This issue of The Journal of Perinatal and Neonatal Nursing focuses on selected topics related to pharmacology. The articles in the perinatal section cover a wide variety of situations in which pharmacologic preparations are useful in managing various conditions affecting the mother. Several of the topics also include discussions of fetal/neonatal implications of drugs since ingestion of agents during pregnancy may have implications for both the mother and the fetus.
Women whose mental disorders are being treated with psychotropic medications and who are either pregnant or want to become pregnant pose a variety of complicated management issues. Psychotropic medications generally are considered to be unsafe during pregnancy. However, women who stop taking their psychotropic medications when they learn they are pregnant or when they want to become pregnant risk relapse of their psychiatric symptoms. Allison's article addresses the complicated dilemmas in such situations where the safety of the fetus may be in conflict with the welfare of the mother. She examines some of the ethical and social aspects affecting the care of these women and provides an overview of the drugs used to treat the major categories of mental illness as well as their risks to the pregnancy and to the fetus. In addition, she offers alternatives for such women, stressing that to provide them with safe holistic care, coordination and collaboration among obstetrical and psychiatric care providers, as well as between the woman and her significant others, is essential.
Genital herpes is a chronic health problem that affects both women and men. Genital herpes can become an acute problem during the perinatal period because it increases the risk of operative delivery and is a potential threat to infants who may acquire it intrapartally. Roe's discussion of antiviral treatment of genital herpes begins with the differences between the two primary viruses responsible for the disorder, how herpes is transmitted, its various manifestations in the adult, and how it is diagnosed. She reviews the various antiviral agents and the different approaches to antiviral treatment as well as the importance of tailoring the treatment regimen to fit the individual woman's lifestyle. Roe provides guidelines for counseling and treating women of childbearing age who have genital herpes or are at risk of acquiring it from an infected partner. She also discusses the risks of genital herpes to the pregnant woman and her fetus and reviews the manifestations of the disease and its treatment in infants.
Although the use of vaccines is a fairly routine practice in modern-day healthcare, debates about the safety and efficacy of various vaccines have been ongoing in the professional and lay media. The modern-day menace of bioterrorism has alerted the world, the nation, the healthcare system, and the public to the fact that diseases once thought to have been eradicated could again become serious health risks and has heated up debates about the use of vaccines. Tillet provides a timely examination of the most up-to-date information about the risks and benefits of vaccination to pregnant women and their fetuses as well as to women who are breastfeeding. In addition to some of the more common vaccines and the diseases they are designed to prevent, she discusses the risks of diseases that could be a danger to women traveling to certain parts of the world, timing of vaccination, techniques for administering vaccines, and issues regarding the safety of vaccines. Finally, she stresses the importance of vaccination screening as a part of healthcare of any childrearing-age woman who seeks care in any healthcare site.
Hypertensive disorders during pregnancy continue to be a matters of serious concern for perinatal healthcare providers. Hypertensive disorders increase the risk of morbidity and mortality to both the mother and the fetus. Yankowitz first reviews the contemporary classifications of hypertension during pregnancy and then discusses pharmacologic strategies for managing hypertension during pregnancy, particularly chronic or pregestational hypertension and severe, acute hypertension. In addition, he presents some of the controversies about treating hypertension during pregnancy, such as whether or not to treat mild gestational hypertension. He describes the relative efficacy of various antihypertensive medications that can be used during pregnancy, as well as the drugs' side effects and their risks to the mother and the fetus.
The articles in the neonatal section offer important information for neonatal nurses. Pharmacologic management of conditions in neonates presents specific challenges because of unique risks and physiology considerations in this population. Infections contribute significantly to morbidity and mortality in the neonatal intensive care unit (NICU) population. Antibiotic use is essential in the neonatal unit to combat bacterial infections. It also contributes to pathogen-resistance, which ultimately makes treatment more challenging. Tom-Revzon provides an in-depth review of antibiotic use in the NICU, with analysis of controversies and recommendations regarding minimizing the emergence of antibiotic-resistant organisms. She reviews common pathogens and recommended treatment regimens including empiric therapy, dosing, and monitoring.
Viral infections offer additional risks to neonates and present special challenges in terms of prevention, diagnosis, and management. Barford, Rentz, and Faix present an overview of viral disease in infants in the NICU, with emphasis on pharmacologic agents currently employed for prophylaxis and treatment of such diseases. The authors present an overview of basic virology, discuss prophylactic therapies to prevent viral infections, and review specific antiviral therapies. Effective antiviral agents are limited, but steadily increasing as knowledge grows about the molecular biology of viruses and the pathogenetic mechanisms of virus-host interactions.
Neonatal seizures are often difficult to assess, diagnose, and manage. Controversies exist regarding the potential short- and long-term impact of seizures on the developing brain versus the underlying cause of the seizures; diagnosis of neonatal seizures; and pharmacologic management strategies. Granelli and McGrath explore these controversies and review current research on this topic, which confronts neonatal nurses in practice frequently. Their review of differentiating seizure types, determining jitteriness versus seizure activity, and medications will be immediately useful to clinicians.