Neonatal Network
August 2001
Vol. 20, No. 5
ABSTRACTS
Fat-Soluble Vitamin Supplements
for Enterally Fed Preterm Infants
A CEU Offering
Frank Greer, MD
Fat-soluble vitamin requirements for the enterally fed premature infant are
an important concern, both before and after discharge from the neonatal intensive care
unit. Because preterm infants fed unsupplemented human milk receive deficient quantities
of these vitamins (A, D, E, and K), supplements are very important for this population.
Vitamin intakes with special formulas for low birth weight infants and human milk
fortifiers are also reviewed.
Anemia of Prematurity
A CEU Offering
Debra C. Salsbury, RNC, MSN, ARNP
Physiologic anemia is a common and normal finding in
newborn infants. In preterm infants, anemia of prematurity is the result of this normal
physiologic process compounded by the morbidity of prematurity. Premature infants reach
their nadir hematocrit sooner and at a lower level than term infants do.
This article reviews the physiology of stem cell
differentiation and the structure and function of the red blood cell, as well as examining
red blood cell indices. It also addresses the etiology, symptomatology, diagnostic workup,
and treatment/prevention modalities of anemia of prematurity. Treatment for and prevention
of anemia of prematurity remain controversial, and specific criteria are lacking.
Systemic Inflammatory
Response Syndrome
A CEU Offering
Carol A. Botwinski, RNC, MS, ARNP
Despite advances in perinatal care in the past decade, sepsis
and its complications continue to present problems for the neonate, remaining a major
cause of neonatal morbidity and mortality. Sepsis research is focusing on how the neonate
(host) responds to bacteria. The newborn may develop a systemic reaction to bacteria that
induces the release of substances known as inflammatory mediators. Termed the systemic
inflammatory response syndrome (SIRS), this reaction is believed to be responsible for the
signs and symptoms of sepsis. This article introduces the neonatal nurse to SIRS,
providing an overview of various inflammatory mediators and cytokines, their clinical
consequences, and potential new therapies in the management of SIRS.
The Safety and Efficacy of
Peripheral Intravenous Catheters in Ill Neonates
Linda S. Franck, PhD, RN, RGN, RSCN
Kelly Connell, RN, MSN
Jane Montgomery, RN
Debra Hummel, RN, MS, NNP
Dolores Quinn, RN, MS, NNP
This article describes the use of a quality improvement clinical audit approach to identify insertion practices, duration of therapy, and complications related to peripheral intravenous catheters. These data provide evidence for adherence to practice standards and benchmarks for evaluation of new interventions to improve the safety and efficacy of intravenous access practices. Implications for quality improvement and clinical research related to intravenous-device practices within the neonatal intensive care unit are discussed.
Kangaroo Mother Care During
Phototherapy: Effect on Bilirubin Profile
Susan Ludington-Hoe, CNM, PhD, FAAN
Joan Y. Swinth, RNC, BSN
Purpose: To determine the safety and efficacy of
allowing kangaroo mother care (KMC) one hour per day during the course of phototherapy
using a fiberoptic phototherapy panel.
Sample: Thirty premature infants, 30–35 weeks
gestation, <2,500 gm, who required phototherapy. Infants were randomized into three
groups: (1) infants who received traditional bank or spotlight phototherapy 24 hours per
day, (2) infants who received traditional phototherapy 23 hours per day and for the 24th
hour lay prone on a fiberoptic phototherapy panel, and (3) infants who received
traditional phototherapy 23 hours per day and for the 24th hour were given KMC with a
fiberoptic phototherapy panel held against their back.
Outcome Variables: Nonparametric statistics were used for
between-group comparisons on number of days of phototherapy, daily bilirubin decrement,
and bilirubin profiles over the course of phototherapy.
Results: Groups did not differ in the number of days of
phototherapy or in daily mean bilirubin decrement. The bilirubin profile for the KMC group
showed a more shallow descent than did the profiles for the other groups, but a
significant difference in decline was present only on day 4 of treatment (p = .05).
Conclusion: This pilot work suggests that KMC using a
fiberoptic panel during phototherapy may be safe, but further study is needed.