This issue of the Journal of Perinatal & Neonatal Nursing focuses on preterm birth, a common obstetric complication that can have devastating results. Globally, the increased incidence of preterm birth remains a public health crisis. Furthermore, preterm birth's impact is substantial with increased rates of neonatal morbidity and mortality, serious long-term complications including neurodevelopmental impairments, and enormous social and economic consequences. Research gaps in prevention and predictive strategies, a lack of evidence-based clinical management approaches, and the mounting evidence on preterm birth's relationship with ethnic and racial disparities demonstrate an urgent need for greater international attention. In 2015, members of the United Nations adopted the 2030 global partnership agenda for international sustainable development.1 Two specific goals that are inclusive of maternal-child care call for universal action in provision of adequate and appropriate healthcare to promote well-being and a reduction in disparities to meet the needs of marginalized populations. Thus, the perinatal section presents a selection of 4 manuscripts focused on prematurity and a guest editorial by one of the leading national organizations dedicated to reducing preterm birth rates.
Invested in optimizing healthcare outcomes, the March of Dimes brings together research, education, community programming, and government advocacy to improve perinatal and neonatal outcomes. In this edition, authors from the March of Dimes provide a commentary spotlighting this organization's commitment to maternal and infant health by raising awareness and use of a multistakeholder approach to lowering preterm birth rates. Behind every maternal or infant statistic is a story. These authors present the nation's current prematurity rates via a unique report card classification. Timely dialogues on the ongoing threat of racial and ethnic disparities in perinatal outcomes are shared. A request to raise attention on the need for quality and comprehensive health services for all women is emphasized.
Decreasing preterm birth's wide-reaching burden requires a dual trajectory: prevention and intervention. For decades, obstetric experts have advocated for numerous strategies to prevent preterm birth. Each was received with great interest, followed by disappointment as several measures did little to significantly impact preterm birth rates. An intradisciplinary team of authors worked in partnership to write "Preterm Birth State of the Science: Assessing Contemporary Screening and Preventive Strategies." This article provides a synopsis of predictive and preventative preterm strategies that are currently offered to women. An evidence-based clinical approach to management using the most current literature is presented in this continuing education article.
Considerable advances in neonatal care have brought an additional clinical dilemma to maternal-newborn care, birth at the threshold of viability. One significant challenge during a periviable period is readiness to adapt clinical care and counseling for women with a threatened or imminent birth as this is one of the most difficult situations perinatal clinicians will face. A nurse and a maternal-fetal medicine physician collaborated to author "Periviability: A Review of Key Concepts and Management for Perinatal Nursing Care." This article provides a scoping review of research and consensus statements that are guiding clinical practice recommendations of periviable pregnancies.
Life transitions often encompass complex decision-making situations, disruptions, and challenges for women across a life span, including those of childbearing age. Transitioning to motherhood is a physically demanding and an emotionally overwhelming event. This experience can be further complicated after a premature infant is born. One nurse researcher highlights important data in the article "Transitioning Into the Role of Mother Following the Birth of a Very Low Birth Weight Infant-A Grounded Theory Pilot Study." This study emphasizes how preterm birth has a multidimensional and dynamic impact on a woman's coping skills and how perinatal nurses have a role in supporting each individual's needs during this shift.
Events that occur in early fetal development and a potential impact on an adult's risk for developing chronic diseases are receiving considerable attention in contemporary literature. A group of authors' impressive article "Stress During Pregnancy and Epigenetic Modifications to Offspring DNA: A Systematic Review of Associations and Implications for Preterm Birth" discusses research findings on how epigenetic patterns contribute to stress-associated preterm birth.
We encourage our readers to look over our popular expert opinion columns. Each contributing author addresses a currently relevant topic in perinatal and neonatal nursing that influences practice, education, or our profession. As always, our Parting Thoughts columnist provides readers with a subject that empowers nurses who are committed to making a difference in the health of women and newborns that we care for everyday.
The neonatal section of JPNN is focused on issues related to Preterm Labor and Birth. This issue features several articles, covering many topics related to the prevention of preterm birth and care of infants born preterm. The issue includes literature reviews, secondary analysis, and original research studies.
In the continuing education article titled, Pharmacology of Preterm Labor, Garfield and Chin reviewed and compared guidelines on pharmacologic management of preterm labor as recommended by the American College of Obstetricians and Gynecologists and the European Association of Perinatal Medicine. Their review focuses on progesterone to decrease risk for preterm birth; corticosteroids to promote fetal lung maturity; and tocolytics to decrease uterine contractions. They also provided nursing implications when administering medications to prevent preterm labor and birth and improve neonatal outcomes.
In the systematic review titled, Protocolized Versus Nonprotocolized Weaning to Reduce the Duration of Invasive Mechanical Weaning in Neonates: A systematic Review of All Types of Studies, Bol and her team performed a literature review to evaluate the effect of protocolized versus nonprotocolized weaning on the duration of invasive mechanical ventilation in critically ill neonates. After an extensive review of the literature, only the study by Hermeto et al fit the criteria to be included in the review. Hermeto et al reported that the duration of mechanical ventilation decreased from 18 days prior to the intervention to 5 days after 1 year and 6 days after 2 years. Bol et al conclude that the data are not sufficient to support or disprove the use of weaning protocol in critically ill neonates.
In a secondary analysis using a qualitative study design titled, Parents' Description of Neonatal Palliation as a Treatment Option prior to Periviable Delivery, Jager and colleagues explored the language that pregnant women at 22 and 24 weeks' gestation (n = 30) and important others (eg, father of the baby) (n = 16) utilize when discussing palliation, or "comfort care," as a treatment option in the context of periviable delivery, defined as birth between 20 and 25 weeks. The majority of parents described their options as a choice between either "resuscitating" or "not resuscitating." Parents' description of "not resuscitating" option included "comfort care," "implicit comfort care," "doing nothing," and "withdrawal of care." The findings suggest that many parents facing periviable delivery may lack understanding of comfort care as a neonatal treatment option.
In the study titled, Application of a Bundle in the Prevention of Peri-intraventricular Hemorrhage in Preterm Newborns, Carvalho and associates evaluated a care bundle intervention for preventing peri-intraventricular hemorrhage (PIVH) among premature infants. The researchers conducted a quasi-experimental design study with 2 stages: (1) a retrospective cohort of premature infants not exposed to the bundle care (n = 198); and (2) a prospective cohort of premature infants who received the bundle care (n = 186). The bundle care consisted of 2 items: (1) keep the infant in the prone position and head in the middle; (2) do not perform physical therapy maneuvers; (3) perform aspiration of the routine orotracheal tube only if necessary; (4) do not collect cerebrospinal fluid; and (5) do not weight infant. The results showed a significant reduction of PIVH rates for premature infants who received the bundle care intervention (34.8% before the bundle care intervention, and 26.3% after implementation of the bundle care intervention) (Please see this paper which is published as online).
In the study titled, Association of Nurse Staffing With Nosocomial Infections of Very Low-Birth-Weight Infants, Lee and colleagues examined the association of nurse staffing and nosocomial infections among very low-birth-weight infants (<1500 g) in neonatal intensive care units in Korea. Data from 52 hospitals were included in the analysis. Nosocomial infections were defined as incidence of bloodstream infection, urinary tract infection (UTI), and rotavirus infection. The researchers found that the UTI rates increased with increasing nurse-patient ratio; bloodstream infection and rotavirus infection were not significant (Please see this paper which is published as online).
-Rebecca L. Cypher, MSN, PNNP
-Lisa M. Foglia, MD
Perinatal Guest Editors
-Carmen Giurgescu, PhD, RN, WHNP
Neonatal Guest Editor
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