The 17:4 issue of JPNN encompasses an array of clinical topics of interest to practicing clinicians. Topics will provide indepth content on selected perinatal and neonatal practices. The perinatal section explores both antepartum and intrapartum clinical practice by including articles on folic acid/neuro tube defects and pain management during labor and birth.

Relative to pain management, Florence and Palmer address the diverse range of therapeutic options for pain available during labor. Increasingly, pregnant women are requesting an expanded repertoire for pain management. Patient satisfaction, as it relates to pain management and pain theory, is also presented. Nonpharmacologic methods of acupuncture and hydrotherapy, as well as pharmacologic methods of pain management and their proposed action, efficacy, risk, and benefits, are noted.

Poole describes neuraxial methods of analgesia and anesthesia during labor. With the shift in practice from dense blocks to techniques that result in minimal motor blockade, women and their providers now have varied options for pain control with regional analgesia. Nursing implicatiaons, physiology, and selected medications are reviewed. Newer techniques of combined spinal-epidural analgesia (CSE) and patient controlled analgesia are highlighted.

An indepth review of the literature on folic acid and neuro tube defects is explored by Geisel. She delves into the historical research on folic acid and accounts for its present day use and notes its updated benefits for prenatal screening. She provides useful and current information for the clinician especially involved in antepartum practice.

The three articles in the neonatal section of this issue focus on issues related to stress and pain in the neonatal intensive care unit (NICU). Sound is a potential stressor in the NICU environment that has received a great deal of attention in recent years. National organizations and multidisciplinary panels have recommended modification of the NICU sound environment to control noise and provide an environment more conducive to infant development and parent-infants interaction. Johnson describes the development and implementation of an evidence-based care protocol to reduce and maintain lower environmental noise levels.

Although the protocol was developed for a specific NICU, she describes how the protocol can be adapted and implemented in other units.

Assessment and management in infants is an ongoing issue in all NICU. Recent guidelines and accreditation requirements have focused on consistent evaluation and documentation of pain assessments. Reyes describes the results of a 2-pronged study that examined how nurses in an infant intensive care unit perceived their assessment of infant pain using and how the pain assessed was documented. On the basis of her findings, she suggests several areas for improving the standard of care in managing infant pain. Prasopkittikun and Tilokskulchai analyzed several studies conducted in Thailand related to nonpharmacological management of pain in neonates, specifically focusing on the effectiveness of several nonpharmacological methods of reducing pain responses to heel stick.