Neonatal Network
January/February 2005
Vol. 24, No. 1

ABSTRACTS

Kernicterus: Still a Concern
A CEU Offering
Linda J. Juretschke, MSN, RNC, APN/NNP

The presence of yellow staining and damage to the brain caused by unconjugated bilirubin was first described by Hervieux in 1847. Kernicterus, the technical term used to describe the intense yellow staining in the basal ganglia of the brain, was first used by Schmorl in 1903. Perhaps as many as 60 percent of all babies born each year in the U.S. are diagnosed with clinical jaundice. Kernicterus is a preventable brain injury caused by severe jaundice, yet it remains a threat today. Because of this, anyone caring for newborns must be aware of the risks and treatment for hyperbilirubinemia and the sequelae of this seemingly benign entity.

Idiopathic Dilation of the Ductus Venosus: An Unusual Anomaly of the Fetal Blood Vessels
Malektaj Yazdani, MD
Amanda Searle, NNP, MN
Ann Chau, MD

The ductus venosus (DV) is a blood vessel unique to the fetal circulation. It functions as a shunt between the umbilical vein and inferior vena cava by passing the hepatic microcirculation and shunting highly oxygenated blood to the brain and myocardium. The DV has received less attention than the ductus arteriosus; however, with modern ultrasonographic imaging, the DV is easily identified and is becoming a valuable diagnostic tool in the areas of maternal-fetal medicine. We report a rare case of idiopathic dilation of the DV that was diagnosed during routine ultrasounds. The presence of blood flow turbulence within the dilated area and the concern that blood vessels might rupture resulted in elective cesarean section at 34 weeks gestation. The infant was discharged after 14 days. Dilation of the DV, its size as well as the presence of turbulence in the dilated area might be important factors in determining the time of delivery and could contribute to a better outcome.

Car Seat Safety: Literature Review
Michelle Lincoln, RN, BSN, CCRN

After staggering numbers of infants were killed in automotive crashes in the 1970s, the American Academy of Pediatrics (AAP) recommended in 1974 universal use of car seats for all infants. However, positional problems were reported when car seats are used with premature infants less than 37 weeks gestational age as a result of head slouching and its sequelae. In 1990, the AAP responded with another policy statement introducing car seat testing. It recommended that any infant at or under 37 weeks gestational age be observed in a car seat prior to discharge from the hospital. The AAP did not give specific guidelines on type of car seat, length of testing, equipment, or personnel proficiency, however. Few nurseries have standard policies to evaluate car seats, to teach parents about car seats, or to position newborns in them, and not all hospitals actually conduct car seat challenges or have common standards for testing that is performed.

A Comparison of the Light-Reduction Capacity of Commonly Used Incubator Covers
Yi-Hui Lee, MSN, RN
Nima Malakooti, BSN
Marilyn Lotas, PhD, RN

Purpose: The use of incubator covers to enhance preterminfants' rest and recovery is common in the NICU.However, the kinds of covers used vary extensively amongand within nurseries. Few data exist on the effectiveness ofdifferent types of covers in reducing light levels to theinfant. This study compared several types of commonlyused incubator covers as to efficacy of light reduction.

Design: A descriptive, comparative design was used in thisstudy.
Sample: Twenty-three incubator covers were tested,including professional, receiving blanket, hand-crocheted,three-layer quilt, and flannel.

Main Outcome Variable: The percentage of light levelreduction of different incubator covers under various ambientlight level settings.

Results: The amount of light reduction provided by incubatorcovers varies depending on type of fabric as well as percentageof incubator surface shielded by the cover.Dark-colored covers provided greater light reduction thanbright/light-colored covers when covers identical in fabrictype were compared. The light-reduction efficiency of thecovers varied depending on the level of ambient light. Covers provided less light reduction in higher ambient light levels.