Neonatal Network
May/June 2005
Vol. 24, No. 3

ABSTRACTS

The Early Feeding Skills Assessment for Preterm Infants
Suzanne M. Thoyre, RN, PhD
Catherine S. Shaker, MS/CCC-SLP, BRS-S
Karen F. Pridham, RN, PhD, FAAN

Preterm infants develop the skills necessary to begin oral feeding as their health stabilizes and as they reach a postconceptional age that supports coordination of breathing and swallowing with oral-motor functioning. The time from initiation of oral feeding to full oral feedings (with adequate intake for growth and maintenance of physiologic stability) can vary from days to months for the preterm infant. The approach to feeding the infant during this transition period must be developmentally supportive and tailored to meet the needs of the individual. To accomplish this, caregivers --notably nurses and parents-- need to communicate about the specific skills that the infant has gained, about skills that are emerging, and about skills that the infant has not yet developed. The Early Feeding Skills (EFS) Assessment is a checklist for assessing infant readiness for and tolerance of feeding and for profiling the infant's developmental stage regarding specific feeding skills: the abilities to remain engaged in feeding, organize oral-motor functioning, coordinate swallowing with breathing, and maintain physiologic stability. This article introduces the EFS.

A Review of Harlequin Ichthyosis
Lt. Jason Layton, RNC, MSN, NC

Harlequin ichthyosis is an extremely rare and historically lethal congenital disorder of the skin caused by abnormal keratinization. This article reviews the embryology and currently understood pathophysiology of the disease, as well as current methods used to diagnose and treat these infants. There are serious implications for the family to consider: the high risk that their newborn will die soon, as well as future family planning issues.

Parents and Professionals in the NICU: Communication within the Context
of Ethical Decision Making--An Integrative Review
Frances R. Ward, MSN, RN

Communication between parents and professionals in the NICU is a necessary part of collaborative decision making in the provision of family-centered care. Decisions with ethical components, those regarding treatment plans or neonatal research enrollment, need to be made conjointly with parents and health care professionals. This article reviews the present state of knowledge of how parents'
input can be facilitated in regard to decisions made about their children. Research studies involving decisions made with ethical components in the NICU since the advent of the Baby Doe regulations reveal parents' frustration with communication practices, their need for control of information, and the trust in their children's health care providers that is required to best facilitate their input into ethical decisions made about their children.

Identifying, Understanding, and Working with Grieving Parents in the NICU, Part I:
Identifying and Understanding Loss and the Grief Response
Kirsti A. Dyer, MD, MS

The admission of an infant to an NICU is an unexpected event for the parents and one often not predicted by health care professionals. This highly stressful and overwhelming hospitalization is likely to be one of the greatest life challenges that parents of newborns face. Parents need support from NICU professionals, among others, to cope with the losses that occur in the hospital setting. This article provides NICU professionals with general information about loss and the subsequent grief response, focusing on losses from sources other than death. Common emotional and physical responses are provided so these can be recognized in affected parents. By increasing their awareness of the topics of loss and grief, health care professionals can help ensure that grieving parents get the support needed to assimilate their loss into a life forever changed.