Neonatal Network
November/December 2004
Vol. 23, No. 6

ABSTRACTS

Extralobar Sequestration with Congenital Diaphragmatic Hernia: A Complicated Case Study
A CEU Offering
Kathryn Harris, RN, BSN, ECLS Specialist

This article presents a case study of an infant (JG) with an antenatal diagnosis of a left diaphragmatic hernia and an extralobar sequestration of his right lung, which was noted postnatally. JG's course was complicated by persistent pulmonary hypertension of the newborn (PPHN) and suspected pulmonary hypoplasia, and he required support with extracorporeal life support (ECLS). JG's case was unusual in his presentation of extreme PPHN that was unresponsive to inhaled nitric oxide and ECLS. His PPHN was nearly intractable, requiring treatment with vasodilators combined with intravenous sildenafil, which had never been tried in our institution before this case. The article concludes with a discussion of the etiology, diagnosis, and management of congenital diaphragmatic hernia and extralobar sequestration, singly and in combination.

Epidermolysis Bullosa: Pathophysiology and Nursing Care
A CEU Offering
Barbara A. Gannon, RN, MSN, RNP

Epidermolysis bullosa (EB) is defined as a group of skin disorders that presents as blistering of the skin in varying degrees of severity. Most cases are inherited, but rare cases may be acquired. There are three main types: simplex, junctional, and dystrophic. The dermal-epidermal junction of the newborn skin is a vital area of attachment. Any defects in the components that comprise this junction can lead to fragility of the skin. EB diagnosis and testing can be performed both prenatally and postnatally. There is no cure for EB. Treatment revolves around supportive care and prevention of complications.The NICU nurse plays an important role on the multidisciplinary team as primary caregiver to the infant and educator to the family.

Foster Families Who Care for Infants with Prenatal Drug Exposure: Support During the Transition from NICU to Home
Lenora Marcellus, MN, RN

Infants exposed prenatally to drugs and alcohol tend to enter the child welfare system at a younger age than many other foster children and often directly from the hospital following birth. This article examines three concepts from the postpartum family adaptation literature: transition to parenthood, maternal and paternal role identities, and attachment. It applies these concepts to the experiences of foster parents who care for infants with prenatal drug and alcohol exposure. Also reviewed are recommended strategies to promote development of the foster parent-infant relationship and to increase parental knowledge within the NICU setting and during the period of transition from hospital to home. Nurses within the NICU have a unique knowledge and experience of caring for infants in withdrawal. This knowledge needs to be shared beyond the hospital with community professionals, who may have limited training in infant health, mental health, or development.

The Causal Pathway Model and Cerebral Palsy
Harold C. Griffin, PhD
Christine L. Fitch, EdD
Linda W. Griffin, MEd

This article reviews possible prenatal, perinatal, and postnatal causes of cerebral palsy. The interactive effects of various causes are evaluated. Groups of intervention strategies are then presented based on the causal pathway model.