This issue of the Journal of Perinatal & Neonatal Nursing focuses on complications during the intrapartum and newborn period. Labor, birth, and the immediate postpartum period are critical events during which major maternal and newborn complications can ensue. The lineup of articles covers a broad spectrum of content for perinatal and neonatal nurses.

Obesity as a complication of pregnancy and labor is presented in the article by Kriebs, which focuses on multiple complications that can stem from obesity. These include hypertension, diabetes, and fetal macrosomia and complications specific to delivery. Appropriate interventions during pregnancy and childbirth used to improve maternal and fetal outcomes are noted.

Balestrieri-Martinez presents obstetric anesthetic complications that require immediate attention during labor. The focus is on interventions and orientation issues that specifically address the nursing role in labor and delivery.

Hanson challenges readers to continue promoting second-stage labor using spontaneous maternal bearing down efforts only. Numerous evidence-based approaches can be used to avoid prolonged second-stage bearing down. Specific strategies to promote physiologic fetal descent are provided.

Perinatal sepsis is one of the most challenging problems encountered today in obstetric and intensive care. Burke brings to our attention risk factors and early detection of sepsis symptoms to improve maternal and fetal intrapartum outcomes.

Another well-known complication of labor is excessive uterine activity with the use of oxytocin. This is a commonly seen patient safety issue that complicates the intrapartum period. Oxytocin was recently added to the Institute for Safe Medical Practices list of high-alert medications. Miller provides a brief overview of relevant literature and strategies to limit sequelae of oxytocin-related induction and augmentation complications during labor.

Since the emergence of the neonatal intensive care unit (NICU) in the late 1960s, the patient population and tools to benefit high-risk neonates have evolved. Early NICUs were poorly equipped to deal with the most pressing issue, that of respiratory distress. For example, the only ventilators in use were designed for adults, making ventilation and oxygenation problematic and frequently requiring hand ventilation in an attempt to optimize gas exchange. NICUs really began to grow in the age of computers and miniaturization, when equipment could be made small enough for neonates and when neonatal healthcare providers became better at providing the individualized care that high-risk neonates require. Evidence-based practice is now the norm, and the growing base of scientific knowledge has broadened the NICU population and treatments of conditions.

This issue reviews a spectrum of complicated neonates, ranging from the extremely low birth weight to the term. Verklan provides a state-of-the-art review on the associated biochemical and physiological events of hypoxic-ischemic encephalopathy (HIE) and discusses clinical presentation, management, and treatment strategies for it. The hypothermia protocol for total body cooling is reviewed using the guidelines suggested by the National Institute of Child Health and Human Development's workshop on hypothermia and perinatal asphyxia.

Rath offers a manuscript on the fascinating topic of intercessory prayer as an intervention in clinical research. Although prayer and the complicated newborn do not, on the surface, appear to have much in common, her findings that prayer could make a difference in a population that could not be cognizant of someone praying for them gives us pause.

The late-preterm newborn population has been defined and has come under close scrutiny since 2004, in part because of the surprising reemergence of kernicterus as a result of early discharge practices. Darcy reviews etiology of late-preterm infants along with their most common ailments, including hypoglycemia, temperature instability, respiratory distress, and sepsis.

The etiology of necrotizing enterocolitis (NEC) remains unclear despite remaining a major contributor to morbidity and mortality in the preterm NICU population. Molecular-level pathophysiology of NEC is now being explored. Bradshaw presents a discussion of intracellular injury, disregulation of blood flow and immunologic factors in the intestine that may increase the susceptibility of NEC, clinical assessment, presentation, diagnosis, and laboratory and radiologic findings.

Complicated high-risk babies are going to remain the focus of the NICU, given the fact that new learning, new therapies, and technique refinement will continue. Translational science will bring more exciting endeavors as our knowledge base moves from the laboratory bench to the direct care nurse. No doubt, the NICU patient populations and interventions will continue to evolve.

Diane J. Angelini, EdD, CNM, FACNM, FAAN, NEA-BC

Perinatal Editor

M. Terese Verklan, PhD, CCNS, RNC

Guest Editor