Front Cover
Contents
Front Matter
Core Curriculum for Neonatal Intensive Care Nursing
Copyright
Dedication
Contributors
Reviewers
Preface
Table of Contents
PART ONE Antepartum, Intrapartum, and Transition to Extrauterine Life
1 Uncomplicated antepartum, intrapartum, and postpartum care
Terminology
Normal maternal physiologic changes by systems
Antepartum care
Assessment of gestational age
Genetic screening
Antepartum visits
Antepartum fetal surveillance
Laboratory assessments for documenting fetal lung maturity (Greenberg and Druzin, 2017)
Maternal infections
Normal labor and birth
Puerperium: The “fourth trimester”
References
2 Antepartumintrapartum complications
Anatomy and physiology (Baschat and Seravalli, 2017; Burton et al., 2017; London et al., 2017)
Conditions related to the antepartum period
Preeclampsia and eclampsia (ACOG, 2013; Sibai, 2017; Webster and Waugh, 2017)
Diabetes in pregnancy (ACOG, 2018; Landon et al., 2017; Soh et al., 2017)
Conditions related to the intrapartum period
Preterm labor (Hezelgrave and Shennan, 2017)
Abruptio placentae (Francois and Foley, 2017; Davidson et al., 2016)
Placenta previa (Davidson et al., 2016; Francois and Foley, 2017; Navti and Konje, 2017)
Umbilical cord prolapse (Davidson et al., 2016; Steer and Chandraharan, 2017)
Shoulder dystocia (Crofts and Draycott, 2017; Lanni et al., 2017)
Breech presentation (Cluver and Hofmeyr, 2017; Lanni et al., 2017)
Obstetric analgesia and anesthesia (Davidson et al., 2016; Hawkins and Bucklin, 2017; Nutter, 2019; Tsen, 2017)
Obstetric analgesia
Inhaled analgesia (Nutter, 2019; Tsen, 2017)
Obstetric anesthesia (general, neuraxial, regional) (Davidson et al., 2016; Hawkins and Bucklin, 2017; Nutter, 2019; Tsen, 2017)
Cesarean delivery (Berghella et al., 2017; Robson and Bergholt, 2017)
References
3 Perinatal substance abuse
Overview
Risk factors associated with substance use disorder in women
Pregnancy outcomes for substance use disorder associated with common drugs of abuse
Fetal and neonatal outcomes for common drugs of prenatal substance dependence
Childhood outcomes for common drugs of prenatal substance dependence
Breast milk and drugs
Preconception counseling and screening
Treatment approaches for pregnant women
Barriers to treatment
Comorbidities associated with substance use disorders
Screening methods to identify potential substance users
Neonatal abstinence syndrome
Clinical signs of neonatal abstinence syndrome
Clinical signs associated with some drugs
Assessment of neonatal abstinence syndrome
Onset of signs of neonatal abstinence syndrome
Differential diagnosis
Nonpharmacologic treatment of neonatal abstinence syndrome
Pharmacologic treatment of neonatal abstinence syndrome (Raffaeli et al., 2017)
Drugs used to treat neonatal abstinence syndrome
Standardization of pharmacologic management
Environment to care for infants with neonatal abstinence syndrome
Discharge and follow-up
The future (Hamdan, 2017)
References
4 Adaptation to extrauterine life
Anatomy and physiology
Characteristics of placental–fetal circulation
Fetal lung characteristics
Fetal metabolism and hematology
Labor
Delayed cord clamping
Cardiopulmonary adaptation at birth
Routine care considerations during transition (Gardner and Hernandez, 2016; Taylor et al., 2018; Walker, 2018)
Recognition of the sick newborn infant
Review of perinatal history (Rezaee et al., 2013)
Physical assessment (refer to chapter 7)
Diagnostic tools (Bradshaw and Tanaka, 2016)
Common problems and clinical presentation
Acute hypovolemic shock
Initial stabilization of the sick newborn infant
Parent teaching
Before delivery
At delivery
During transition
Postpartum period (early discharge)
Transfer to level II, III, or IV setting
References
5 Neonatal delivery room resuscitation
Definitions
Anatomy and physiology
Risk factors
Anticipation of and preparation for resuscitation
Equipment for neonatal resuscitation
Apgar scoring system
Decision-making process
Initial steps of resuscitation
Postresuscitation care
Complications of resuscitation
The premature neonate
Special situations
Resuscitation outside the hospital or beyond the immediate neonatal period
Ethics
References
PART 2 Cornerstones of Clinical Practice
6 Thermoregulation
Introduction
Physiology of thermoregulation
Management of the thermal environment
Summary
References
7 Physical assessment
Perinatal history (see chapters 1, 2, 3, and 4)
Gestational age instruments
Classification of growth and maturity
Physical examination
References
8 Fluid and electrolyte management
Fluid balance
Physiologic and assessment considerations
Disorders of fluid balance
Fluid depletion
Fluid excess
Electrolyte balance and disorders
Sodium
Potassium
Calcium
Magnesium
Acid–base balance and disorders
Acid–base physiology
Disorders of acid–base balance
References
9 Glucose management
Glucose homeostasis
Hypoglycemia
Infant of diabetic mother
Hyperglycemia
Transient or permanent neonatal diabetes
References
10 Nutritional management
Anatomy and physiology of the premature infant’s GI tract
Nutritional requirements
Parenteral nutrition (Denne, 2018; AAP Committee on Nutrition, 2014)
Enteral feedings: Human milk and commercial formulas for term, special-needs, and premature infants
Enteral feeding methods
Nursing interventions to facilitate tolerance of enteral feedings
Nutritional assessment and standards for adequate growth
References
11 Developmental support
Threats to development
Early experience
What is developmental care?
Operationalizing developmental care
Developmentally supportive environment
Developmental care practices
Parent support and involvement (Papile and Spruill-Turnage, 2017; Pineda et al., 2018)
Teamwork and continuity of care (Spruill and Heaton, 2015)
References
12 Pharmacology
Principles of pharmacology
Terminology
Pharmacodynamics
Pharmacokinetics
Medication categories
Antimicrobial agents
Cardiovascular agents
Central nervous system medications
Diuretics
Immunizations
Nursing implications for medication administration in the neonate
References
13 Laboratory testing in the nicu
Laboratory testing in the NICU
Laboratory specimen collection best practices
Laboratory test collection methods in the NICU (see also chapter 15)
Laboratory test interpretation principles
Principles of test utilization
Laboratory interpretation—decision tree
Laboratory testing—iatrogenic sequelae and preventive strategies
Decision questions to ask before obtaining a laboratory test
References
14 Radiologic evaluation
Basic concepts
Terminology
X-ray views commonly used in the newborn infant (fig. 14.1)
Risks associated with radiographic examination in the neonate
Approach to interpreting an x-ray
Respiratory system
Pulmonary parenchymal disease
Pulmonary air leaks
Miscellaneous causes of respiratory distress
Thoracic surgical problems
Cardiovascular system
Gastrointestinal system
Skeletal system
Indwelling lines and tubes
Diagnostic imaging
References
15 Common invasive procedures
Airway procedures
Endotracheal tube suctioning: Fundamental procedure
Oral endotracheal intubation: Advanced practice procedure
Thoracentesis: Advanced practice procedure
Circulatory access procedures
Peripheral intravenous line placement: Fundamental procedure
Peripherally inserted central catheter and midline catheter: Advanced practice procedure
Removal of peripherally inserted central catheter: Fundamental procedure
Umbilical vessel catheterization: Advanced practice procedure
Umbilical artery catheterization
Umbilical vein catheterization
Peripheral artery catheterization: Advanced practice procedure
Blood sampling procedures
Choice of method for blood sampling
Capillary blood sampling: Fundamental procedure
Venipuncture (phlebotomy): Fundamental procedure
Radial artery puncture: Advanced practice procedure
Miscellaneous procedures
Bladder catheterization: Fundamental procedure
Male catheterization
Female catheterization
Lumbar puncture: Advanced practice procedure
Simulation
References
16 Pain assessment and management
Definition of pain
Neonatal intensive care unit procedures that cause pain
Postoperative pain
Physiology of acute pain in preterm neonates
Standards of practice
Pain assessment
Pain assessment instruments
Echelle douleur inconfort nouveau-né, neonatal pain and discomfort scale (EDIN) (Debillon et al., 2001) (fig. 16.3)
Nursing care of the infant in pain
Pain management at end of life
Parents’ role in pain assessment and management
References
17 Families in crisis
Grief
Interventions for facilitating crisis resolution
Interventions for facilitating grief resolution
Interventions for parents experiencing a perinatal loss
References
18 Patient safety
Domain one—culture
Structured effective methods of communication
Domain two—learning system
Core value of the framework: Parent/family engagement
References
19 Discharge planning and transition to home
Introduction
General principles
Health care trends
Individualized discharge criteria for the infant and family
Parenting in the nicu and after discharge
Discharge preparation and process for all NICU infants
Additional considerations for discharge of infants with complex medical needs (table 19.1)
Family and infant care postdischarge (box 19.9)
References
20 Genetics: From bench to bedside
Basic genetics
Terminology
Dominance and recessiveness
Autosomal disorders
X-linked disorders
Mitochondrial disorders
Chromosomal defects
Abnormal number
Abnormal structure
Prenatal diagnosis
Indications and advantages of prenatal diagnosis
Prenatal tests
Triple and quad screen tests
Ultrasonography
Amniocentesis (“amnio”)
Chorionic villus sampling
Percutaneous umbilical blood sampling
Postnatal testing
Human genome project
Genetic counseling
Newborn care
Diagnosis
History
Examination and care
Examples of specific disorders (for more specific disorders, see chapter 35)
Vater association
Vacterl association
Common trisomies
Trisomy 21 (Down syndrome) (table 20.2)
Trisomy 18
Trisomy 13
References
21 Intrafacility and interfacility neonatal transport
Historical aspects
Philosophy of neonatal transport
Intrafacility neonatal transport (AAP, 2007, 2016; Demmons and James, 2008; National Association of Neonatal Nurses, 2010a)
Interfacility neonatal transport
Types of transports (AAP, 2007, 2016)
Selection of transport vehicles
Transport personnel
Transport equipment (Gershanik, 2006; Orlando et al., 2007)
Neonatal transport process (AAP, 2007, 2016; NANN, 2010a)
Documentation
Safety (AAP, 2016; Camts, 2018; Levick, 2010)
Disaster preparation (AAP, 2016; Gershanik, 2006; Orlando et al., 2007)
Air transport considerations
Legal and ethical considerations
Quality management (CAMTS, 2018; NANN, 2010a, GAMUT, 2019)
References
22 Care of the extremely low birth weight infant
Overview
Epidemiology (Centers for disease control and prevention [CDC], 2017; March of Dimes, 2018)
Mortality and morbidity (Eichenwald, 2018; Revenis, 2016; Stoll et al., 2015)
Perinatal management (American academy of pediatrics [AAP] and American college of obstetricians and gynecologists [ACOG], 2017)
Perinatal consultation (Cummings and Committee on Fetus and Newborn, 2015)
Antenatal steroids
Timing of umbilical cord clamping after birth (ACOG, 2017; AAP, 2017; AAP and American heart association [AHA], 2016)
Delivery room care specific to ELBW infants
Thermoregulation (see chapter 6) (AAP and ACOG, 2017; Eichenwald, 2018)
Ventilatory practices in the delivery room (AAP and AHA, 2016)
Admission to the neonatal intensive care unit
Vascular access (see chapter 15)
Skin care (see chapter 36)
Assisted ventilation (see chapter 26)
Nutritional management (Dell, 2019; Poindexter and Martin, 2019) (see chapters 8 and 10)
Management and prevention of infection (Esper, 2019) (see chapter 32)
Neurosensory complications (Papageorgiou et al., 2016)
Developmental interventions (Eichenwald, 2018) (see chapter 11)
End-of-life care (AAP and ACOG, 2017)
Future directions
References
23 Care of the late preterm infant
Gestational age assessment (see chapter 7) (Holditch-Davis et al., 2017; Trotter, 2019)
Respiratory (see chapters 24 and 25) (Holditch-Davis et al., 2017; Mohan and Jain, 2018; Williams and Pugh, 2018)
Thermoregulation issues (see chapter 6) (Holditch-Davis et al., 2017; Mohan and Jain, 2018; Williams and Pugh, 2018)
Hypoglycemia (see chapter 9) (Blackburn, 2018; Holditch-Davis et al., 2017; Mohan and Jain, 2018; Williams and Pugh, 2018)
Sepsis (see chapter 32) (Blackburn, 2018; Holditch-Davis et al., 2017; Mohan and Jain, 2018)
Hyperbilirubinemia (see chapter 29) (Blackburn, 2018; Holditch-Davis et al., 2017; Mohan and Jain, 2018; Williams and Pugh, 2018)
Feeding difficulties (see chapter 10) (Evans et al., 2019; Holditch-Davis et al., 2017; Mohan and Jain, 2018; Williams and Pugh, 2018)
Neurologic development (see chapter 34) (Mohan and Jain, 2018; Williams and Pugh, 2018; Woythaler, 2019)
Parent education and support (see chapters 17 and 19) (Holditz-Davis et al., 2017; Williams and Pugh, 2018)
Discharge criteria (Mohan and Jain, 2018; Williams and Pugh, 2018)
Long-term outcome (Woythaler, 2019)
References
PART 3 Pathophysiology: Management and Treatment of Common Disorders
24 Respiratory distress
Lung development
Physiology of respiration
Respiratory disorders
Respiratory distress syndrome
Pneumonia
Retained lung fluid syndromes—transient tachypnea of the newborn
Persistent pulmonary hypertension of the newborn
Meconium aspiration syndrome
Bronchopulmonary dysplasia
Pulmonary air leaks (pneumomediastinum, pneumothorax, pneumopericardium, pulmonary interstitial emphysema)
Pulmonary hypoplasia
Pulmonary hemorrhage
Other causes of respiratory distress
References
25 Apnea
Definitions of apnea (table 25.1)
Types of apnea
Pathogenesis of apnea in the premature infant
Causes of apnea (table 25.2)
Evaluation for apnea
Management techniques
Home monitoring
References
26 Assisted ventilation
Physiology
Treatment modalities
Types of assisted ventilation
Ventilator modes
Nursing care of the patient requiring respiratory support or conventional mechanical ventilation
High-frequency ventilation
Nursing care during therapy
Medications used during ventilation therapy
Weaning from conventional ventilation
Nursing care during the weaning process
Interpretation of blood gas values
References
27 Extracorporeal membrane oxygenation
ECMO: A historical perspective
Common neonatal ECMO pathophysiology
Criteria for use of ECMO
ECMO perfusion techniques
Circuit components and additional devices
Physiology of extracorporeal circulation
Care of the infant requiring ECMO
Post-ECMO care
Parental support
Follow-up and outcome
References
28 Cardiovascular disorders
Cardiovascular embryology and anatomy
Cardiac development
Great vessel development
Circulatory development
Cardiovascular physiology
Congenital heart defects
Occurrence
Risk assessment and approach to diagnosis of cardiac disease
Sex preferences associated with cardiac lesions
History (Swanson and Erickson, 2016)
Clinical presentation
Diagnostic adjuncts
Defects with increased pulmonary blood flow (table 28.6)
Patent ductus arteriosus
Ventricular septal defect
Atrial septal defect (Swanson and Erikson, 2016)
Endocardial cushion defect (canal)
Obstructive defects with pulmonary venous congestion (see table 28.6)
Coarctation of the aorta
Critical aortic stenosis
Obstructive defects with decreased pulmonary blood flow (see table 28.6)
Tetralogy of fallot
Pulmonary stenosis
Pulmonary atresia
Tricuspid atresia
Mixed defects
Transposition of the great vessels
Truncus arteriosus
Total anomalous pulmonary venous return
Hypoplastic left heart syndrome
Congestive heart failure
Etiology
Clinical manifestations
Management of congestive heart failure
Postoperative cardiac management
Noninvasive monitoring
Invasive monitoring
Hemodynamic management
Postoperative disturbances
Heart failure
Etiology
Recognition of low cardiac output
Management of low cardiac output
Bleeding
Pulmonary hypertension/pulmonary vasospasm (see chapter 24)
Maintenance of fluid and electrolyte balance (see chapter 8)
Shock
Etiology
Clinical indicators
Management of shock
Pain control and sedation (see chapter 16)
Developmental care (see chapter 11)
Long-term outcomes
Congenital heart disease and pregnancy
Parental support and education (see chapter 17)
General information.
References
29 Gastrointestinal disorders
Gastrointestinal embryonic development
Functions of the gastrointestinal tract
Assessment of the gastrointestinal system
Abdominal wall defects (O’Connell et al., 2016; Raymond et al., 2018)
Obstructions of the gastrointestinal tract
Necrotizing enterocolitis (Fidanza and Sables-Baus, 2019; Hagen and Skelley, 2019; Kim and Claud, 2019; Yanowitz et al., 2019)
Short-bowel syndrome (Chandra and Kesavan, 2018; Mayer and Kerner, 2017; Norsa et al., 2019)
Biliary atresia (Bezerra et al., 2018; Siddiqui and Ahmad, 2019; Wehrman et al., 2019)
Cholestasis (Ananth, 2018; Moreira-Silva et al., 2019; Pandita et al., 2018)
Gastroesophageal reflux (Gulati and Jadcherla, 2019; Janek et al., 2019)
Multisystem disorders with gastrointestinal involvement (Achour et al., 2018)
Congenital diaphragmatic hernia (Aydin et al., 2019; Basurto et al., 2018)
References
30 Endocrine disorders
The endocrine system
Pituitary gland disorders
Thyroid gland disorders
The thyroid gland
Hypothyroidism (Kim et al., 2018; Wassner, 2017; Wassner and Brown, 2018)
Hyperthyroidism (Kim et al., 2018; Léger, 2017)
Adrenal gland disorders
The adrenal gland
Adrenal disorders in the neonate
Congenital adrenal hyperplasia (Fechner, 2018; Mccann-Crosby and Sutton, 2015; Shnorhavorian and Fechner, 2018; Stokowski, 2014; Witchel, 2017)
Sexual development
Disorders of sexual development (Mccann-Crosby and Sutton, 2015; Mcnamara et al., 2017; Shnorhavorian and Fechner, 2018; Stokowski, 2014)
46,XX DSD
46,XY DSD
Androgen insensitivity syndrome (AIS)
Testosterone biosynthetic defects
5-α-reductase-2 deficiency
Gonadal dysgenesis
Ovotesticular DSD
General principles of management of DSDs
Pancreas
Disorders of the pancreas
Infant of a diabetic mother (see chapter 9).
Neonatal diabetes mellitus (NDM) (see chapter 9).
Congenital hyperinsulinism (Arnoux et al.,2011; Devaskar and Garg, 2018).
Cystic fibrosis
References
31 Hematologic disorders
Development of blood cells
Coagulation
Anemia
Hemorrhagic disease of the newborn
Disseminated intravascular coagulation
Thrombocytopenia
Polycythemia
Inherited bleeding disorders
Transfusion therapies
Evaluation by complete blood cell count
References
32 Infectious diseases in the neonate
Transmission of infectious organisms in the neonate
Risk factors
Identification of predisposing risk factors for neonatal infection
Diagnosis and treatment
Recognition of clinical manifestations of neonatal infection
Hematologic evaluation
Additional diagnostic evaluation
Systemic inflammatory response syndrome (SIRS)
Therapy
Treatment of septic shock
Treatment goals and prevention strategies
Neonatal septicemia
Common focal sites and pathogens
Infection with specific pathogens
Group B streptococcus
Fungal infection: Candidiasis
Torches clap infections
Infection control
References
33 Renal and genitourinary disorders
Overview
Fetal development of the kidney
Development of the bladder and urethra (Vogt and Springel, 2020)
Renal function
Renal anatomy
Regulation of postnatal renal hemodynamics (Solhaug and Jose, 2017)
Clinical evaluation of renal and urinary tract disease
Prenatal diagnosis of renal disorders (Bates and Schwaderer, 2018; Gimpel et al., 2018)
Postnatal evaluation of renal and urinary tract disease (Bates and Schwaderer, 2018)
Laboratory evaluation of renal function (table 33.1)
Radiographic evaluation (Gimpel et al., 2018; Vogt and Springel, 2020)
Acute kidney injury (table 33.2)
Evaluation of acute kidney injury (Vogt and Springel, 2020)
Medical management of acute kidney injury (Vogt and Springel, 2020)
Renal tubular acidosis
Developmental renal abnormalities
Disorders of the genitalia
References
34 Neurologic disorders
Anatomy of the neurologic system (Blackburn, 2018; Moore et al., 2012; Volpe, 2018)
Physiology of the neurologic system (Blackburn, 2018; Mclean et al., 2012; Volpe, 2018; Yager, 2012)
Neurologic assessment (Blackburn, 2018; Rennie and Huertas-Ceballos, 2015; Volpe, 2018)
Neural tube defects (NTDs)
Anencephaly (Ditzenberger and Blackburn, 2014; Volpe, 2018)
Encephalocele
Spina bifida
Neurologic disorders
Intracranial hemorrhages
Seizures (Piña-garza and James, 2013; Porsors et al., 2016; Scher, 2012, 2013)
Hypoxic–ischemic encephalopathy (Laptook, 2012; Mcadams and Traudt, 2018; Porsors et al., 2016; Scher 2013)
Periventricular leukomalacia (Back and Miller, 2018; Neil and Inder, 2018; Scher, 2013)
Meningitis (see chapter 32)
References
35 Congenital anomalies
Specific disorders
Abnormalities of chromosomes
Trisomy 21 (Down syndrome)
Trisomy 18 (Edwards syndrome)
Trisomy 13 (Patau syndrome)
22q11.2 deletion syndrome.
Sex chromosome abnormalities
Turner’s syndrome
Klinefelter’s syndrome
Non-chromosomal abnormalities
Malformation disorders
Osteogenesis imperfecta.
Achondroplasia
Specific neural tube defects
Developmental dysplasia of the hip (DDH).
Talipes equinovarus (clubfoot)
Polydactyly
Deformation abnormalities
Amniotic band syndrome
Talipes calcaneovalgus
Congenital metabolic problems
Inborn errors of metabolism
Disorders of metabolism
Errors of amino acid metabolism
Phenylketonuria
Maple syrup urine disease
Errors of carbohydrate metabolism
Galactosemia.
Errors of fatty acid oxidation
Medium-chain acyl-coenzyme a dehydrogenase deficiency
References
36 Neonatal dermatology
Anatomy and physiology of the skin
Care of the newborn infant’s skin
Assessment of the newborn infant’s skin
Common skin lesions
References
37 Ophthalmologic and auditory disorders
Anatomy of the eye (fig. 37.1)
Protective structures
The eyeball
Extraocular muscles
Patient assessment
History
Examination (de Alba Campomanes and Binenbaum, 2017; Johnson, 2016)
Pathologic conditions and management
Birth trauma
Conjunctivitis
Etiology
Neisseria gonorrhoeae
Chlamydia trachomatis
Nasolacrimal duct obstruction
Cataracts
Retinoblastoma (de Alba Campomanes and Binenbaum, 2017)
Congenital infections
Congenital rubella syndrome
Cytomegalovirus
Toxoplasmosis (Peyron et al., 2016)
Retinopathy of prematurity
Anatomy of the ear (fig. 37.3)
External ear
Middle ear
Inner ear
Innervation
Patient assessment
History
Examination
Hearing loss
Hearing screening
References
PART 4 Professional Practice
38 Foundations of neonatal research
Research and generation of nursing knowledge
Research process and components of a research study
Quantitative research
Qualitative research
Areas of exploration in neonatal nursing
Nurses as consumers of research
Ethics in research and nurses as advocates
References
39 Ethical issues
Examining ethical issues in the NICU
Principles of biomedical ethics
Beneficence
Nonmaleficence
Respect for autonomy
Justice
Utilization of the principle approach in the NICU
Other approaches to ethical issues
Ethical theories
Kantianism
Utilitarianism
Liberal individualism
Case analysis model
Medical indications
Patient preferences
Quality of life
Contextual features
The nurse’s role in ethical issues
Adequate communication with parents
Supporting the NICU team
Assessing ethical advisories from maternal child organizations
Consulting the hospital ethics committee
Summary
References
40 Legal issues
Nursing process
Standard of care
State and federal regulations
Institutional policies, procedures, and protocols
Testimony from expert witnesses
Standards of professional organizations
Current professional literature
Further issues: Practice guidelines and ethical standards
Malpractice
Liability
Advanced practice
Documentation (Yankowsky, 2017)
Informed consent
Professional liability insurance
References
APPENDIX A Newborn metric conversion tables
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Z
