Neonatal Network June 2001 Abstracts

Neonatal Network
June 2001
Vol. 20, No. 4

ABSTRACTS

When It Is More than Transient Neonatal Hypoglycemia:
Hyperinsulinemia - A Case Study
A CEU Offering
Lee Shirland, MS, RNC, NNP

Persistent uncontrolled neonatal hypoglycemia may cause irreversible brain damage. Hyperinsulinemia is a rare cause of persistent hypoglycemia, diagnosed by excluding other etiologies. Inappropriately high fasting serum insulin levels with concurrent hypoglycemia confirm the diagnosis. Initial interventions for hyperinsulinemia are conservative. The first line of therapy is administration of adequate intravenous (IV) glucose to maintain serum or whole blood glucose levels at or greater than 40 mg/dl. When enteral feedings are tolerated, schedules and caloric concentration are adjusted. Pharmacologic therapy is added to facilitate weaning from IV glucose. The drug of first choice is diazoxide. Octreotide is added if diazoxide therapy fails. Partial or complete pancreatectomy is the final treatment option. Nursing care for infants with hyperinsulinemia must also focus on the support and education of families. Family education must be individualized and should cover feeding regimes, administration of medication, proper use of equipment, and care during illness.

Arthrogryposis Multiplex Congenita
A CEU Offering
Pat O'Flaherty, MEd, MN, NNP

Arthrogryposis multiplex congenita (AMC) is a term that is used to describe the presence of multiple joint contractures at birth. AMC can be seen singularly or in conjunction with other abnormalities. Historically, the term arthrogryposis was used as a disease diagnosis, but it is now clear that AMC is not a disease entity but a syndrome, involving a manifestation of many fetal and neonatal disorders of the neuromuscular system. Its etiology is multifocal, and there is a wide variation in the degree to which muscles and joints are affected. Early identification and implementation of a plan of therapy are essential. The purpose of this article is to provide an overview of the AMC syndrome, specifically, clinical features, etiology, diagnosis, therapeutic interventions, family support, and outcomes

Congenital Toxoplasmosis
A CEU Offering
Sara Martin, RNC, MSN, NNP

Toxoplasma gondii, a parasite, has three modes of transmission: oral intake of raw or undercooked meat or contaminated fruits and vegetables, ingestion of materials contaminated with cat feces, and transplacental infection. The focus of this article is congenital toxoplasmosis, which is transmitted to the fetus across the placenta. When primary infection of the mother occurs during pregnancy, there is a 40 percent chance of fetal infection; rate of transmission and severity of infection are related to gestational age at the time of infection. The brain and retina are often affected, and there can be a wide range of clinical disease. Amniocentesis or cordocentesis provides the most accurate diagnosis. At birth, 80–90 percent of infants with congenital toxoplasmosis are asymptomatic. But further testing may reveal retinal and central nervous system abnormalities, and there is a risk of long-term sequelae. Chorioretinitis, hydrocephalus, intracranial calcifications, and convulsions are the typical presentation of classic congenital toxoplasmosis. Serology is the most common method of diagnosing neonatal infection, but more complex tests are also utilized. The prognosis for the untreated infant is poor; however, when antibiotic therapy is started early, the rate of sequelae is reduced significantly.

What Every Nurse Needs to Know about Breast Pumping:
Instructing and Supporting Mothers of Premature Infants in the NICU
Karen Spicer, RNC, BSN

Research has established that breast milk is the best source of nutrition for the premature infant. Because the infant is born prematurely, the mother will need support in expressing breast milk for her infant’s use. The clinical nurse has the opportunity to educate the mother on the importance of breast milk for the premature infant and to support the mother through the course of pumping. However, many nurses are not sufficiently educated in the physiology of lactation to adequately support the mother. The purpose of this article is to educate the bedside nurse in the physiology of lactation so that the mother is adequately assisted in expressing breast milk for her vulnerable infant.

Evaluation of a Program to Promote Positive Parenting
in the Neonatal Intensive Care Unit
Jolene Pearson, MS
Kate Andersen, RN

Purpose: To describe and evaluate a parent education program to promote positive parenting in the NICU. Design: Program evaluations completed by parent participants and staff members. Sample: 104 parents (59 mothers and 45 fathers) who attended the Parent’s Circle; also 44 NICU or SCN staff members. Main Outcome Variable: Family and staff evaluations of the Parent’s Circle program. Results: Families reported that attending Parent’s Circle helped them gain perspective on their situation, feel supported, learn key developmental concepts, locate hospital and community resources, and optimize interactions with their fragile infant. Staff reported that the knowledge parents gained from Parent’s Circle influenced their interactions and behaviors in the NICU.