Neonatal Network
September/October 2006
Vol. 25, No. 5

ABSTRACTS

Understanding Neonatal Bowel Obstruction: Building Knowledge to Advance Practice
Nicole T. de Silva, RN, MSc
Jennifer A. Young, RN, MN
Paul W. Wales. MD, MSc, FRCS(C)

Providing care to neonates with bowel obstruction requires a basic understanding of gastrointestinal (Gi) anatomy and functional landmarks as well as knowledge of the pathophysiology associated with intestinal blockage. Early recognition and prompt diagnosis necessitate astute assessment of common presenting symptoms and accurate interpretation of diagnostic investigations. Initial medical management is focused primarily on gastric decompression and maintenance of fluid and electrolyte balance. This article describes features of the neonatal Gi tract and discusses common causes of neonatal bowel obstruction.

Caring for the Newborn with an Omphalocele
Carol McNair, RN, MN, NNP
Judy Hawes, RN, MN, NNP
Heather Urquhart, RN, MEd, NNP

An omphalocele, a ventral defect of the umbilical ring resulting in herniation of the abdominal viscera, is one of the most common congenital abdominal wall defects seen in the newborn. Omphaloceles occur in 1 in 3,000 to 10,000 live births. Associated malformations such as chromosomal, cardiac, or genitourinary abnormalities are common. Postnatal management includes protection of the herniated viscera, maintenance of fluids and electrolytes, prevention of hypothermia, gastric decompression, prevention of sepsis, and maintenance of cardiorespiratory stability. A primary or staged closure approach may be used to repair the defect. Some giant omphaloceles require a skin flap or nonoperative management approach, however. Immediate postoperative complications, usually related to significant changes in intra-abdominal pressures, include compromise of interior venous blood return and hemodynamic and respiratory instability due to diaphragmatic elevation. Complications occur more frequently with giant defects. Potential short-term complications include necrotizing enterocolitis, prolonged ileus, and respiratory distress. Long-term complications include parenteral nutrition dependence, gastroesophageal reflux, parenteral nutrition-related liver disease, feeding intolerance, and neuro-developmental delay. Overall, advances in surgical therapies and nursing care have improved outcomes for infants with omphaloceles; survival rates for those with isolated omphaloceles are reported at 75 to 95 percent. Infants with associated anomalies and giant omphaloceles have the poorest outcomes.

Partnering with Parents: Establishing Effective Long-Term Relationships
with Parents in the NICU
Mary McAllister, RN, MHSc, NNP
Kim Dionne, RN, MN, NNP

Advances in health care have led to unprecedented innovation in the care provided to critically ill newborns. One outcome of this new reality is that newborn intensive care units have become "homes" for fragile infants who require long-term hospitalization. Clearly, NICUs were never so envisioned; thus, this reality has resulted in challenges for families and health professionals alike. As the duration of hospitalization increases, relationships between families and health care professionals become increasingly important. Parents of hospitalized newborns face fear, anxiety, and frustration as they struggle to cope with an ill child while developing their parental role. The quality of relationships established between families and health care professionals is crucial to their coping and adaptation. This article addresses challenges faced by families whose infants experience extended hospitalization, applies a model to help health care professionals understand parent perspectives, and proposes strategies to promote effective partnerships and alliances with families.

Pain Assessment and Pharmacologic Management for Infants with NEC: A Retrospective Chart Audit
Sharyn Gibbins, RN, PhD, NNP
Patricia Maddalena, RN, MHSc, NNP
Wendy Moulsdale, RN, MN, NNP
Fiona Garrard, RN
Taslin jan Mohamed, RN
Allyson Nichols, HRA
Elizabeth Asztalos, MD, FRCP

Purpose: To examine (1) the frequency and types of painful procedures, (2) the frequency and types of analgesic/sedative use, and (3) the frequency of documented pain assessments that infants experience during the five days following a diagnosis of necrotizing enterocolitis (NEC).

Design: A retrospective descriptive cohort design.

Sample: Thirty-nine infants from one tertiary care unit diagnosed with stage II NEC.

Main Outcome Variable: Painful procedure data were classified into highly invasive procedures and moderately invasive procedures and were collected for five days following the diagnosis of NEC. Frequency and types of analgesic/sedative administration and frequency of documented pain assessments during each of the five days following the NEC diagnosis were collected.

Results: The average number of painful procedures was 16.3 per day, with documented PIPP scores performed on 30-60 percent of the infants during each of the days following the diagnosis of NEC. At no time were more than two PIPP scores per infant documented in a 24-hour period. Analgesics were used in 52-76 percent of infants during the first three days following the diagnosis of NEC, but use decreased gradually on the fourth and fifth days. No correlation between painful procedures and analgesic/sedative administration on any day was found. Similarly, no correlation between documented PIPP scores and analgesic/sedative use on any day was found.