Neonatal Network
January/Februaryl 2008
Vol. 27, No. 1

ABSTRACTS

Transitioning Premature Infants from Gavage to Breast
Carla Nye, RN, DNP, CNE

Breast milk provides physiologic and neurodevelopmental protection for premature infants. Most hospitals are breast-milk friendly, but the number of premature infants breastfeeding successfully at discharge is relatively small. There are evidence-based techniques to improve the odds of premature infants breastfeeding at discharge and into the first year of life. Measures that help the infant make the transition to the breast include kangaroo care, nonnutritive sucking, avoidance of bottles, and consistent and supportive staff. A guide to management of the transition process is provided in this article.

State Changes in Preterm Infants in Response to Nursing Caregiving: Possible Gender Effects
Karen A. Thomas, RN, PhD
Shao-Yu Tsai, RN, MS, PhC
Sara N. Brown, ARNP, MN

Purpose: to describe the effect of nursing caregiving on infant sleep-wake states by gender in preterm infants

Design: descriptive measures at 34 weeks postmenstrual age and at dischargeSample: twenty-two hospitalized preterm infants

Main Outcome Variable: infant state and caregiving episodes were coded in 15-second intervals from video recordings of approximately three hours duration. time plots of state and caregiving were analyzed visually to summarize spontaneous state changes and state change associated with caregiving.

Results: sleep and wake state distribution did not differ statistically by gender; however, the rate of state change in male infants was twice that of females (p=.012) at discharge. at discharge, male infants received approximately twice as many care episodes as females. at discharge, the rate of state change in response to caregiving in male infants was four times that of female infants (p=.026). males exhibited a greater percentage of caregiving episodes related to state change than did females at discharge (p=.018). findings suggest further exploration of possible gender differences in state regulation and state change in response to caregiving.

Infant Intraosseous Infusion
Scott DeBoer, RN, MSN, CEN, CCRN, CFRN
Terri Russell, RNC, MS, NNP
Michael Seaver, RN, BA
Amir Vardi, MD

Neonatal health care providers are fortunate that the umbilical cord generally provides easy intravenous (IV) access for newborn patients. Outside of the immediate newborn period, however, it may be impossible to obtain peripheral or umbilical IV access in critically ill newborns. Intraosseous (IO) infusion is not widely used in the neonatal population, but is a viable option when IV access cannot be established quickly. This article examines IO infusion devices and placement sites and addresses assessment and care of the infant receiving IO fluids and medications.

Trisomy 18: A Case Study
Jacqueline Shaw, BSN, RNC, CPN

Trisomy 18 is a devastating genetic disorder that can be characterized by multiple congenital anomalies. some of these anomalies have no medical significance, but merely provide clues to suggest the diagnosis. The most common form of trisomy 18 is the nondisjunction type, which affects every cell of the body with an extra chromosome 18. affected infants are typically born with a prominent occiput, short eye fissures with droopy eyelids, micrognathia, external ear variations, clenched fist with index finger overlapping the third finger and fifth finger overlapping the fourth, small fingernails and toenails, underdeveloped or altered thumbs, “rocker-bottom” feet, and redundant skin at the back of the neck. congenital heart defects are common. The mortality rate among infants with trisomy 18 is high as a result of cardiac and renal malformations, feeding difficulties, sepsis, and central apnea caused by central nervous system defects. a case study is provided.