In this issue of MCN, we are pleased to present a special topics series focusing on newborn care. Three important aspects are covered; safe sleep in the hospital to promote safe sleep at home, the Eat, Sleep, Console protocol for babies with neonatal opioid withdrawal syndrome (NOWS), and a scoping review of the role of the gastrointestinal microbiome in colic. Each of these topics plays a significant role in nursing care of the newborn. Thank you to Ellise Adams, PhD, CNM, professor in the College of Nursing at the University of Alabama in Huntsville, AL who took the lead as guest editor for this special topics series.
Incidence of NOWS has significantly increased in the United States over the last decade coincident with a rise in maternal opioid use during pregnancy. Babies with NOWS require extra nursing care, close assessment, and treatment for symptoms. The traditional treatment plan includes a tool that involves frequent assessment and waking the sleeping baby, often leading to pharmacotherapy. A new approach, developed by Grossman et al. (2017) Eat, Sleep, Console, has been evaluated in several recent quality improvement projects. It involves the mother as a caregiver and focuses on three aspects of functionality, the newborn's ability to eat well, sleep undisturbed, and be consoled with relative ease. Eat, Sleep, Console assessments are performed by the nurse every 3 hours, preferably after feeding. A private room setting for the mother-baby couplet is ideal. Drs. Wortham and Bianchi review the evidence for Eat, Sleep, Console and offer strategies to implement the protocol in a community hospital.
Safe sleep in the hospital for newborns is not always reality despite detailed recommendations from the American Academy of Pediatrics unit (AAP Task Force on Sudden Infant Death Syndrome et al., 2016; Feldman-Winter et al., 2016). One of the goals is to role model safe sleep practices during the childbirth hospitalization and share information with parents, so they know the importance of continuing safe sleep practices at home after discharge. Sudden Unexpected Infant Death continues to be an issue in the United States. Each year approximately 3,400 babies die unexpectedly, often related to as asphyxiation, suffocation, and entrapment in an unsafe sleep environment. Drs. Patterson, Adams, and Ramieh conducted a quality improvement project in a small community hospital to promote the safe sleep practices recommended by the American Academy of Pediatrics for nurses and new parents and found positive changes in newborn care such as avoiding use of multiple blankets or swaddling of the infant, and parent teaching about safe sleep.
Most parents have had the stressful experience of their newborn crying and not being able to comfort and quiet them. Some babies up to 5 months old have colic, with recurrent periods of prolonged, inconsolable crying or fussiness without signs of failure to thrive, fever, or illness, yet colic has no recognized etiology. Gastrointestinal health problems and dysfunction have been suspected in the etiology of colic. Disruptions to the microbiome colonization of the gastrointestinal system may lead to excess gas and inflammation that are associated with the crying of colic. Drs. Johnson and Adams performed a scoping review that presents the collective evidence from 21 original, primary research articles on what is known about the gastrointestinal microbiome at colic onset and resolution.
We hope you enjoy reading these articles about newborn care and are able to incorporate the information into your clinical practice.
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