This issue of the Journal of Perinatal & Neonatal Nursing (JPNN) introduces a new feature for our readers. "Parting Thoughts" is a new section for the back page of JPNN. The idea came from Lisa Miller who will share authorship of the back page with Terese Verklan who aptly gave the back page its title. The purpose of "Parting Thoughts" cuts across multiple dimensions: (1) to bring forth an opinion piece for the journal; (2) to offer stimulating topics for the reader to ponder and reflect in everyday practice; and (3) to present an opportunity to share various viewpoints on a topic. We welcome Lisa and Terese as part of our contributing editors group and hope you will enjoy their insights. Lisa authors the first Parting Thoughts piece on Followership for this issue.
The perinatal section of JPNN includes 3 feature articles. The first is by Jody Farrell. Her topic, the advanced fetal treatment center, provides a historical overview of fetal treatment, including the development and evolution of fetal surgery. She reviews the clinical milestones and the components and dynamics of collaborative team management in fetal therapy and fetal surgery while also introducing emerging trends in this field.
Elizabeth Stevens and Jennifer Gilbert-Cohen present 2 potential perinatal surgical conditions: ovarian torsion and ectopic pregnancy. Although ectopic pregnancy can be managed medically, the surgical component of treatment is critical for nurses, midwives, and nurse practitioners, especially those working in obstetric triage. These are 2 of the most common causes of acute abdominal pain in early pregnancy. Both conditions require timely diagnosis to prevent maternal morbidity and mortality.
The last feature in the perinatal section is by Nell Tharpe. Nell writes about the role of first assist in obstetrics, primarily at cesarean sections. As the cesarean rate rises nationwide, nurses and midwives are expanding their scope of practice to include surgical first assisting at cesarean delivery. She describes the cesarean procedure and the role expectations of the surgical first assistant.
Birth defects are the leading cause of perinatal morbidity and mortality according to the March of Dimes and Centers for Disease Control and Prevention. All neonatal nurses will encounter babies requiring surgical care. It is with these thoughts in mind that the neonatal section focuses on neonatal surgical topics. Because of space constraints, I chose to select those topics thatwere timely and relevant, but entire volumes could be devoted to prenatal diagnosis of birth defects and subsequent neonatal surgical care. I believe the future of neonatal nursing will include dedicated surgical nurses, surgical neonatologists, and pediatric surgeons devoted to providing specialized care to these neonates.
Harres provides a historical perspective and elucidates the techniques of minimally invasive surgery in the neonate. The indications, instrumentation, and techniques have been refined and will play prominently in the care of those neonates requiring surgery. She describes the role of the operating room and neonatal nurse during these procedures.
Gastrointestinal diagnoses continue to plague the neonate and 2 topics address these issues. Nguyen and Lund reviewthe current research related to necrotizing enterocolitis and perforated bowel. Their article explores the controversy that continues to surround the management of these neonates as to whether to perform an exploratory laparotomy or place a peritoneal drain or employ a combination of both techniques. While the controversy continues, a skilled neonatal nurse who recognizes the early symptoms of necrotizing enterocolitis can improve outcomes. Lund, Bauer, and Berrios discuss gastroschisis as the most common abdominal wall defect, present a case study detailing the nursing care required, and provide a retrospective analysis of gastroschisis cases admitted to a single institution (Children's Hospital of Oakland).
Finally, Hurtekant and Spatz articulate the challenges of achieving breastfeeding with mothers and their newborns with spina bifida so that these infants can enjoy benefits such as shortened preoperative fasting times, decreased pain, reduced infection rates, reduced allergies and enhanced cognitive development, and lower rates of obesity. They cite specific goals for breastfeeding and provide practical care advice.
Diane J. Angelini, EdD, CNM, FACNM, FAAN, CNAA, BC, Perinatal Editor
Lori J. Howell, MS, RN, Neonatal Guest Editor
Executive Director, The Center for Fetal Diagnosis and Treatment Director, Surgical Advanced Practice Nurse Program The Children's Hospital of Philadelphia Clinical Associate, University of Pennsylvania School of Nursing Philadelphia, Pa