All articles published in JPNN in the past 10 years were evaluated by a subgroup of members of the neonatal section of the JPNN Editorial Board consisting of Maryann Bozzette, Karen D'Apolito, Peggy Gordin, Linda LeFrak, Mary Lynch, Julie Novak, and Terese Verklan. From this review, the top 24 articles were identified and sent to all the members of the neonatal section of the Editorial Board for review and ranking to determine the top 10 articles from the past decade of JPNN. The members were asked to consider specific criteria for this ranking as follows. For clinical and professional issues articles, rankings were based on how well the article/topic or subject reflected new scientific knowledge that required a novel nursing response (new practice, new protocol, new procedure, etc), presented a new model for neonatal nursing care or a nursing approach predicated on new evidence-based practice guidelines, and represented a pioneering new approach or paradigm shift to a longstanding problem in neonatal nursing or for the neonatal patient. For research articles, rankings were based on how well the research made a substantial contribution to the science of neonatal nursing, was novel, innovative, or creative in its approach to some aspect of neonatal nursing, and how well the results (findings and implications for practice) were presented so that the neonatal nurse could clearly identify aspects that might impact practice choices. The articles selected by the board reflect the range of neonatal care issues from advanced practice roles and issues to pathophysiology, management of common neonatal healthcare problems, and developmentally supportive care. Each provides a different thread of the art and excellence in neonatal nursing. The articles are described below in alphabetical order by author.
Banta-Wright SA, Steiner RD. Tandem mass spectrometry in newborn screening: a primer for neonatal and perinatal nurses. J Perinat Neonatal Nurs.2004;18(1):4158.
"Newborn Screening" for errors in metabolism is positively impacting the lives of many infants and families. What was once known simply as the "PKU test" has grown into a powerful screening method for more than 30 different disorders in metabolism because of advances made in tandem mass spectrometry. Banta-Wright and Steiner provide a definition by which metabolic disorders should be considered for newborn screening and why a single bacterial assay screening provides a more powerful and efficient test for screening. Understanding how mass spectrometry works provides the bedside caregiver with an increased understanding of each metabolic pathway, the occurrence of the disorder, better understanding of why collection guidelines are important, and more importantly, helpful information for parents. This article provides information on the full implications for specimen collection and appropriately sending it to the laboratory. Knowing the "why" behind caregiving practices can only continue to facilitate best newborn care.
Brown P, Taquino LT. Designing and delivering neonatal care in single rooms. J Perinat Neonatal Nurs.2001;15(1):6883.
Neonatal intensive care unit design has evolved to incorporate principles of developmentally supportive and family centered care. Groups of experts in neonatal intensive care unit design and care have met serially to review, revise, and publish neonatal intensive care unit standards based on the best available evidence. In an effort to provide a more individualized, supportive environment for infants and families, many units have chosen to move to a single room design. Brown and Taquino examined the process of design and implementation of such a design that serves as a model for others contemplating such a change. They provide a comprehensive discussion of the design phases, from team development and project goal setting, through schematic design, design development, construction document, construction, move planning and moving to postoccupancy. For each phase, the major tasks, stakeholders, and players are delineated along with suggested strategies for accomplishing each task. Finally, the authors discuss the impacts of single-room care on infants, families, and staff as well as on aspects of the physical environment (sound, light). This article provides an excellent blueprint for successful neonatal intensive care unit redesign.
Dawson PM. Vancomycin and gentamicin in neonates: hindsight, current controversies, and forethought. J Perinat Neonatal Nurs.2002;16(2): 5472.
Infection is one of the most common diagnoses encountered in the high-risk neonatal environment. Care of neonates with probable or confirmed sepsis continues to be an area of concern since the diagnosis is often difficult to completely substantiate and treatment modalities are not without risks. In the article by Dawson, each of these issues is thoroughly examined. She begins with a brief overview of the issues related to neonatal pharmacokinetics and pharmacodynamics and then applies these principles to antibiotic medication administration and management in the neonatal setting. More specifically, the risk/benefit ratio for using vancomycin and gentamicin is explored and recommendations for dosing, monitoring, and reducing resistance over the lifetime of the child provided. Although these issues are changing as our body of knowledge about antibiotic therapy grows, the discussion has relevance today and causes us to continue to examine our practices and make sure we are delivering care based on the best evidence available.
Elser A, McClanahan M, Green TJ. Advanced practice nurses: change agents for clinical practice. J Perinat Neonatal Nurs.1996;10(1):7278.
Advanced practice nurses are change agents. Elser et al explore the role of the advanced practice nurse in research utilization, and evidence-based practice in the care of the very low birth weight infant. They outline the clinical problem (staff understanding and need for minimal stimulation for the population), the need for change (literature to support the change process), and the implications for implementing and evaluating the process. This article concisely outlines the change process in such a way that it could be used as an exemplar for how this process can be used regularly to impact the care of infants and families in the newborn setting.
Furdon SA, Eastman M, Benjamin K, Horgan MJ. Outcome measures after standardized pain management strategies in postoperative patients in the neonatal intensive care unit. J Perinat Neonatal Nurs.1998;12(1):5869.
Pain assessment and management is a continuing challenge in neonatal care. Many misconceptions about neonatal pain have been dispelled with the renewed focus and growing evidence base generated in the past decade. Although staff members may feel that they are adequately managing an issue, documentation of actual practices and relevant issues can provide new perspectives. Furdon et al present their analysis of and response to postoperative pain management. They describe how responding to a national survey on pain management resulted in data collection on their own practices, which revealed areas of inconsistency and inadequate pain management. The article describes the interdisciplinary quality improvement process used to further explore the issues and develop solutions. They then implemented standardized pain management and evaluated the effectiveness of the strategies identified. The description of their process provides a model that can be applied to other care issues in the neonatal intensive care unit.
Horns KM. Being-in-tune care giving. J Perinat Neonatal Nurs.1998;12(3):3849.
Providing care with a clear understanding of the individual feelings and needs of the patient is the essence of artful nursing practice. In the care of verbal patients, talking with them and gaining an understanding of their personal needs is essential to the foundation of selection of appropriate caregiving interventions. In the neonatal population, however, gathering this information is more difficult since infants do not talk and their behavioral cues can be difficult to discern given their immaturity and concurrent disease state. Horns explores this phenomenon through a qualitative study involving experienced neonatal nurses. Two concepts that are interrelated and interdependent emerge from the data: individually defined physiologic stability of the critically ill neonate and being-in-tune caregiving, which is the nurse's ability to decipher and provide care that supports infants during this tenuous time. Stepping back from caregiving and examining the aspects of care provides neonatal nurses with a better understanding of the caregiving process and allows assessment for improving practice.
McGrath JM, Braescu AV. State of the science: feeding readiness in the preterm infant. J Perinat Neonatal Nurs.2004;18(4):353368.
Successful oral feeding is one of the major criteria for discharge from the neonatal intensive care unit, yet it remains an area with significant gaps in the evidence base and variation in practice. McGrath and Braescu note that oral feeding is often considered a routine nursing care task in the neonatal intensive care unit, seen as having a lower priority than high-tech critical care issues. Transition to oral feeding is actually a complex process. Support of feeding readiness and success has implications not only for length of stay and cost of care but also for long-term infant and parent-infant interaction outcomes. These authors provide an excellent, comprehensive literature review of feeding readiness in the preterm infant. Specifically, the authors review what is known and the relevant evidence base for 11 intrinsic and extrinsic characteristics that influence oral feeding success. These characteristics include maturation, severity of illness, enteral tolerance, physiologic stability such as cardiorespiratory status, tone control, behavioral state organization, hunger cues, coordination of sucking, swallowing, and breathing, and learned feeding behaviors. The concepts discussed in this article provide a research agenda for feeding readiness. The article concludes with practical suggestions for supporting feeding readiness and success that should be read and used by all neonatal intensive care unit caregivers.
Peters KL. Neonatal stress reactivity and cortisol. J Perinat Neonatal Nurs.1998;11(4):4559.
Infants in the neonatal intensive care unit often experience stressful situations. Sources of stress include care procedures, handling, pain, pathological conditions, and aspects of the neonatal intensive care unit environment such as noise and lighting. Although the biological consequences of stress have been studied for many years in adults, research regarding neonates is more recent. Peters presents a comprehensive review of the concept of neonatal stress, the development of stress responses, and the consequences of neonatal stress. She does an excellent job of summarizing the state of the science at that point and addresses what was known about cortisol secretion in well and ill term and preterm infants. Although this is an area that is changing as the body of knowledge expands, even with newer work, there is much we do not understand about neonatal stress responses and the short-term and long-term consequences through childhood into adulthood. As a result, this article remains relevant today for nurses caring for infants in the nenatal intensive care unit in understanding the issues in studying and understanding stress responses and the short- and long-term consequences of stress on the young infant.
Thomas KA. Biorhythms in infants and role of the care environment. J Perinat Neonatal Nurs.1995;9(2):6175.
Biological rhythms underlie all life functions. Biorhythms are an important consideration in care since they can affect vital signs, laboratory values, physiologic functioning, and responses to therapies. Biorhythms provide the basis for neonatal intensive care unit practices such as cycled lighting. Prior to birth, the fetus develops his or her own rhythms while simultaneously being entrained to maternal rhythms. After birth, the infant's biorhythms change with development and are influenced by interactions with the new care environment. The article by Thomas is one of the earliest to integrate the concept of biorhythms in provision of nursing care in the neonatal intensive care unit. She provides a basic primer on biorhythms and terminology and an outstanding review of infant biorhythms, particularly in relation to infant temperature and sleep-wake patterns and the care environment. The article describes how nurses can incorporate knowledge of biorhythms into their practice, focusing on 3 areas-care unit lighting, feeding schedules, and caregiver impact-and identifies other areas that have future potential. The evidence base regarding biorhythms in infants continues to expand; however, the basic principles and implications for nursing practice set forth in this article continue to be relevant and applicable.
Wilder MA. Ethical issues in the delivery room: resuscitation of extremely low birth weight infants. J Perinat Neonatal Nurs.2000;14(2):4457.
In the neonatal and perinatal environment where life is supposed to begin, ethical dilemmas surrounding end-of-life decisions continue to be an area of great concern. These concerns are not diminishing and with the technological advances of the past decade they are to some degree escalating given our sense of success, and the dilemma of just because we "can" should we provide every means of support (and who decides). In this excellent article by Wilder, these issues are explored in depth as they relate to the birth of extremely low birth weight infants. She eloquently demonstrates the resuscitation decision-making process in the delivery room in an algorithm examining the possible scenarios and outcomes. She also examines each ethical principle and relates it to the care of extremely low birth weight infants. Finally, she concludes with 3 recommendations that delineate the ethical considerations of resuscitation of extremely low birth weight infants in the delivery room; each is not without conflict or long-lasting consequences for both the infant and the family but examining each helps the care provider to better understand why some infants are resuscitated while others are not. None of the 3 recommendations for delivery room practices is right or wrong; they provide guidance to facilitate better decision making in the clinical setting. The essence of this article remains relevant and the article should be reread on a regular basis.