Neonatal Network
November/December 2006
Vol. 25, No. 6

ABSTRACTS

Palliative Care Delivery in the NICU: What Barriers Do Neonatal Nurses Face?
Victoria J. Kain, RN, NICC, MN

Despite the existence of a universal protocol in palliative care for dying babies and their families, provision of this type of care remains ad hoc in contemporary neonatal settings. Influential bodies such as the American Academy of Pediatrics and the World Health Organization support palliative care to this patient population, so why are such measures not universally adopted? Are there barriers that prevent neonatal nurses from delivering this type of care? A search of the literature reveals that such barriers may be significant and that they have the potential to prevent dying babies from receiving the care they deserve. The goal of this literature review is to identify these barriers to providing palliative care in neonatal nursing. Results of the research have been used to determine item content for a survey to conceptualize and address these barriers.

Evidence-Based Review of Retinopathy of Prematurity Prevention in VLBW and ELBW Infants
AnnMarie DiBiasie, BSN, MS, CNNP

Retinopathy of prematurity (ROP) continues to be a significant complication in preterm neonates despite advances in neonatal care. Very low birth weight and extremely low birth weight infants continue to suffer from the sequelae of premature birth, including ROP. Controversy and uncertainty surround prevention of ROP. Possible preventive strategies include the use or restriction of oxygen therapy; steroid therapy; changes in blood transfusion protocols; reduced exposure of the retina to light; and administration of nutritional factors, indomethacin, and D-penicillamine. This article reviews recent studies that have proved or disproved the effectiveness of these preventive measures. It also identifies the implications of the study results for clinical practice and makes recommendations for future research.

Considerations for Implementation of a Neonatal Kangaroo Care Protocol
Lisa DiMenna, MS, NNP, RNC

Kangaroo care (KC) is skin-to-skin contact between an infant and parent, where the infant is usually held chest-to-chest in an upright prone position. It is a very simple, beneficial developmental intervention for both baby and parent, as demonstrated in the literature, but many parents and health care professionals are not aware of KC, its benefits, or how to perform it. The purpose of this article is (1) to inform health care professionals about the research literature on KC and its benefits and (2) to develop a list of evidence-based KC guidelines for the use of all infants and their parents. Increased knowledge of and education on KC for healthcare providers should lead to increased, routine use of this beneficial intervention.

Cobedding in the NICU: A New Adventure
Cheryl R. Taylor, RNC, MSN, CNNP
Kimberly L. LaMar, RNC, ND, CNNP

With advances in neonatal and obstetric care over the past few years, the number of premature, multiple-birth neonates entering NICUs has increased. As we have started to recognize the special bond that twins and higher multiples share, cobedding has emerged as an NICU practice. As with any change, the introduction of cobedding presents challenges in the NICU. Both the theoretical benefits and the potential concerns are many. Although nursing staff and parents may be excited about the prospect of placing these infants in the same crib, careful investigation and planning are necessary for any new procedure. This article discusses the cobedding of multiples as implemented at the University of Michigan. As a new practice, cobedding warrants further research, especially regarding its proposed benefits and implementation in the NICU.

Going Home: What NICU Nurses Need to Know about Home Care
Rosalyn F. Scherf, RNC
Karen White Reid, RN, MSN

Pediatric home health care enables patients to be at home with their families in settings that bring them joy, comfort, and the security we all feel when we are at home. There is also a feeling, no matter how small, that the parents have some control over what is happening to their child. Infants with multiple needs require in-depth discharge planning. There are the physical and health concerns of the preterm infant and the potential complications that he could still develop. Parent teaching is vital for the successful transition from hospital to home. When the neonatal discharge nurse is aware of what difficulties the parents and the patient might face at home, her teaching can be tailored to meet the specific needs of these vulnerable, complicated infants. This article discusses the discharge planning process, which begins upon admission to the neonatal intensive care unit, as well as common problems encountered by many premature infants discharged home.