DRUG ABUSE I S A MAJOR psychiatric problem in the U.S.1 The American Academy of Pediatrics (AAP) Committee on Substance Abuse notes that increasing numbers of women are reported to use licit and illicit substances during pregnancy.2 Statistical data are insufficient because of the difficulty in obtaining accurate information from a medical history, but as many as one in ten infants has been estimated to have been exposed to illicit drugs in utero. The reported incidence is higher in inner-city hospitals.3 Some of these infants are known to be experiencing complications related to drug exposure during the neonatal period. Others may be sent home with undetected problems. Long-term health and well-being of the infant and family may be negatively influenced by the lack of identification of drug exposure. This concern has prompted increased efforts to identify the exposed infant and the substance to which the infant was exposed.
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When nurses work in the same neonatal intensive care unit for many years, they tend to follow routines. They follow their schedule in a certain way, report to the next shift in a certain way, and proceed with their workload in a certain, predictable way. Because many of us are creatures of habit, the routines of the unit can be comforting. We like to know what to expect. Especially in a busy NICU, often subject to unknowns from the high-risk antepartum unit, the delivery room, and community hospitals, we relish the complacency of that which we can control.
I HAVE READ SEVERAL OF YOUR LETTERS DECLARING THAT they are “The Best NICU in America” and I had to write because I truly believe that I work in “The Best NICU in America.” I have been involved in neonatal nursing in some aspect or another since I graduated from Ohio State University in 1977. I worked at Children’s Hospital of Philadelphia’s NICU as a new graduate, and at Ohio State University’s NICU. Both were wonderful experiences and helped me to get started on the right track when it came to my neonatal nursing career. In 1983 I moved to Connecticut and started to work at Danbury Hospital in their NICU. I am currently an NNP but have held management and staff positions there. I feel privileged to have been in several positions in this NICU because it has given me the chance to experience nursing from all aspects.
AHARSH, VIBRATING SOUND OF variable pitch, stridor implies partial airway obstruction resulting in turbulent airflow through a narrowed segment of airway.1 Stridor is characteristically heard on inspiration, suggesting airway obstruction above the glottis in either the larynx or the pharynx.2 Infants with upper-airway obstruction typically demonstrate prolonged inspiration.3 Expiratory stridor suggests lower-airway obstruction in the intrathoracic tracheobronchial tree.2 Stridor may also manifest as biphasic (both inspiratory and expiratory), usually indicating midtracheal lesions.4
ONCE CONSIDERED AN environmental nuisance at best and a dangerous poison at worst, nitric oxide (NO) has been discovered to be an important biologic messenger, sending a shock wave through the scientific community. This article briefly reviews the discovery of NO as a regulator of vascular muscle tone and describes important events on its road to fame. The application of inhaled NO (iNO) for the treatment of hypoxic respiratory failure in neonates is discussed.
Yesterday, I went out with my wife for some coffee. The cost was nearly ten dollars as we ordered one regular coffee, one tall mocha and two scones. (If you know what a “tall mocha” is, you too are spending anywhere from $1.35 for a regular coffee to $2.50 for a mocha [the cost of a tall mocha at my local coffee hangout is much less expensive than the cost of the exact same cup of coffee in a major city, an airport, or hotel].) If you buy a magazine when you are waiting in line at the grocery store, it will cost you three or four dollars (O: The Oprah Magazine costs $3.95 and Martha Stewart Living costs $4.75 for a single issue). If you drink one tall mocha a day and buy one magazine such as O, you will spend at least $21.45 per week or about $3.00 a day.
AS HISTORY REPEATS ITSELF, the national health care system faces another nursing shortage crisis. Vacant full-time positions in acute care facilities alone number 120,000, a figure projected to continue climbing at an unprecedented rate, with long-term and permanent effects.1 One nursing labor economist, Peter Buerhaus, forecasts that this is only the beginning.2 Some organizations, desperate for help, are recruiting registered nurses from countries as far away as the Republic of the Philippines and Indonesia. Legions of traveling nurses and agency personnel have no difficulty finding work.1 According to one survey, specialty unit positions, such as those in the NICU, had the highest vacancy rates and were the hardest to fill in 57 percent of the hospitals.3
The liver, the largest organ in the body, is critical to a number of key metabolic functions. It also plays an important role in removing the waste products of metabolism (particularly ammonia) and in detoxifying drugs and other substances such as endogenous hormones and steroid compounds. In addition, the liver plays a major role in the production of clotting factors, plasma proteins, bile salts, and bilirubin.
Many neonates display signs of hepatic dysfunction such as hyperbilirubinemia, hepatomegaly, or elevated liver enzymes. These often occur secondary to systemic illness, such as sepsis or hypoxic injury, or following the use of drugs or parenteral nutrition to treat other problems. Although rare, primary liver disease does occur in neonates and must be recognized promptly, with treatment initiated in a timely manner to prevent unnecessary sequelae. This article, the third in a series on the liver, examines causes of liver dysfunction in neonates, beginning with an overview of jaundice and hepatomegaly and moving to a discussion of specific diseases.
THE VERB PALLIATE COMES FROM the Late Latin palliatus, past participle of palliare, to cloak, conceal. Merriam-Webster Online defines palliate as “to reduce the violence of (a disease)” or “to moderate the intensity of” something.1 Understanding the features of palliative care can challenge NICU staff, whose focus is primarily promotion of the neonate’s survival and healing. Many staff members may be ill prepared to assist the family of a newborn who is dying.2