Gastroschisis is a congenital anomaly that results in the presentation of various portions of the bowel and abdominal contents outside of the body through a defect or opening in the abdominal wall. The absence of a protective membrane around the bowel is a hallmark sign of gastroschisis, in which prior to birth the bowel floats freely in the amniotic fluid. The anomaly is detectable via ultrasound, occurring early in embryologic development, but is not identified prior to 12 weeks' gestation, when the bowel fails to involute to the abdomen. Gastroschisis occurs in 4-4.5/10,000 live births in the United States. The greatest risks identified are maternal age <20 years, low body mass index, and primigravida. Classified as simple or complex, management of gastroschisis requires a multidisciplinary collaborative approach that includes obstetrics, maternal-fetal medicine, pediatric surgery, nutrition, and neonatology. Simple gastroschisis is closed with primary or staged reduction and closure, while complex gastroschisis requires surgical intervention to address associated complications, including bowel atresia, necrosis, perforation, or volvulus, leading to long-term management. This article presents a case report of a 37 3/7 weeks' gestation female who presented with simple gastroschisis managed with staged silo reduction and sutureless closure. This article reviews the embryology, epidemiology, pathophysiology, and classifications of gastroschisis, with a focus on sutureless closure involving the use of the preserved umbilical cord. Nursing management of surgical and postsurgical care and long-term concerns for the family are discussed.
Iron is an essential element for fetal and neonatal development. It is an important component of hemoglobin and plays an important role in delivering oxygen to the body. Iron also plays a critical role in brain development, and iron deficiency can be described on a spectrum, from mild to severe. The role of iron in fetal and neonatal development, iron deficiency, indices for monitoring iron, indications for and dosing of enteral iron, and contraindications are described in this column.
The Baby-Friendly Hospital Initiative strives to increase exclusive breastfeeding rates. Research findings suggest that NICU nurses' actions and support may be a key factor in increasing breastfeeding rates. Our needs and feasibility assessment identified a NICU lacking a NICU-specific breastfeeding policy, and a review of the electronic health record (EHR) showed nurses did not assist patients with breastfeeding. We conducted a quality improvement project that included the creation of a NICU-specific breastfeeding policy, educational inservices, and real-time coaching for nurses. Additionally, pre-post questionnaires were administered to the nurses, and a review of the EHR was performed to assess nurse-assisted breastfeeding attempts pre and post project implementation. Thirty-six (80%) nurses attended the inservice. Almost two thirds of nurses (63%) had adequate breastfeeding knowledge prior to the inservice. Nurses' knowledge gained from the inservice was not statistically significant from pre/post implementation of the project (t = 0.48, p = 0.32). We identified 11 nurse-assisted breastfeeding attempts in our 10-day review of the NICU EHR after project implementation. This result was compared with zero nurse-assisted attempts in our EHR review prior to this project. We conclude that a multimodal approach to support breastfeeding in the NICU may be beneficial to increase breastfeeding rates by ensuring nurses have the knowledge and skills to promote breastfeeding.
Hypoglycemia, a common infant disorder caused by maternal antihypertensive medications, is a rare but serious complication. Increasing awareness of this potential side effect is crucial for all infant health care providers to facilitate early recognition and treatment, thereby mitigating risks of adverse infant outcomes. In this unique case, maternal metoprolol was prescribed for dysautonomia during pregnancy, which resulted in hypoglycemia in the infant. Born at 39 weeks' gestation, male infant presented with signs of hypoglycemia in the first 12 hours of life. After persistent prompting from the mother, a bedside glucose test was performed, with a "low" result. The infant received glucose gel and formula supplementation after breastfeeding, but persistent hypoglycemia necessitated a 4-day admission to the NICU. The diagnosis was hypoglycemia related to maternal prenatal metoprolol use. In addition to standard treatment for hypoglycemia, this infant's parents chose to cease breastfeeding to avoid potential adverse effects of hypoglycemia is understandable but should be of concern to all infant providers. Treatment of maternal hypertensive disorders utilizing beta-blocker medications during pregnancy is common. Increased awareness of hypoglycemia as a rare but potential complication can lead to early recognition by infant providers to reduce the risk of NICU admission.
This article explores the barriers leading to the decline in enrollment in neonatal nurse practitioner (NNP) programs. It also identifies gaps and offers evidence-based strategies to improve recruitment and retention in the NNP workforce. These gaps in the literature involve issues of diversity within the NNP workforce, marketing approaches, and undergraduate exposure. Effective strategies include mentorship programs, academic-practice collaborations, and wellness initiatives. The findings highlight the need to invest in NNP education, implement policy support for workforce sustainability, and foster collaboration among academia, practice settings, and organizations to secure the future of neonatal advanced practice nursing. Without coordinated efforts, the NNP role may decline, potentially harming neonatal outcomes.
Because of the novelty and complexity of the construct of enjoyment in preterm infants, an exploration of insights from clinical and research perspectives is warranted. The purpose of this article is threefold: (a) to describe the clinical and research-based indicators of enjoyment, (b) to promote clinical strategies that may facilitate enjoyment, and (c) to identify potential benefits of enjoyment for preterm infants in the NICU. We conducted a comprehensive literature review to explore the clinical and research perspectives of enjoyment in preterm infants in the NICU. Articles were selected for full-text review if they discussed the potential clinical and research-based indicators of enjoyment, clinical strategies that may facilitate enjoyment, or benefits of enjoyment. There is a limited description of this construct for preterm infants in the NICU. Our synthesis of the literature highlights the relative value of enjoyment in preterm infants and its clinical and research implications. A conceptual framework was developed to guide further exploration of the construct of enjoyment in preterm infants and aimed at sparking deeper discussions among neonatal researchers and clinicians. Enjoyment in preterm infants remains an underrecognized construct in the literature. Initiating discussions on its meaning and potential impact to transform NICU care and research is essential. Further research is warranted to develop and test validated measures to assess enjoyment in preterm infants. Clinicians are encouraged to reflect on their practice and consider strategies to foster enjoyable experiences for preterm infants in the NICU.
This column advances neonatal orthopedic knowledge from an overview of common issues to clinical application by using concise, practice-focused case studies that align with newborn orthopedic care. This article is an extension of the published article, "The Ins and Outs of Neonatal Orthopedic Disorders: Back to Basics," in Neonatal Network Each scenario includes presentation, diagnostic reasoning (targeted labs and imaging), nursing care, and outcomes to demonstrate how bedside care influences outcomes. These exemplars translate evidence into repeatable workflows allowing for improved orthopedic stability, comfort, and function in the newborn period and beyond.
Otopalatodigital syndrome type 2 (OPD2) is a rare, typically lethal X-linked congenital disorder associated with craniofacial, skeletal, and visceral malformations. Because of its rarity, each case provides valuable insights into neonatal care, genetic counseling, and anticipatory guidance. A male infant diagnosed prenatally with OPD2 after ultrasound revealed multiple anomalies, and genetic testing confirmed the pathogenic variant. The mutation was de novo, as there was no family history of X-linked inheritance. The infant exhibited cleft palate, skeletal deformities, omphalocele, thoracic hypoplasia, and additional brain and renal anomalies consistent with the lethal phenotype. Intensive neonatal care included respiratory support, nutritional interventions, and multidisciplinary consultations. Despite intensive medical management, the infant remained critically ill. Palliative care was introduced early after admission and played an important role in subsequently assisting with arranging the discharge of the infant home on hospice care. The infant survived 6 weeks postnatally, allowing meaningful time with his family. This case highlights the critical importance of prenatal genetic counseling, early anticipatory guidance, and shared decision making, with palliative care integrated as part of the care continuum. Neonatal nurse practitioners and NICU registered nurses are not only essential members of the multidisciplinary team but also serve as consistent advocates for the infant and the family. Their roles in care coordination, ongoing bedside support, and facilitation of compassionate, family-centered communication are vital in helping parents navigate the complex decisions and emotional challenges that accompany a lethal congenital diagnosis.
Neonatal herpes simplex virus (HSV) infection is a potentially fatal complication of maternal HSV infection, and while potentially fatal it is also entirely preventable. Although rare, the disease is associated with significant morbidity and mortality, with long-term neurologic impairment being a major concern even with current treatment advances. This review examines the epidemiology, transmission patterns, clinical manifestations, diagnosis, treatment, and prevention strategies for neonatal HSV infection. In conclusion, neonatal HSV infection represents a preventable cause of significant infant morbidity and mortality. Clinical awareness among health care providers is crucial for early recognition and prompt treatment. Prevention strategies include antiviral suppressive therapy for pregnant women with known HSV history and cesarean delivery when active lesions are present. The challenge remains in identifying asymptomatic maternal infections, as most neonatal cases occur in mothers without known HSV diagnosis.
Persistent pulmonary hypertension of the newborn is characterized by elevated pulmonary vascular resistance, impaired oxygenation, and delayed transition from fetal to adult circulation. Managing infants with pulmonary hypertension is particularly challenging because of the intricate and multifactorial nature of the underlying pathophysiology. A comprehensive and consistent approach to care for these critically ill infants is essential. Although numerous interventions have been extensively studied, a lack of consensus persists in clinical practice, and until recently no formal evidence-based guidelines were available. Developing a bundle of evidence-based interventions available at specific Level III NICUs may increase stabilization and decrease the need for transfer to a Level IV NICU in this high-risk population.
Pulmonary hemorrhage (PH) is a critical and often life-threatening condition that involves the extravasation of blood into the alveolar spaces of the lungs, resulting in impaired gas exchange and acute respiratory compromise. Very low birth weight (<1,500 g) and extremely low birth weight (ELBW; <1,000 g) infants, particularly those with underdeveloped lungs and some degree of pulmonary hypoplasia, are considered at heightened risk for PH. Among ELBW infants, PH carries an estimated mortality rate of up to 50%, underscoring its continued significance as a major contributor to neonatal morbidity and mortality. Other risk factors include a hemodynamically significant patent ductus arteriosus, surfactant administration, mechanical ventilation, and sepsis, which promote pulmonary interstitial edema and compromise alveolar integrity. This article offers neonatal clinicians a timely exploration of the current state of the science of PH, including a review of the physiology of lung and pulmonary vasculature development and treatment modalities.
This prospective cohort study aimed to evaluate whether using a crocheted octopus reduces procedural pain during venipuncture in preterm neonates. The study compared two time-based cohorts: one receiving standard care and one receiving a nurse-led tactile intervention using a crocheted octopus. The study included 122 preterm neonates (<36 weeks' gestational age) admitted to a NICU in Iraq, with 61 infants per cohort. Procedural pain was assessed using the Premature Infant Pain Profile (PIPP) total score. Neonates in the intervention group had significantly lower PIPP scores compared with controls (mean 7.15 vs 11.67; p < 0.0001). No significant differences were found in gestational age or behavioral state scores. The crocheted octopus proved to be a feasible, safe, low-cost, and nurse-led intervention for managing pain in preterm neonates, particularly in resource-limited NICU settings with minimal parental involvement.
Pulmonary hypoplasia (PH) is a rare congenital anomaly involving reduced or incomplete development of lung tissues and vasculature. Approximately 33% of pregnancies complicated by oligohydramnios are associated with PH, and upwards of 9-11/10,000 liveborn infants are diagnosed with PH each year. The estimated perinatal mortality risk is 70%. The management of affected neonates is challenging in that clinicians need to balance the need to provide adequate respiratory support in order to achieve proper ventilation-perfusion matching yet do so in the gentlest manner possible to avoid ventilator-induced lung injury and associated comorbidities. This article presents a case report of a preterm infant born with significant PH attributed to premature prelabor rupture of membranes and severe oligohydramnios, as well as a discussion of relevant physiologic, pathologic, diagnostic, and treatment data. We also emphasize the importance of multidisciplinary collaboration in optimizing prenatal counseling, parental involvement, team readiness, and coordination of care.
This column interviews the leaders of the Adult Preemie Advocacy Network, focusing on awareness about patients born prematurely who are now adults. The challenges in life are real but are sometimes not as obvious. However, they are all extremely important for practitioners of all patients young and old to be aware of, as well as the larger community.
A transition from a pharmacological-based model of care, such as Finnegan scoring, to a behavioral-based model, such as the Eat-Sleep-Console, for newborns experiencing neonatal abstinence syndrome (NAS) or neonatal opioid withdrawal syndrome (NOWS) has resulted in shorter lengths of stay and a decreased need for pharmacological management. However, many newborns continue to be exposed to opioids. Use of opioids for NAS/NOWS prolongs the length of stay and often the separation of mothers and their newborns as well. Additionally, opioids may have detrimental neurodevelopmental consequences for newborns. Researchers are seeking safe and effective pharmacological adjuncts to behavioral-based NAS/NOWS management. Could ondansetron be an answer? This column provides a brief review of a meta-analysis supporting the benefits of a behavioral approach to NOWS, a discussion about why ondansetron may be useful in NOWS, an overview of a pharmacokinetic study of ondansetron in mother-infant dyads, and a review of a recently published clinical trial of ondansetron for NOWS.
