In the United States, there are almost 4 million births each year. Of these, 2.7% will have birth defects incompatible with life. Critically fragile newborns are at a lifetime risk for adverse outcomes and disabilities. Parents may be faced with the option of making complicated decisions regarding the continuation of pregnancy in these circumstances. The nurse provides support and education when a family is facing the death of an infant. Perinatal hospice can provide support, neonatal care, and comfort measures for dying newborns. This chapter delineates the factors that need to be considered when making decisions related to the care of neonates born on threshold of viability. It also delineates the adverse outcomes associated with critically fragile neonates. The chapter analyzes the needs of families following a neonatal death and describes the purpose of perinatal hospice care. It lists ethical resources that are available for care providers involved in ethical decision-making.

The comprehensive review of history includes the maternal medical and social history, genetic history, prenatal history, the course of the labor and birth, and the initial newborn transition to extrauterine life. Many components of this review will guide the nurse in identifying risk factors for certain abnormalities that could potentially be identified during the physical examination. Some historical information will prompt further screening or testing in the newborn period. This chapter helps the nurse to list the historical information that is pertinent to review prior to performing the newborn examination and to identify pertinent prenatal factors that should be reviewed prior to conducting a newborn exam. It documents potential in utero environmental exposures that can lead to adverse neonatal outcomes and discusses the importance of obtaining genetic information from a historical perspective. The chapter describes labor and birth historical data, and reviews the neonatal information.

Congenital cardiac defects occur when there is an abnormality in the structure of the heart. Critical congenital heart defects are more severe and typically require surgical intervention in infancy. The nurse may detect a potential defect in the first few minutes of life based on abnormal color, vital sign alternations, abnormal cardiac sounds, or difficulty with adaptation to extrauterine life. This chapter helps the nurse to compare and contrast the difference between congenital cardiac defects and critical congenital heart defects. It lists the different types of critical congenital heart defects. The chapter differentiates the different clinical treatments and expected outcomes of the various congenital cardiac defects. It outlines nursing interventions for infants with cardiac defects. Congenital cardiac defects are abnormalities in the heart's structure that occur as a result of incomplete or abnormal development in utero or as a result of a genetic defect.

Infant feeding practice decisions involve a variety of factors, including comfort with breastfeeding, modesty, family values, and cultural norms. Some women will not feel comfortable breastfeeding and will choose formula feeding. These women should be fully supported in their decision-making and should receive educational information on proper formula preparation and storage. Premature infants require special attention and may warrant supplemental feedings. Prematurity and low birth weight put some infants at risk for poor postnatal growth in the newborn and early-infancy period. This chapter describes nursing interventions that help support successful breastfeeding in the early postpartum period and lists the benefits of breastfeeding. It discusses challenges associated with breastfeeding in the neonatal intensive care unit. The chapter helps the nurse to identify the contraindications for breastfeeding and proper pumping and storage guidelines for breast milk. It reviews the discharge preparation for infant feeding instructional information.

Underlying birth defects include disorders that are not readily apparent at the time of birth via physical examination. Some conditions will not be known until the newborn is born. In modern obstetrics, some of these conditions are identified in utero by ultrasound. In these cases, careful follow-up in the neonatal period is warranted. In cases without a known diagnosis, specialty referrals and consultations are often warranted. This chapter helps the nurse to identify the different types of inborn errors of metabolism and list common gastrointestinal abnormalities. It differentiates between kidney and liver abnormalities. The chapter compares and contrasts the different hematological conditions that can present in the newborn period and discusses the different thyroid disorders that can affect the newborn.

Each infant undergoes an initial physical examination in the delivery room immediately after birth to detect gross abnormalities and birth defects and to assess the newborn's transition to extrauterine life. A comprehensive examination is then typically performed within the first 2 hours of birth, once the newborn enters the nursery. The nurse performs the initial assessment in the delivery room and then completes the comprehensive examination. The pediatric care provider is then notified of the infant's status. Any abnormalities identified may warrant prompt intervention or referral for additional assessments from specialty providers. This chapter discusses the importance of documenting the initial neonatal weight and measurements. It describes normal newborn appearance. The chapter helps the nurse to identify the routine measurement data that are obtained during a comprehensive newborn examination. It discusses normal skin variations present in newborn infants and compares and contrasts normal and abnormal physical characteristics in the newborn.

For new parents, leaving the healthcare setting can create mixed feelings. Parents need extensive education prior to discharge in order to learn how to adequately and safely provide for their newborn. Ongoing well-baby visits and immunizations are imperative for the newborn to ensure proper growth, development, and optimal health. This chapter helps the nurse to identify appropriate components of discharge from the neonatal intensive care unit (NICU) setting. It lists the appropriate intervals for routine well-baby visits during the first month of life. The chapter discusses strategies to reduce parental refusal of immunizations. Discharge from the NICU setting can bring a variety of emotions for new parents who may be both anxious and excited at the prospect of caring for their baby at home. The initial follow-up visit following a NICU stay has many of the components of a well-baby visit.

The care of high-risk newborns and their families occurs most commonly in the neonatal intensive care unit. Family-centered developmentally supportive care models embrace care of the newborn and focus on the developmental needs along with the care required for the entire family unit. Infants in the neonatal intensive care unit (NICU) often face invasive procedures that require pain-relieving strategies to keep them comfortable. The nurse plays an important role in the preparation of the infant and the education of parents when invasive procedures are needed. This chapter helps the nurse to identify interventions to reduce pain for the newborn undergoing invasive procedures and lists common neonatal procedures performed in the NICU. It describes the concept of family-centered developmentally supportive care and discusses issues that occur related to newborn transport. The chapter outlines common concerns related to the use of anesthesia for surgical interventions in the newborn period.

Fetal growth in utero can be affected by a variety of maternal, fetal, placental, and environmental conditions. Some conditions result in low birth weight, whereas others result in macrosomia, which has different, but still significant implications. Monitoring for causative factors and signs and symptoms during pregnancy can alert the neonatal team to potential variations in fetal growth that impact the neonatal period. This chapter helps the nurse to differentiate between the different categories within the low birth weight definition. It describes the difference between intrauterine growth restriction and small for gestational age. Intrauterine growth restriction (IUGR) is an alteration in fetal growth in which the fetus's/newborn's weight is at or below the tenth percentile. The chapter helps the nurse to identify risk factors for macrosomia and details adverse events associated with post-maturity.

For some infants, total parenteral nutrition may be warranted when oral feedings are not possible. Other infants may receive breastmilk, formula, specialty formulas, or a combination of both formula and breastmilk. Effective feeding techniques are important to ensure the infant is getting optimal intake. Premature infants may require specialty formula, tube feedings, or feeding support in the early newborn period. Infants with anatomical issues may require specialized bottles or feeding support. Postnatal growth is an important indicator of newborn feeding adequacy. This chapter helps the nurse to name conditions that may be present that warrant the need for total parenteral nutrition and also helps to identify potential genetic or neurological factors that could impact infant feeding. It outlines the process for reconstituting commercial powdered formula and discusses the importance of postnatal growth in infancy.