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.
