In this issue of The Journal of Perinatal & Neonatal Nursing dedicated to respiratory disorders, the perinatal section addresses a number of topics that pose unique and complex challenges for the nursing management of both the mother and the fetus. While the maternal state of compensated respiratory alkalosis associated with pregnancy releases oxygen more freely to the fetus, the goal of pulmonary therapy for complications during pregnancy is to ensure optimal maternal oxygenation, which indirectly promotes maximal oxygenation of the fetus.
Connors and Ulles discuss the pregnant woman with cystic fibrosis (CF). With a dramatic increase in the survival of patients with CF in the last several decades, the prospect of childbearing has been realized for some of these women. Taking a systems approach, the effects of CF are detailed with accompanying management strategies. Psychological and educational considerations are presented for the antenatal, intrapartal, and postpartal periods. The authors finish with an important discussion of the newborn's diagnosis of CF, which includes the sweat chloride test, newborn screening, meconium ileus, and pancreatic insufficiency.
In their article on pulmonary edema in pregnancy, Poole and Spreen detail this secondary disease process that quickly leads to pulmonary dysfunction and can be potentially life-threatening for the woman and her fetus. The complex pathophysiology of pulmonary edema is discussed, as well as risk factors, assessment, diagnosis, and management recommendations. Nursing vigilance promotes early diagnosis and optimal interventions to improve perinatal outcomes and prevent more severe complications in those at risk.
In the final article in the perinatal section, Rebman provides a wonderful introduction to, and comprehensive discussion of, severe acute respiratory syndrome, a potentially fatal respiratory disease. To halt potential outbreaks of this emerging infection, she presents a clinical description, including commons signs and symptoms, diagnosis, and treatment. Recommended isolation practices for labor and delivery and potential maternal and neonatal outcomes are outlined. Nurses should remain vigilant in implementing infection control precautions to help ensure preparedness for severe acute respiratory syndrome and other emerging respiratory infections in their communities.
The neonatal section of this issue of The Journal of Perinatal & Neonatal Nursing focuses on pulmonary issues. In 2002, 12.1%of all live births were premature ones.1 Two thirds of all neonatal deaths are due in part to prematurity and low birth weights, and complications of respiratory distress and other pulmonary problems are among the leading influencing factors.2 Pulmonary problems in the newborn still rank among the top 3 clinical issues resulting in neonatal and infant morbidity and mortality. New therapies and treatment plans are evolving and are grounded more in evidence than in tradition. The articles included in the neonatal section discuss a variety of topics, and several reflect the efforts of nursing research to improve outcomes of our tiniest patients. The topics are as follows: the effects of fetal hemoglobin on accurate measurements of oxygen saturation in neonates, neonatal lung remodeling, and room air versus oxygen resuscitation in the delivery room.
Shiaos' article on the effects of fetal hemoglobin is a nurse-led study funded by the National Institutes of Health, the National Association of Neonatal Nurses, and the American Association of Critical Care. This study and another in an upcoming volume are the beginning of a new area of research that has great potential for changing practice once they are replicated in other populations.
Barbara Turner and colleagues examine 3 of the influences the developing lung is subject to both prenatally and postnatally that alter the normal developmental process. An excellent overview of pulmonary physiology is presented along with selected conditions such as congenital diaphragmatic hernia, prematurity, and bronchopulmonary dysplasia and the effects of current treatments on this system's development. They conclude with the notion that more research needs to be done on the long-term outcomes of these conditions as well as examination of genetic and nutritional influences on lung maturation and remodeling.
And finally, neonatal nurse practitioners Corff and McCann review animal and human research comparing oxygen and room air resuscitation in the asphyxiated newborn. They conclude that variations between term and preterm infants have not been systematically studied nor has there been an adequate or consistent definition of "normal" progression of physiologic changes in the first minutes of life. The studies reviewed would suggest that room air can be just as effective as resuscitation with oxygen but until more research addresses the variations in infants and the definition of normal transition there are gaps in our evidence to support such changes.
Cyndy Krening, MS, RNC
Perinatal Clinical Specialist Littleton Adventist Hospital Littleton, Colo, Issue Editor, Perinatal Sect
Mary Ellen Burke Sosa, MS, RNC
President, Perinatal Resources Staff Nurse, Women and Infants Hospital of Rhode Island, Providence, Issue Editor, Perinatal Section
Carole Kenner, DNS, RNC, FAAN
Dean, University of Oklahoma Health Sciences Center College of Nursing, Oklahoma City, Issue Editor, Neonatal Section
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