Neonatal Network最新文献

Newborn infants experience significant fluid shifts following delivery as a result of the contraction of extracellular water. Without prompt identification and treatment, significant weight loss can result in neonatal hypernatremic dehydration. This case study presents an infant with significant weight loss, dehydration, and electrolyte imbalances. The differential diagnosis for hypernatremia is presented along with clinical presentation, treatment, and discharge education recommendations.

Biliary atresia (BA), a rare cholangitis, is considered a progressive inflammatory disease of the biliary tree that if left untreated can lead to cholestatic jaundice, cirrhosis, and liver failure. It remains the most common cause of chronic liver disease and the most common indication for liver transplant in children. Biliary atresia can develop concurrently with laterality defects, namely polysplenia and asplenia. This presentation is termed biliary atresia splenic malformation (BASM) and accounts for merely 10% of all cases of BA. The purpose of this article is to present a case report of a neonate with BASM. Following the case report, we present a discussion of risk factors, clinical manifestations, diagnostic modalities, and management strategies, including the Kasai portoenterostomy procedure. Long-term implications of BASM and care strategies to optimize outcomes for the family unit are also included for the benefit of neonatal providers.

Congenital heart disease (CHD), the most common type of congenital anomaly affecting approximately 1% of all births, presents with altered blood flow and circulation due to structural defects. Interrupted aortic arch (IAA) is a rarer type of cyanotic CHD, which tends to present elusive, nonspecific symptoms in the immediate newborn period. As the pathology progresses, symptoms become severe and quickly life-threatening. Timely identification and intervention is crucial, often requiring astute clinical acumen by newborn nursery providers. We present a case report of a neonate with unknown IAA, type A, at birth. A discussion of the pathogenesis, diagnosis, and treatment of IAA follows the case presentation.

Infant pain can be challenging to identify and treat accurately, especially in the postoperative patient. Failure to recognize pain in infants has been associated with poor neurologic outcomes and increased risk of death. A literature review was conducted using PubMed and CINAHL from 2019 to 2024. Articles included those published in the English language, published within the last 5 years, that discussed infant postoperative pain, pain assessment, and treatment. Sources utilized outside the 5-year time frame are primary sources from the most current systematic literature reviews. Inadequately managed pain in infants can have long-term consequences, including the development of chronic pain. These concerns make adequate treatment of all pain essential, though recognition of pain can be complex in preverbal and neurologically immature patients. Several evidence-based pain assessment scales are available but must be used appropriately in the right population and setting. Five pain scales appropriate for postoperative pain in the infant population are COMFORT; Cries, Requires oxygen, Increased vital signs, Expression, Sleeplessness (CRIES); Face, Legs, Activity, Cry, and Consolability (FLACC); Neonatal Pain, Agitation, and Sedation Scale (N-PASS); and Premature Infant Pain Profile-Revised (PIPP-R). Nursing staff and providers must be educated in proper pain assessment and advocate for adequate analgesia for their postoperative patients. While some infants will require opioids for adequate pain relief, nonopioid pain medications can be used in the postoperative period. An algorithm for postoperative analgesia in neonates and infants could be beneficial in appropriately treating pain with targeted interventions, escalating care, and reducing cumulative opioid exposure.

Advances in prenatal and postnatal genetic testing have greatly improved the identification and management of genetic and chromosomal conditions in neonates. By understanding the benefits and limitations of genetic testing, health care providers can ensure that patients receive comprehensive, evidence-based support when navigating complex reproductive decisions. We begin with a review of fundamental embryologic development and genetic principles, emphasizing the need for informed consent and patient education in genetic screening. Variations in genetic makeup, including chromosomal abnormalities and their implications for reproductive health, are explored. Next, the article explores the evolution of testing methodologies, the importance of genetic counseling, and the role of interdisciplinary health care teams in supporting patients. While genetic counselors provide specialized expertise, nurses can play a crucial role in bridging gaps in access to genetic information.

Anemia of prematurity is a physiologic and iatrogenic process defined by gestational age and involves a decrease in an infant's red blood cell mass by 2 SD Severity is often inversely proportional to gestational age and the presence of comorbid conditions that alter erythropoietin production, reduce red blood cell life span and iron stores, and necessitate frequent serum blood draws. Blood transfusion is a common treatment for severe anemia, and when nonemergent it requires informed consent from a parent or a court-appointed guardian. Jehovah's Witness (JW) community members typically do not accept blood products based on their beliefs. This situation presents a unique ethical and legal dilemma for healthcare providers when the neonate's family denies lifesaving treatment. We present a case study of a 24 weeks' gestation infant born to parents of JW beliefs, as well as a discussion of the pathophysiology and clinical manifestations of anemia.

Occipital encephalocele, a rare and unique congenital brain malformation, occurs when a portion of the brain and/or cerebrospinal fluid (CSF) protrudes through a defect in the bony structure of the skull. This herniation of CSF and brain tissue is usually contained within a skin-covered sac. When an occipital encephalocele measures larger than the circumference of the head, it is classified as a giant occipital encephalocele. This article presents a case study of a neonate affected by a giant occipital encephalocele. We follow with a discussion of risk factors, applicable pathophysiology, clinical manifestations, diagnosis, and management strategies. A discussion of the implications of the disease on care providers and the family unit is included to highlight the importance of integrating the family as a critical member of the health care team.