The Journal of Perinatal & Neonatal Nursing (JPNN) is celebrating its 30th year of publication starting with this issue...30:1 "Cardiopulmonary Complications." We at JPNN are very excited to be in our 30th year of publication. We would like to take this opportunity to thank Wolters Kluwer Publishing, our Contributing Editors ... Susan Blackburn, Terese Verklan, Lisa Miller, and Jackie Tillett ... all editorial board members and authors-for all their support and hard work making JPNN, "The Pink Journal," a 30-year success! To all our readers, please peruse the 4 upcoming issues within the 30-year volume and watch for the Special 30:3 Issue focusing on key aspects in perinatal and neonatal care.
During pregnancy, the cardiovascular, respiratory, and hematologic systems make the most significant changes of all physiologic systems to support the pregnancy. In addition, cardiac sequelae and thromboembolism are leading in maternal morbidity and mortality. It is essential that perinatal nurses have the latest evidence-based information to provide optimal care of pregnant women with cardiopulmonary complications. For these reasons, 4 articles concentrating on cardiovascular and pulmonary issues with the provision of care are presented in the perinatal section.
The CE article "Acute Myocardial Infarction in Pregnancy: An Update" by Kennedy and Baird presents an overview of this condition. This article highlights a comprehensive, collaborative management for care of the woman, neonate, and family. Myocardial infarction is a rare event in pregnancy but carries a high morbidity and mortality rate. Perinatal nurses play a key role in caring for the pregnant patient with acute myocardial infarction.
With advancement of healthcare and technology, infants diagnosed with congenital heart disease are now living to childbearing age and later adulthood. Osteen and Beal contributed the article "Reproductive Health Issues for Women With Congenital Heart Disease: A Practice Update." An overview of the different types of congenital heart disease along with related complications during pregnancy is reviewed. Critical nursing interventions are discussed from preconception through postpartum and breast-feeding.
In pregnancy, pulmonary changes increase oxygen transport between the maternal-fetal unit. This allows for adequate oxygenation during increases of maternal workload and protection when oxygenation pathway disruptions occur. Most women adapt to biochemical, functional, and anatomic stressors with minimal symptoms but acute and chronic pulmonary conditions may compromise oxygenation, leading to adverse outcomes. Leidecker and Dorman's contribution "Pulmonary Disorders Complicating Pregnancy: An Overview" explores descriptions of asthma, tuberculosis, cystic fibrosis, and pneumonia, including etiology, pathophysiology, impact on pregnancy, and clinical interventions.
"Shedding Light on Inherited Thrombophilias: The Impact on Pregnancy" focuses on a major contributor to perinatal and neonatal morbidity and mortality. Coagulation and fibrinolytic processes undergo significant adaptations, placing pregnant women in a hypercoagulable state. In turn, physical adaptations, specifically those leading to venous stasis, predispose women to thrombosis while those with an underlying thrombophilias are at even greater risk. A multidisciplinary approach to prevention, timely diagnosis, and prompt treatment provides the foundation of thrombophilia management. Dobbenga-Rhodes focuses on these aspects as well as patient education needs that ultimately can reduce thrombosis incidence and maximize opportunities for optimal pregnancy outcomes.
Finally, please take the opportunity to peruse the journal's perinatal expert opinion column as well as the legal issue and risk management column. A wealth of information can be gleaned from these valuable contributions to the journal.
Neonatal articles for this cardiopulmonary volume focus on cardiovascular issues. Dr M. Terese Verklan served as neonatal guest editor for the issue.
The CE article by Sharron Forrest is titled "Intrauterine Tobacco Smoke Exposure and Congenital Heart Defects." Active and second-hand tobacco exposure is well known to be associated with health risks, and pregnant women are routinely encouraged to quit smoking. Forrest reviews evidence showing that tobacco exposure during early fetal development is associated with congenital heart defects and implications for nursing practice.
Verklan and Walheed present findings from a retrospective evaluation of complications of long-term prostaglandin E1 (mean: 38 days) use in neonates in Saudi Arabia. Common adverse effects included hypokalemia, hypotension, and apnea/bradycardia. These and more rare complications such as pseudo-Barett syndrome and gastric outlet obstruction are described to inform and build awareness in neonatal clinicians.
The article by Cheryl Milford is "Care of the Family of an Infant With a Congenital Heart Defect During the NICU Hospitalization." In it, she reviews important elements of nursing care for families of infants born with congenital heart defects. She emphasizes family-centered and relationship-based practices along with nurse self-reflection to collaborate with families in determining how best to meet their needs.
Kristen Evans provides an overview of cardiovascular transition to extrauterine life in the extremely premature infant and presents care challenges in maintaining hemodynamic stability after the immediate transition period. Cardiopulmonary immaturity predisposes the extremely low-birth-weight newborn to specific challenges and complications. Main evidence-based management approaches are summarized.
Neonatal columns for the issue offer Internet resources from Susan Blackburn, HPV vaccination in "Parting Thoughts" by Terese Verklan, and pharmacologic management of patent ductus arteriosus from Katherine Gregory.
-Renee Jones, DNP, WHNP-BC, RNC-OB
-Rebecca L. Cypher, MSN, PNNP
Perinatal Guest Editors
-Susan Bakewell-Sachs, PhD, RN, PNP-BC, FAAN
Neonatal Editor
-M. Terese Verklan, PhD, CCNS, RNC, FAAN
Neonatal Guest Editor