NEONATAL NURSING NEONATAL NURSING Edited by Doreen Crawford RGN, RSCN, ENB 405, ENB 870, ENB 998 Senior Clinical Nurse and Maryke Morris BSc(Hons), RGN, ENB 405 Senior Clinical Nurse Neonatal Unit Lekester Royal Infirrnary Leicester, UK mJ] Springer-Science+Business Media, B.V. ISBN 978-0-412-48730-9 ISBN 978-1-4899-3101-6 (eBook) DOI 10.1007/978-1-4899-3101-6 First edition 1994 © 1994 Springer Science+Business Media Dordrecht Originally published by Chapman & Hall in 1994. Typeset in 10/12pt Palatino by Mews Photosetting, Beckenham, Kent Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act, 1988, this publication may not be repro duced, stored, or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licences issued by the Copyright Licensing Agency in the UK, or in accordance with the terms of licences issued by the appropriate Reproduction Rights Organization outside the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the London address printed on this page. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. A catalogue record for this book is available from the British Library Library of Congress Catalog Card Number: Printedon permanent acid-free text paper, manufactured in accordance with ANSIINISO Z39.48-1992 and ANSIINISO Z39.48-1984 (Permanence of Paper). Charles-Michel Billard (1800-1832) stated that: During uterine life man can suffer from manY. afflictions . . . the consequences of which are brought wzth 'him into this world . . . children may be born healthy, sick, convalescent, or entirely recovered from former disease. This amazing perception from a neonatal pioneer still applies today. Contents List of contributors xüi About the authors xvii Preface xxi 1 N eonatal care today 1 The neonatal environment 1 Admission to the NNU 3 Response to having a special care baby 4 Caring as a neonatal nurse 7 Family-centred care 8 Some aspects of nursing that enhance family- centred care 10 Caring for the dying baby 11 Stress and the neonatal unit 12 References 14 2 Nursing models: suitable frameworks for care? 16 Models for nursing 17 Structure of a model 18 The Orem systems-oriented model 18 Roper, Logan and Tierney model 20 Other frameworks 21 A model for neonatal care 22 References 24 3 Prenatal and intranatal care of the fetus, mother and father 25 Prenatal care 25 Intranatal care 29 viii Contents Midwifery care of the mother 29 Care of the father 35 Conclusion 37 References 38 4 Resuscitation - flying squad transfer 43 Infants most likely to need support 43 Transition from intra- to extrauterine existence 44 Basic emergency resuscitation of the newborn 46 Flying squad transfer 51 References 59 5 Nursing care of babies who are bom too soon or too small 61 Terminology 61 Characteristics of the preterm baby (born too soon) 63 Characteristics of the light-for-dates baby (born too small) 64 Factors contributing to a preterm delivery 65 Factors contributing to a light-for-dates baby 66 Nursing care of the baby born too soon or too small 66 References 79 6 Nursing care of a baby with a disorder of the gastrointestinal system 81 Nursing care of a baby undergoing surgery 82 Nursing care of a baby after surgery 83 Oesophageal atresia and tracheo-oesophageal fistula 86 Necrotizing enterocolitis 89 Gastroschisis 95 References 101 7 Feeding low birth weight infants in today's neonatal environment 103 Nutrition-related problems 104 Nutritional requirements 106 Nutritional management 112 References 127 Contents ix 8 Nursing care of a baby with a disorder of the respiratory system 131 Anatomy and physiology of the respiratory system 132 Transition from intrauterine life to independent existence 134 Structural differences in anatomy between the infant and the adult 135 Care of the infant with breathing difficulties 136 Common investigations 156 References 158 Further reading 160 Acknowledgement 160 9 Nursing care of a baby with a disorder of the cardiovascular system 161 Anatomy and physiology 161 Causes of congenital heart disease 164 Congestive cardiac failure (CCF) 165 Care of an infant undergoing diagnostic investigations 168 Care of an infant with an abnormal heart rate, rhythm or pressure 170 Some common congenital cardiac malformations 174 Acyanotic cardiac malformations 174 Cyanotic cardiac malformations 177 Care of an infant undergoing cardiac catheterization 180 Care of an infant undergoing cardiac surgery 182 Complications of congenital heart disease 185 Common drugs used in cardiac management 186 The present and the future 188 References 189 10 Infant neurology 191 Anatomy of the central nervous system 191 Neurological conditions seen in the neonatal. unit 194 lnvestigations used to aid diagnosis 204 Ethical issues 204 References 205 Further reading 206 X Contents 11 Nursing care of a baby in renal failure 207 Homoeostasis and assessment of fluid balance 208 Chemical equilibrium and electrolyte disturbances 211 Acid-base balance 213 Regulation of blood pressure 214 Vitamin D metabolism 216 Erythropoiesis 217 Peritoneal dialysis 217 Nutrition in renal failure 222 Drugs in renal failure 223 Psychosocial aspects 223 Conclusion 224 References 224 12 Neonatal infection 226 Immune response to infection 227 Specific risk factors for infection 227 Detection and diagnosis of infection 228 Bacterial and fungal infection 230 Sites of infection 235 Non-bacterial infections 238 Conclusion 242 References 243 Further reading 244 13 Nursing care of a baby with jaundice 245 Physiology of the bilirubin mechanism 245 Investigations 247 Treatment for jaundice 248 Causes of jaundice 252 References 257 Further reading 258 14 Nursing care of a baby in pain and discomfort 259 Effect of pain and discomfort on the newborn baby 259 Infant responses to pain and discomfort 260 Categories of environmental disturbance 268 Pain management 272 Summary 275 References 275 Contents xi 15 Enhancing development in the neonatal unit 278 Neonatal infant development 278 Sensory Stimulation and the neonatal unit 280 Role and importance of play 281 Play and the infant in the neonatal unit 282 Play and the sick preterm neonate 286 Play and the geriatric neonate 288 The play specialist 292 References 292 16 Neonatal pharmacology 295 Drug absorption 295 Distribution 299 Metabolism 301 Excretion 301 Drug receptors 302 Therapeutic drug monitaring 302 Drug administration 304 Drug formulation 307 References 308 17 Ethical issues in the neonatal unit 309 Ethical issues in neonatology 310 Aspects of personhood 311 To treat or not to treat? 314 Caring or curing? 316 Balancing the cost of neonatal care 318 Conclusion 320 References 321 18 Horne oxygenation 325 Definitions 325 Pathophysiology 326 Management of BDP/CLD 327 Breathing 329 Medications 331 Positioning 332 Growth and nutrition 332 Feeding problems 333 Gastro-oesophageal reflux and vomiting 334 Environment 335