ABSTRACT
BACKGROUND: A level 1 community hospital with a labor, delivery, recovery, and postpartum (LDRP) unit delivering over 2800 babies per year was operating without dedicated neonatal resuscitation and stabilization support. PURPOSE: With lack of funding and space to provide an onsite level 2 neonatal intensive care unit (NICU), a position was created to provide neonatal nurse practitioner (NNP) coverage to support the LDRP unit. METHOD: The article describes the innovative solution of having an NNP team rotate from a regional neonatal intensive care program to a busy community LDRP unit. The presence of the NNP supported the development and integration of the advanced practice nursing role with interdisciplinary team members in both the LDRP and the emergency department. RESULTS: The NNP was able to provide expertise, leadership, and mentorship for neonatal resuscitation and stabilization as well as education and consultation on neonatal care. In addition to the services provided by the NNP for infant's requiring acute care, the NNP provided transitional support for those infants who remained with their mothers in the LDRP unit. Furthermore, time required by the neonatal transport team to stabilize babies before transport to the NICU was decreased with NNP presence. IMPLICATIONS FOR PRACTICE: The divergence from practice of the traditional NNP clinical role in the NICU setting to more of a consultant and nursing leader has proven to be a valued role at the community hospital. IMPLICATIONS FOR RESEARCH: A solid economic analysis of the cost-effectiveness of the NNP role in this community hospital is warranted.
Subject(s)
Hospital Units , Hospitals, Community , Nurses, Neonatal , Pediatric Nurse Practitioners , Postnatal Care , Delivery Rooms , Hospital Units/organization & administration , Hospitals, Community/organization & administration , Humans , Infant, Newborn , Intensive Care, Neonatal , Nurse's Role , Patient Transfer , Postnatal Care/organization & administration , Resuscitation , WorkforceABSTRACT
Despite comprehensive antenatal screening recommendations and inexpensive treatment, congenital syphilis has long been and continues to be a public health concern, causing substantial morbidity and adverse outcomes. The following article reviews syphilis etiology and presentation, clinical disease, laboratory diagnosis, and treatment of congenital syphilis. A case will be presented describing a 31-week male infant exposed to infectious syphilis in utero. The neonate presented with classic signs of infection at birth. After initial serology testing of the infant, appropriate treatment was commenced. The infant received crystalline penicillin G for a period of ten days in consultation with pediatric infectious disease specialists. As expected, the infant's rapid plasma reagin (RPR) titers declined by three and six months of age. An interdisciplinary approach provided safe and optimal care for this infant. He was discharged, stable, and thriving at 38 weeks corrected age. Long-term multidisciplinary management and follow-up were arranged.
