended in April of 2003. The resulting real-time implementation and expanded use of genetic testing in clinical practice, especially in the NICU, has often left ethicists playing catch-up and providing reactive guidance rather than proactive guidance, and nurses struggling to understand their role in resolving associated legal, ethical, and social concerns. This article provides proactive guidance concerning some of the common ethical issues that are manifest in the application of genomics in the NICU as well as practical resources for navigating these conversations with parents and families. Clinical scenarios illustrate key points of consideration for NICU nurses engaged with challenging issues related to genomics in the NICU. [ABSTRACT FROM AUTHOR]

Our understanding of epigenetics and the mechanisms of gene expression has grown rapidly, requiring the NICU nurse to understand the implications on a neonate's health. Epigenetics is heritable changes of the gene expression without changing the DNA sequence. Though most of the etiologies of birth disorders remain unknown, they could result from interactions of genetics, lifestyle, and environment that make changes in the epigenome landscape. Epigenetics may help explain disorders neonates express including cardiovascular defects, cleft lip and palate, and neural tube defects. As our understanding of epigenetics improves, NICU nurses will need to understand possible epigenetic implications on the neonate's health so as to provide better care and guidance to families. [ABSTRACT FROM AUTHOR]

Understanding of genetics has grown rapidly over the past 20 years and has led to the new diagnostic genetic technologies used in the NICU. These molecular genetic tests help diagnose neonates with congenital anomalies, growth disorders, and dysmorphic features. This article presents the basic molecular biology needed to understand such diagnostic tools. Neonatal intensive care nurses are on the forefront of this technology, and need to understand it so they can provide optimal nursing care and support to parents of neonates going through this advanced genetic testing. [ABSTRACT FROM AUTHOR]

Trauma-informed care (TIC) has been described to apply to several groups of traumatized patient/families in the NICU. Trauma is multidimensional, including physical and psychological injuries with long-term effects on well-being and function. A newborn experiences the best outcomes when the mother also experiences the best outcomes. Thus, the TIC approach is applicable to the care of the infant with neonatal abstinence syndrome (NAS) and mother. Organizational adoption of this model is likely to provide a supportive and therapeutic environment for the infant with NAS and family. [ABSTRACT FROM AUTHOR]

NICU parents are stressed, and adding vaccinations into the discussion can cause resistance. Their baby is already enduring pain with the various interventions keeping him alive, so a parent is likely to balk at the very mention of vaccinations. Enter Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, who works with parents all the time around this issue. I interviewed her about how to help "vaccine-hesitant" parents come around in complying with vaccinations while in the NICU. [ABSTRACT FROM AUTHOR]

The vast majority of infants in the NICU receive peripheral intravenous (PIV) therapy for administration of fluids, nutrition, medications, and blood products. The potential complications of infiltration and extravasation are common in this population. Consequences of inf.ltration and extravasation may be prevented or mitigated by early detection and prompt treatment. In addition, innovative therapies for wound care are constantly evolving. In order to improve outcomes, a practice guideline for intravenous (IV) infiltration prevention, management, and treatment is presented based on literature review and consultation with wound care experts. The guideline includes preventive measures, standardized IV assessment, staging, an algorithm outlining injury, and wound care recommendations. [ABSTRACT FROM AUTHOR]

Infant medical trauma in the NICU is associated with serious and lasting consequences. Skin-to-skin contact (SSC) of infants with their parents is a nursing intervention that provides significant benefits and can mitigate the negative consequences of the infant's traumatic experiences in the NICU. The purpose of this article is to explain how SSC aligns with the concept of trauma-informed age-appropriate care (TIAAC) in the NICU. The evidence supporting SSC will be reviewed and discussed using TIAAC as a framework. SSC is an effective and evidence-based care strategy that reduces the infant's traumatic NICU experiences by improving parental proximity, attachment, and lactation; decreasing stress and pain; improving physiologic stability; supporting sleep; and enhancing neurologic outcomes. [ABSTRACT FROM AUTHOR]

The aim of this project was to determine how implementing neuroprotective, family-centered, developmental care interventions would impact the satisfaction of nurses and families compared with traditional care in a NICU. Neuroprotective, family-centered, developmental care is grounded in the principle that optimal health outcomes are accomplished when patients' family members play an active role in contributing emotional, social, and developmental support for their babies. To accomplish this, nurses needed an understanding of the developmental problems associated with high-risk premature infants, fundamentals of neurosensory growth, and how the intrauterine environment protects the infant from the fluctuation of an unstable extrauterine environment. The model we chose to use was the Neonatal Integrative Developmental Care Model. Pre- and post-surveys showing an increase in knowledge and benefits of these interventions were collected from nurses. Pre- and post-Press Ganey reports showed families had a strong satisfaction with neuroprotective, family-centered, developmental care in our NICU. [ABSTRACT FROM AUTHOR]

There are numerous factors placing neonates at increased risk of developing pressure injuries while hospitalized. Prevention of hospital-acquired pressure injuries in this vulnerable patient population requires early risk identification. Unfortunately, identifying neonates who are at risk of developing pressure injuries is complicated because of the lack of pressure injury risk assessment tools validated for use in neonates. The Braden Q risk assessment scale was adopted by two NICUs within a health care system to aid in identifying neonates at risk of developing a pressure injury. Additionally, the electronic health record was adapted to assist nurses in implementation of appropriate interventions to prevent pressure injuries based on Braden Q subscores. [ABSTRACT FROM AUTHOR]

Congenital heart defects (CHD) are the most common congenital malformation reported in the literature, with a global incidence of eight per every 1,000 live births. In the United States approximately 40,000 infants are born each year with a CHD. Of the infants diagnosed with a CHD, one in every four heart defects are life threatening in origin. Early identification and treatment of congenital heart lesions, beginning with a comprehensive physical assessment after birth, are critical. For infants delivered at community-based hospitals, the importance of the physical assessment, timing of diagnostic strategies, anticipatory planning, and interprofessional collaboration among referring and accepting centers cannot be understated. This article presents a rare case of an infant with arteriovenous canal complicated by dextrocardia. Embryology, pathophysiology, epidemiology, symptomology, cardiac assessment, diagnostics, treatment, and nursing strategies for facilitating transfer of care from community-based hospitals to tertiary medical centers are discussed. [ABSTRACT FROM AUTHOR]

Endotracheal intubation, a common procedure in neonatal intensive care, results in distress and disturbs physiologic homeostasis in the newborn. Analgesics, sedatives, vagolytics, and/or muscle relaxants have the potential to blunt these adverse effects, reduce the duration of the procedure, and minimize the number of attempts necessary to intubate the neonate. The medical care team must understand efficacy, safety, and pharmacokinetic data for individual medications to select the optimal cocktail for each clinical situation. Although many units utilize morphine for analgesia, remifentanil has a superior pharmacokinetic profile and efficacy data. Because of hypotensive effects in preterm neonates, sedation with midazolam should be restricted to near-term and term neonates. A vagolytic, generally atropine, blunts bradycardia induced by vagal stimulation. A muscle relaxant improves procedural success when utilized by experienced practitioners; succinylcholine has an optimal pharmacokinetic profile, but potentially concerning adverse effects; rocuronium may be the agent of choice based on more robust safety data despite a relatively prolonged duration of action. In the absence of an absolute contraindication, neonates should receive analgesia with consideration of sedation, a vagolytic, and a muscle relaxant before endotracheal intubation. Neonatal units must develop protocols for premedication and optimize logistics to ensure safe and timely administration of appropriate agents. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article was to develop standardized nutritional guidelines that would promote increased growth velocity (GV) in premature infants. Design: Evidence-based standardized nutritional guidelines were developed. Guidelines included total parenteral nutrition advancement; enteral feeding advancement; and a bedside nurse gastric residual management algorithm. Staff education was given. Guideline compliance was measured. Nutritional intake and daily weights were recorded. Sample: Infants of birth weight <1,500 grams who were admitted to the NICU before day of life four. Main Outcome Variable: Increase in GV from 12 to 15 g/kg/d. Results: Growth velocity was unchanged. Compliance to the nutritional guidelines was 70 percent. No difference was seen in length of stay. Rate of necrotizing enterocolitis was decreased. [ABSTRACT FROM AUTHOR]

Disseminated intravascular coagulation (DIC) is a serious secondary disease that alters the events in the clotting cascade. DIC leads to microclots in the peripheral vasculature. The uncontrolled formation of these clots consumes the body’s clotting factors, which precipitates bleeding. Neonates, defined as newborns zero to one month old, are born with slightly altered hemostasis, also known as developmental coagulopathy. This coagulopathy puts neonates at a greater risk of developing DIC, specifically when additional body systems have been compromised by a primary disease. Because of the serious nature of this disease and its precipitating factors, advanced practitioners should study the nuances of DIC to provide accurate diagnosis and proper treatment. The aim of this article is to discuss the pathophysiology behind DIC along with etiologies, diagnosis, treatment, and prognosis in neonates, along with gaps in current research. [ABSTRACT FROM AUTHOR]

Infantile hypertrophic pyloric stenosis (IHPS) is the most common gastrointestinal disease among infants. IHPS occurs as an isolated condition or together with other congenital anomalies. Association with genetic and environmental factors, bottle feeding, younger maternal age, maternal smoking, and erythromycin administration in the first two weeks of life has been shown. Familial aggregation has been described and a family history is seen in 47.9 percent of siblings. Infants typically present with projectile vomiting associated with symptoms of failure to thrive. An olive-like mass palpable in the right upper abdominal quadrant is being reported less frequently because of earlier diagnosis by ultrasound. IHPS is generally corrected through laparoscopic pyloromyotomy. Endoscopic pyloric balloon dilation is a novel alternative. Further studies on different populations, the general population, and familial segregation to determine the prevalence, influence, and mode of familial aggregation and correlation with environmental factors are needed to determine the etiology of IHPS. [ABSTRACT FROM AUTHOR]

Neonatal infections result in significant morbidity and mortality. Antibiotics are vital for the treatment of infections but disrupt the neonatal microbiome, put the infant at risk for an adverse drug reaction, and may lead to the development of antibiotic resistance. Immediately after birth, clinicians must determine which infants require empiric antibiotics. Online risk stratification tools may provide a superior approach to decision trees. In infants who require empiric therapy for early-onset sepsis, ampicillin and an aminoglycoside with dosing based on recent pharmacokinetic studies represents the most appropriate first-line agents; third-generation cephalosporins should be reserved for patients with a high likelihood of Gram-negative meningitis. An antistaphylococcal penicillin and gentamicin should be utilized for suspected late-onset sepsis. Vancomycin and other broad-spectrum agents are reserved for patients with a history of resistant organisms. Antibiotic duration should be guided by understanding the clinical indications and obtaining the necessary cultures appropriately (i.e., adequate volume blood cultures). In the absence of a positive culture, antibiotic duration should often be limited. Individual institutions should leverage a multidisciplinary, interprofessional team to identify opportunities for antimicrobial stewardship. A collaborative, transparent system is required to change unit culture and generate a sustained impact on antibiotic utilization with optimal patient outcomes. [ABSTRACT FROM AUTHOR]

Central venous catheters are commonly used for the provision of parenteral nutrition and medications for critically ill neonates in the NICU. However, central line-associated bloodstream infections (CLABSIs) are a major complication associated with their use and remain an important cause of nosocomial sepsis in NICUs. Central line-associated bloodstream infection has shifted from being an expected routine complication of central line use to an adverse event now evaluated as a critical event with the goal of identifying root causes so future CLABSI events are prevented. Success has been achieved through multiple strategies including implementation and maintenance of care bundles, education strategies to promote consistent adherence to bundle components, and institutional and unit support. Although low CLABSI rates can be achieved, sustaining low CLABSI rates and achieving zero CLABSI remain an ongoing challenge. We describe our experience with lessons learned, with an emphasis on the areas of difficulty during implementation of the bundle elements and the strategies and tools we utilized to overcome them. [ABSTRACT FROM AUTHOR]

Aim: The global aim of this quality improvement project was to develop and implement a systematic process to assign and maintain consistent bedside nurses for infants and families. Methods: A systematic process based on a primary care nursing model was implemented to assign consistent care for a 48-bed, single-family room NICU. Results: Four PDSA cycles were necessary to obtain agreement from the nursing staff as to the best process for assigning primary nurses. Post-intervention data revealed a 9.5 percent decrease of consistent caregivers for infants in the NICU ≤ 28 days and a 2.3 percent increase of consistent caregivers for infants in the NICU ≥ 29 days. Conclusion: Although these findings did not meet the goal of the specific aim, a systematic process was created to assign bedside nurses to infants. Further PDSAs will be needed to refine the process to reach the aim. [ABSTRACT FROM AUTHOR]

Quality improvement has evolved rapidly in neonatal nursing. This review outlines the history and current state of quality improvement practice and education in neonatal nursing. The future of neonatal nursing includes a stronger emphasis on quality improvement in advanced practice education that promotes doctoral projects that result in clinical improvements. A collective focus will ensure that neonatal nurses not only deliver evidence-based care, but also continually improve the care they deliver. [ABSTRACT FROM AUTHOR]

Compassion fatigue is a concept used to describe how various stressors affect individuals who work in health care and other caregiving professions. The results of compassion fatigue may include decreased work productivity, poor quality of care, safety concerns, job dissatisfaction, and job turnover. The NICU professionals are at an increased risk for experiencing compassion fatigue because of the nature of working with critically ill infants, their families, and the additional stress of the workplace. The purpose of this article is for the NICU professional to understand compassion fatigue, identify the risk factors, recognize the signs and symptoms, and offer strategies to implement within the NICU environment. [ABSTRACT FROM AUTHOR]

Early exposure to age-appropriate, meaningful auditory stimuli, such as lullaby singing, has been shown to advance various medical and developmental goals in premature infants in the NICU while reducing medical costs. A primary goal of NICU music therapists is to control auditory stimuli in the unit to help premature infants reach the greatest possible sedation. In hospitals with limited or no NICU music therapy (NICU-MT) coverage, nurses and other NICU staff can play an important role in providing neuroprotection to these premature infants while also optimizing neurodevelopment via use of recorded music. Based on current literature, this article provides a set of evidence-based guidelines for the use of recorded music with premature infants. [ABSTRACT FROM AUTHOR]

Placental blood remains an underused resource for early neonatal care despite ample evidence that placental blood provides the same clinical decision making information without the need for painful, invasive blood sampling procedures. Potential benefits of placental/umbilical blood sampling (PUBS) for neonatal admission labs include decreases in pain reactivity, rates of anemia, need for blood transfusions, use of vasopressors, and rates of intraventricular hemorrhage. Here, we present a unique case study of a critically ill infant with contradictory blood culture results from PUBS and direct infant sampling. A negative admission direct sample blood culture result compared with a positive admission PUBS blood culture result suggests that infection may have been missed in the direct infant sample. Relevant placental embryology and circulation is also described, as well as the benefits of PUBS for neonatal admission labs (with focus on the blood culture), challenges associated with PUBS practice, and strategies for implementation of PUBS. [ABSTRACT FROM AUTHOR]

The imprinting disorder, Prader-Willi syndrome, is a condition associated with the gene region 15ql 1.2-q.l3. The phenotype includes multiple characteristics, most of which are endocrine-related. An accurate diagnosis is done mostly through pre- or postnatal genetic testing. Management is mainly aimed at correcting the endocrine dysfunctions present in these patients. Genetic testing is also important to distinguish between the different causes and to calculate the recurrence risk for parents with affected children. Although a lot has been discovered and this syndrome can be managed to a satisfactory degree, further research is still important especially regarding new potential treatments with greater efficiency and reduced invasiveness. The neonatal nurse has an important role because the management requires thorough monitoring as well as high compliance from both the patient and the carers. Thus, it is essential for the neonatal nurse to have a good knowledge of this condition. [ABSTRACT FROM AUTHOR]

It is a practice with strong roots in nature and has a significant influence on health outcomes, particularly for at-risk newborns in low-resource settings. In this comprehensive review, benefits of SSC for newborns, mothers, and fathers after vaginal and cesarean births are discussed as well as the benefits of SSC observed for infants in the NICU. Barriers to SSC practice implementation are discussed, and proposed solutions and recommendations are offered. By understanding the many benefits of SSC and strategies for implementation, health care providers can best support and promote this high-quality, evidence-based practice with mothers, newborns, and dieir families. [ABSTRACT FROM AUTHOR]

Congenital diaphragmatic hernia (CDH), a major congenital defect, occurs in 3.3-5 per 10,000 live births. It is associated with significant morbidity and mortality risks, with lifelong implications imposed on survivors. The pathophysiology, diagnostic tools, and treatment modalities for CDH must be understood to provide timely, holistic care to the infant and family. Swanson's theory of caring can effectively guide the interprofessional perinatal/neonatal team in the prenatal and postnatal care of the infant and family. [ABSTRACT FROM AUTHOR]

Infants with neonatal abstinence syndrome (NAS) are a growing population in the NICU setting, and nurses report that caring for families can be challenging. Women who are pregnant and newly parenting who use drugs and alcohol typically face significant negative attitudes, judgment, and stigma within their communities and from providers when they access health care. When nurses witness biased behavior or communication front their peers, they may feel distressed and unprepared to address the situation. Using script guides or structured communication frameworks (e.g., SBAR) is one helpful strategy for rehearsing actions and responses. The ACTS script was developed specifically to address peer attitudes and stigma in relation to substance use during pregnancy. [ABSTRACT FROM AUTHOR]

Neonatal abstinence syndrome (NAS) affects 3.39 in every 1,000 live births. A literature review was conducted to determine the varying types of nonpharmacologic management being used currently and its effect on the treatment of NAS symptoms. Fourteen articles were found that used nonpharmacologic management in the treatment of NAS. Therapies included breastfeeding, positioning, rooming-in, acupuncture/acupressure, and beds. Each of the nonpharmacologic therapies in these articles, with the exception of rocking beds, was shown to have a positive effect on the newborn with NAS. These effects include a shorter length of stay, a decrease in NAS scores, a decrease need for pharmacologic treatment, less agitation, a better quality' of sleep, and a decrease in the severity of NAS symptoms. This review article shows that nonpharmacologic management is an effective tool for NAS symptom treatment. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this focused ethnography was to describe the culture of care and nonpharmacologic nursing interventions performed by NICU nurses for infants with neonatal abstinence syndrome (NAS). Method: Roper and Shapira's1 framework for the analysis included participant observation, individual interviews, and examination of existing documents. Sample: Twelve full-time nurses were observed and interviewed. Results: Results described the culture of care provided to infants with NAS by NICU nurses as evidenced by six themes: learn the baby (routine care, comfort care, environment, adequate rest and sleep, feeding), core team relationships (support, interpersonal relationships), role satisfaction (nurturer/ comforter, becoming an expert), grief making a difference (wonderful insanity, critical to them), and education and care of the mother. [ABSTRACT FROM AUTHOR]

Neonatal nurses frequently care for babies who have been exposed in utero to potentially harmful substances, both licit and illicit. The risks to die fetus from nicotine, marijuana, alcohol, and opiates are significant. Adverse effects from environmental factors may confound pharmacologic effects of substances. Nurses are called to shift the perception of substance use disorder from that of willful harm to the fetus to that of an opportunity to provide treatment assistance that can positively affect child health and development. Concerns for unethical practices in die toxicology screening of pregnant women and their babies by risk factors that are unproven or disproven are discussed, and three goals of toxicology screening based on the ethical principles of justice and beneficence are proposed. This article will help equip neonatal nurses to fulfill their professional responsibility' to advocate for just screening and referral practices in their institutions and communities. [ABSTRACT FROM AUTHOR]