Neonatal Network
March/April 2008
Vol. 27, No. 2

ABSTRACTS

Probiotics for the Prevention of Necrotizing Enterocolitis
Janeen Gaul, RNC, BSN

Necrotizing enterocolitis (NEC) remains a significant cause of morbidity and mortality for low birth weight premature infants. Prematurity, ischemia, formula feeding, and bacterial colonization are risk factors for the self-perpetuating cycle of damaged intestinal epithelia, inflammation, bacterial entry, sepsis, and shock that characterizes NEC. Probiotics are food supplements containing live bacteria that benefit the recipient by improving the microflora balance within the intestine. Several studies suggest that the administration of probiotics may have a prophylactic effect for NEC and may reduce morbidity and mortality rates for low birth weight infants.

Meconium Aspiration Syndrome
Jeanne Ray Wiedemann, RNC, MS, NNP
Andrea M. Saugstad, RNC, MS, NNP
Laura Barnes-Powell, RNC, MS, NNP
Karen Duran, RNC, MS, NNP

Meconium aspiration syndrome (MAS) is one of the most common conditions associated with aspiration during the newborn period. MAS can be defined as respiratory distress in a neonate born through meconium-stained amniotic fluid (MSAf) with symptoms that cannot otherwise be explained. It can be characterized by early onset of respiratory distress in term and near-term infants delivered through MSAf. Early presentation includes respiratory symptoms such as respiratory distress, poor lung compliance, hypoxemia, and radiographic findings of hyperinflation and patchy opacifications. This article discusses the pathophysiology of MAS, historical and current prevention strategies, current management strategies, and prognoses for infants born through MSAf

The Changing Role of Parents in Neonatal Care:
A Historical Review
Lori M. Thomas, RNC, MN, NNP/CNS

Over the past century, improvements in technology and neonatal care techniques have dramatically reduced infant mortality rates. While this progress continues, a growing body of literature supports the significant role that parents play in the development of infants, particularly within the hospital setting. Throughout much of the twentieth century, various barriers prevented many parents from participating in the care of their neonates, negatively influencing infant outcomes. Today parental involvement in neonatal care has become a key part of a larger family-centered care model. This historical review describes how past neonatal care practices affected the roles of parents, from absence or indirect involvement to the important involved roles of today. Understanding current trends in relation to these past experiences may encourage the formulation of family-centered care practices now and in the future.

Conscientious Objection: A Potential Neonatal Nursing Response to Care Orders
That Cause Suffering at the End of LIfe? Study of a Concept
Anita Catlin, DNSc, FNP, FAAN
Christine Armigo, RN, BSN, MSN
Deborah Volat, CPM, BSN
Elnora Valle, RN, BSN
Mary Ann Hadley, BSN
Wendy Gong, BSN
Ranginah Bassir, BSN
Kelly Anderson, BSN

This article is an exploratory effort meant to solicit and provoke dialog. Conscientious objection is proposed as a potential response to the moral distress experienced by neonatal nurses. The most commonly reported cause of distress for all nurses is following orders to support patients at the end of their lives with advanced technology when palliative or comfort care would be more humane. Nurses report that they feel they are harming patients or causing suffering when they could be comforting instead. We examined the literature on moral distress, futility, and the concept of conscientious objection from the perspective of the nurse’s potential response to performing advanced technologic interventions for the dying patient. We created a small pilot study to engage in clinical verification of the use of our concept of conscientious objection. Data from 66 neonatal intensive care and pediatric intensive care unit nurses who responded in a one-month period are reported here. Interest in conscientious objection to care that causes harm or suffering was very high. This article reports the analysis of conscientious objection use in neonatal care.