Clear definitions of family and the philosophy of family-centered care (FCC) are critical to the foundation of the concepts presented in this chapter. The chapter explains the issues families face during this challenging time using a role theory. Factors that influence parenting behaviors include personal experiences, medical and nursing staff expectations, environmental conditions, and peer relationships. These factors can either promote or interfere with the development of intact family unit. The birth of a critically ill newborn complicates the attachment process as well as the learning of parenting skills. The chapter provides an evidence-based framework for understanding what families need in terms of true support in the neonatal setting. It presents several different models of family-centered care. The chapter concludes with evidence-based FCC strategies that support optimal family functioning during the NICU experience and promote the discharge of intact families as the crisis of newborn intensive care begins to resolve.

Research demonstrates that developmental care is an effective method to support the premature and sick infant during a time of vital neuro and neurosensory development, leading to short- and long-term benefits, and perhaps diminishing morbidity. The comprehensive benefits of developmental care are neuroprotective. Evidence demonstrates that neuronal cell death can be avoided, and the fragile brain can even heal with neuroprotective developmental care. The seven neuroprotective core measures used to frame this protocol include: the healing environment, partnering with families, positioning and handling, minimizing stress and pain, safeguarding sleep, protecting skin, and optimizing nutrition. Common threads of the seven neuroprotective core measures simultaneously aid caregivers as they endeavor to support the neurodevelopment of premature and sick infants. Neuroprotective care has been critically important in achieving improved outcomes for fragile infants. Promoting neuroprotection for premature and sick infants requires skillful care and a multidisciplinary team approach.

This chapter describes fetal treatment and, in particular, fetal surgery. Fetal therapy includes any intervention (invasive and/or noninvasive) performed to improve the health of children by intervening before birth to correct or treat a prenatally diagnosed abnormality. These therapies include ultrasound-guided needle procedures (fetal blood sampling, intrauterine blood transfusion, shunts, balloon valvuloplasty or septostomy, and radiofrequency ablation), fetoscopic procedures (posterior urethral valves, photocoagulation, umbilical cord occlusion, tracheal occlusion, and amniotic band release), open fetal surgery (myelomeningocele repair, lobectomy, and teratoma resection), and ex-utero intrapartum treatment. The chapter provides a historical overview of fetal therapy, the importance of a multidisciplinary approach, fetal diagnoses amenable to fetal therapy, and care of the maternal-fetal dyad before, during, and after intervention. It recognizes the critical, complex, and often difficult role nurse specialists fulfill in fetal treatment, acting as both patient advocate and fetal treatment team representative.

This chapter outlines various technologies that are impacting neonatal care. Simulation is a highly effective and innovative educational tool. It can be used for many purposes, including healthcare education, quality improvement, and patient safety. A newer area of neonatal technology is the apps. These range from interactive drug calculators to apps that offer algorithms or infographics for common neonatal conditions, neonatal checklists to guide health professionals, and parent support apps. All of these apps are aimed at use of technology to support professionals and parents in providing care in the hospital and at home. Use of telemedicine is growing with neonatal specialists-physicians and nurses reaching out to provide consultations to community-based hospitals. Use of technologies, whether through apps or virtual consults, is growing as is the evidence to support skill development/maintenance as well as impact on neonatal/family outcomes.

Nursing has historically demonstrated a commitment to assuring competency that relied on initial licensure, testing, continuing education (CE), codes of ethics, and comprehensive certification programs designed to protect public safety. This chapter traces the evolution of the competency movement in healthcare, discusses the advantages and disadvantages of competency-based education (CBE), and describes the impact of the competency movement on neonatal nursing practice and education. It discusses the future of competency-based neonatal care. CBE provides a mechanism for contemporary nursing to provide a cost-effective, quality approach to nursing education. The competency-based approach is also well suited to individualizing orientation programs to meet the unique needs of nurses who have significantly different backgrounds and levels of experience. CBE shifts the focus of learning from the traditional model of objectives and classroom teaching to a new model based on achievement of specified competencies and outcomes.

Comprehensive nursing care of infants with renal or genital disorders requires a thorough understanding of normal anatomy and physiology. Development of renal and genital systems arises from shared structures; therefore, abnormalities in one system may indicate abnormal development in the other. Because nurses provide hands-on care to infants in both the newborn nursery and neonatal intensive care unit, they are often the first to recognize abnormalities in the renal and genital systems. To readily identify such disorders and participate in their collaborative management, nurses need a clear understanding of the normal anatomy and physiology of the genital and renal systems and the pathological processes that may be present in the neonatal patient. This chapter outlines embryological development and anatomy, physiology, and assessment of the genitourinary system. It describes various abnormalities and disease processes commonly identified in the neonatal period, including pathophysiology, risk factors, clinical manifestations, diagnosis, collaborative management, and prognosis.

Late preterm infants are infants born between 34-0/7 and 36-6/7 weeks, and are of increasing interest to medical providers caring for them throughout the country and around the world. There are two main etiologic categories of late preterm births, spontaneous late preterm births and babies born after induction of labor or cesarean section. Late preterm deliveries are due to spontaneous preterm labor and inductions for fetal and maternal indications. Late preterm infants require closer monitoring and specialized medical and nursing care for this higher risk population with stricter discharge criteria and follow-up care. These infants have a higher rehospitalization rate and long-term sequelae. Additional research is needed to gain a better understanding of late preterm infants. This knowledge will help to guide obstetrical and neonatal care to reduce the late preterm infant birth rate and provide specialized care to improve patient outcomes in the future.

The discovery and management of gastrointestinal (GI) dysfunction requires knowledge of both embryogenesis, and normal anatomy and physiology. Formation of the GI tract largely depends on the folding of the embryo during the first month of development. This chapter discusses the embryologic development and normal anatomic structure and physiology of the GI tract and describes common causes of neonatal dysfunction and their implications for care. The GI system is vital to human growth and development and ultimately long-term survival. The vast majority of conditions that cause GI dysfunction in the infant are the result of congenital anatomic malformations. Additionally, any condition or situation that leads to ischemia and bacterial overgrowth places an infant at risk for necrotizing enterocolitis and resultant long-term sequelae. The input and support of a variety of nursing, medical, and other specialists are required for optimal outcomes of the infant’s physiologic well-being and the parents’ psychosocial stability.

Most infants admitted to the neonatal intensive care unit (NICU) present with breathing difficulty. Nursing care of these infants requires a broad knowledge of newborn physiology and practical skills in the application of therapies that are directed toward solving the many problems that sick infants can have. This chapter provides a brief description on: embryologic development of the lung; newborn pulmonary physiology and the onset of breathing; and assessment of the neonate with respiratory distress. It then discusses the common disorders of the respiratory system; and collaborative management of infants with respiratory disorders. While managing the nursing care for several patients, the neonatal nurse must also care for the sickest of infants. Parents and families of all infants in the NICU require special attention not only to achieve an understanding of the complex issues surrounding the infant’s illness but also to calm fears and guilt that are often experienced.

A comprehensive physical assessment is performed for various reasons. The assessment may be the initial examination at birth, assessment of extrauterine transition, determination of gestational age, comprehensive assessment after transition, discharge examination, well-baby outpatient examination, or evaluation of an illness or injury. Although these assessments have many commonalities, each has a somewhat different purpose. While advances in technology have improved our ability to provide care to newborns, there is no substitute for hands-on assessment. This chapter discusses various aspects of a comprehensive physical assessment. The comprehensive history and physical assessment create the framework for identifying problems and planning interventions. Assessment allows the nurse to gather information and to evaluate and integrate that information as care of the newborn proceeds. Although careful attention to the obvious is important, subtle findings detected by an experienced practitioner also may play a crucial role in the continuing care of the infant and family.