Hydrocortisone to Improve Survival without Bronchopulmonary Dysplasia.

Background: Bronchopulmonary dysplasia is a prevalent complication after extremely preterm birth. Inflammation with mechanical ventilation may contribute to its development. Whether hydrocortisone treatment after the second postnatal week can improve survival without bronchopulmonary dysplasia and without adverse neurodevelopmental effects is unknown.

Neurodevelopmental outcome of preterm infants enrolled in myo-inositol randomized controlled trial.

Objective: This study evaluates the 24-month follow-up for the NICHD Neonatal Research Network (NRN) Inositol for Retinopathy Trial.

Study Design: Bayley Scales of Infants Development-III and a standardized neurosensory examination were performed in infants enrolled in the main trial. Moderate/severe NDI was defined as BSID-III Cognitive or Motor composite score <85, moderate or severe cerebral palsy, blindness, or hearing loss that prevents communication despite amplification were assessed.

Growth from Birth to 30 months for Infants Born with Congenital Gastrointestinal Anomalies and Disorders.

Objective: This study aimed to investigate growth among neonates with gastrointestinal disorders.

Study Design: Inclusion criteria included neonates with gastroschisis, omphalocele, intestinal atresia, tracheoesophageal fistula, Hirschsprung's disease, malabsorption disorders, congenital diaphragmatic hernia, and imperforate anus born between 2010 and 2018. Anthropometrics were collected for the first 30 months, and a subgroup analysis was performed for gastroschisis infants.

Two-Year Neurodevelopment and Growth Outcomes for Preterm Neonates Who Received Low-Dose Intravenous Soybean Oil.

Background: In some studies, the dose of intravenous soybean oil (SO) has been associated with a decreased incidence of intestinal failure-associated liver disease. The effect of lipid sparing on neurodevelopment (ND) and growth remains unknown. This study investigated the impact of SO dose on ND and growth over the first 2 years of age in preterm neonates.

Neonatal Nurses NICU Quality Improvement: Embracing EBP Recommendations to Provide Parent Psychosocial Support.

Background: The neonatal intensive care unit (NICU) can be a stressful environment for infants, their families, and the healthcare team. There is an immediate need for neonatal nurses to embrace and translate the new National Perinatal Association recommendations for psychosocial support of NICU parents into clinical practice to demonstrate best practices for infants, their families, and the whole team.

Purpose: To summarize the current evidence-based practice recommendations and to provide suggestions for team members to develop strategies to adopt and implement them through quality improvement (QI) projects.

Biophysiologic and social stress relationships with breast milk feeding pre- and post-discharge from the neonatal intensive care unit.

Objective: To determine influences on incidence of breast milk feeding (BMF) at time of discharge and 6 months later among infants cared for in the neonatal intensive care unit (NICU).

Design: A 2-year prospective descriptive NICU hospital-based cohort design.

Setting: Academic Center Level III-IV NICU.

Clinical nurse specialists shaping policies and procedures via an evidence-based clinical practice council.

In the practice of nursing, organizations with progressive evidence-based practice programs implement structures and processes whereby nurses are engaged in the review of existing research and in the development of clinical practice documents to better align nursing practices with the best available scientific knowledge. At our academic hospital system, clinical nurse specialists (CNSs) took the lead to help transform a traditional nursing policy and procedure committee into a hospital-wide, staff-represented Clinical Practice Council (CPC) that ensures evidence-based nursing practices are reflected in the organization's nursing practice documents for the provision of patient care. Clinical nurse specialists function as mentors and cochairs who are dedicated to ensuring that nursing practice is supported by the latest evidence and committed to guiding staff nurses to continually move their practice forward.

A psychoneuroimmunologic examination of cumulative perinatal steroid exposures and preterm infant behavioral follow-up.

Purpose: This study's aim was to explore relationships between preterm infant behavioral outcomes and maternal/infant glucocorticoid (dexamethasone [DEX]) treatments using a psychoneuroimmunologic approach. Research questions were (a) do relationships exist between infant cumulative perinatal steroid (PNS) exposure and child behavioral problems? and (b) do maternal/infant characteristics (e.g.

Vein of Galen arteriovenous malformation with PAPVR and use of serial B-type natriuretic peptide levels in the management: a case report and review of the literature.

Background: Arteriovenous malformation of the vein of Galen with partial anomalous pulmonary venous return can lead to a critically challenging condition associated with a high morbidity and mortality.

Case Report: We report a case of a full term infant born with a vein of Gallen arteriovenous malformation complicated by partial anomalous pulmonary venous return and congestive heart failure where B-type natriuretic peptide was used as a vital tool in clinical assessment and treatment management.

Conclusions: Rapid diagnosis and treatment in infants with complex conditions such as this are imperative to expedite appropriate treatments, preventing long term negative outcome.

B-type natriuretic peptide utilization as an adjunct to management in a case of conjoined twins with pulmonary hypertension.

This article reports a case of pulmonary hypertension in 37-week-gestational-age, pygopagus conjoined twins where B-type natriuretic peptide (BNP) was used as a cost-effective and important tool to aid effective management. Pulmonary hypertension in neonates is associated with high morbidity and mortality and multiplies the challenge of caring for conjoined twins. BNP is a peptide hormone secreted by cardiac ventricles that have undergone stress related to ventricular filling, volume overload, and pressure.

Implementing evidence-based practice: a mantra for clinical change.

Evidence-based practice (EBP) requires a commitment to adopting innovation to change clinical problems. In perinatal and neonatal care, this commitment involves utilization of current best evidence in decision making about patient care for the benefit of mothers, infants, and their families. Embracing EBP can lead to increased patient and professional outcomes, creating synergy that will be welcomed on all levels.

Predictors of neurodevelopmental outcome for preterm infants with brain injury: MRI, medical and environmental factors.

This multi-center correlational prospective study examined early neonatal predictors of neurodevelopment in 59 premature infants (mean birth weight=1713.8+/-1242.5 g; mean gestational age=31.

Cumulative perinatal steroids: child development of preterm infants.

The development of premature infants may be altered due to exposure to high cumulative doses of the perinatal corticosteroid dexamethasone during critical growth periods. To compare child behavioral development of prematurely born infants who were exposed to higher perinatal steroids (PNS; >0.2 mg/kg) with that of infants exposed to lower PNS ( View Article and Find Full Text PDF

Brain injury in the infant: the old, the new, and the uncertain.

Although neonatal brain injury occurs most frequently after a perinatal hypoxic-ischemic insult, recently studies have noted that variable causes such as metabolic and reperfusion events can result in, or aggravate, a brain insult. Current data suggest that about 2 to 5 of 1,000 live births in the United States and more so in developing countries experience a brain injury Approximately 20% to 40% of infants who survive the brain injury develop significant neurological and developmental impairments. The resulting impact on the child, family, and society presents a formidable challenge to health care professionals.

Embracing bioethics in neonatal intensive care, part II: case histories in neonatal ethics.

Ethical treatment dilemmas are not new to the NICU. With technologic advances over the past 20 years, NICU care has developed rapidly, and survival rates have improved for some of the tiniest and most critically ill infants. In guiding clinical practice, however, standards in evidenced- based medicine have often superseded standards in evidence-based ethics.

Embracing bioethics in neonatal intensive care, part I: evolving toward neonatal evidence-based ethics.

Ethical treatment dilemmas are not new to the NICU. With technologic advances over the past 20 years, NICU care has developed rapidly, and survival rates have improved for some of the tiniest and most critically ill infants. In guiding clinical practice, however, standards in evidenced-based medicine have often superseded standards in evidence-based ethics.

Vulnerable: a concept analysis.

Topic: In spite of the significance of vulnerable as a phenomenon that affects the human condition, its essence remains complex and elusive.

Purpose: A conceptual analysis to clarify knowledge of this concept to explore the common and scientific usage.

Sources Of Information: A comprehensive and systematic review from bibliographic and abstract databases and online searches.

Perinatal corticosteroids: A review of research. Part I: Antenatal administration.

The premature infant may receive therapeutic glucocorticoid drugs while in utero or in the postnatal period. This article (part I of a two-part series) discusses the benefits and risks of in utero, or antenatal, corticosteroids (ACS) for the premature infant. Part II addresses the benefits and risks of postnatal corticosteroid (PCS) use.

Magnetic resonance imaging and the neonate.

Over the past decade, advances in neuroimaging have given birth to a new field of diagnostic pediatric neurologic assessment that includes magnetic resonance imaging (MRI). This invaluable tool helps medical professionals to resolve many clinical and research questions related to neonatal neurodevelopment that other imaging technology cannot explain. Nurses and others who accompany infants to MRI would benefit from a better understanding of early neurodevelopment and of the neuroimaging procedure.