Neonatal Network
July/August 2004
Vol. 23, No. 4

ABSTRACTS

An Update on ECMO
A CEU Offering
Diane R. Tulenko, MSN, RN, C-NNP

Extracorporeal membrane oxygenation (ECMO) is essentially a heart-lung bypass machine that can be used to support certain critically ill neonates. ECMO therapy reached a peak in usage in the mid to late 1980s. At that time, ECMO was most often used for severe complications of persistent pulmonary hypertension, meconium aspiration, congenital diaphragmatic hernia, and sepsis. Since that time, the use of ECMO has decreased, due largely to newer medical advances that have improved the course of these neonates. Whether a nurse works in a Level III ECMO center or a Level I, II, or III NICU, ECMO treatment has become less familiar than it once was. But even though ECMO is used less often, there are times when nothing can take its place. It is important to stay informed so that families of those critically ill newborns who do need ECMO can be educated and supported. This article defines ECMO, discusses when it should be incorporated into the plan of care, describes advances in the NICU that have resulted in the dramatic reduction in the use of ECMO, and provides information and communication strategies to better support the family of a very sick newborn.

Vitamin A and Bronchopulmonary Dysplasia: Research, Issues, and Clinical Practice
A CEU Offering
Anne M. Mentro, MS, RN, CPNP

Vitamin A is a crucial antioxidant for preterm infants because it protects the lungs from oxidative damage induced by the administration of supplemental oxygen. Although all preterm infants are born with smaller vitamin A stores than full-term infants, the store of vitamin A in preterm infants at risk for bronchopulmonary dysplasia (BPD) is often especially deficient. Despite the increases in plasma vitamin A concentrations that have been achieved with vitamin A supplementation, only modest improvements in clinical outcomes and incidence of BPD have been noted in this population. This article reviews the research on vitamin A supplementation for preterm infants, as well as the issues and clinical implications associated with this intervention.

The Australian Safe-n-Sound Baby Safety Capsule and Its Effect on Oxygen Saturation Values in Infants Ready for Discharge Home
Jennifer Anne Dawson, RN, CM, MN (Res)
M. Colleen Stainton, RN, DNS, FCN

Purpose: To examine the effect of the Australian Safe-n-Sound Baby Safety Capsule (BSC) on oxygen saturation (SpO2) values of preterm and term infants ready for discharge home.
Design: A two-group pretest/ posttest quasi-experimental study compared the effect of the BSC on SpO2.
Sample: Thirty-nine low birth weight premature newborn infants and 19 term newborn infants ready for discharge home.
Main outcome variable: Mean oxygen saturation values and the number of oxygen desaturation events below 90 percent.
Results: The mean SpO2 values for both preterm and term infants were within the normal range (>90-100 percent) for each phase of data collection (baseline, capsule, and recovery). However, mean SpO2 values decreased from baseline during the 60 minutes spent in the BSC for the preterm infants.


Treatment of Neonatal Pain without a Gold Standard: The Case for Caregiving Interventions and Sucrose Administration
Wende L. Prince, MSN, NNP, RNC
Kimberly M. Horns, PhD, NNP, RNC
Teresa M. Latta, MSN, NNP, RNC
Kale R. Gerstmann, MD

Although many different neonatal pain assessment scales are used in clinical research, no gold-standard instrument exists. The multitude of pain assessment scales used has, in fact, threatened the validity of many studies and confused the construct of pain. This integrative review of the neonatal pain literature provides the recommendations from practice guidelines and the current evidence for modifying the pain response prior to and during common painful procedures.