Racial, Ethnic, and Gender Composition Among Neonatal Nurse Practitioner Faculty Ranks.

BACKGROUND: Despite increases in nursing faculty diversity, representation is lacking in positions of higher faculty rank. Challenges for minority faculty include decreased awareness of promotion standards, less mentoring, and increased stress from being the sole representative of their respective underrepresented population. METHODS: The purpose of this study was to determine the racial, ethnic, and gender composition of neonatal nurse practitioner (NNP) faculty in the United States. A nonexperimental survey was sent to all accredited NNP programs to describe demographics of NNP faculty in the United State. RESULTS: Of the 128 survey participants, 84% self-identified as White. Forty-eight of the participants ranked Professor or Associate professor were White. In contrast, all other races only had 8 respondents who were of the higher faculty ranks. There were only 2 male participants; one identified as full professor and one as associate professor. CONCLUSION: Limitations of this project included a small sample size leading to an inability to determine statistical significance. Previous evidence supports decreased diversity in higher faculty rank in other healthcare providers and the results of this study add to that body of literature. Barriers to increased diversification need to be rectified to ensure health equity to all patients.

The Use of Cerebral Near-Infrared Spectroscopy in Neonatal Hypoxic-Ischemic Encephalopathy: A Systematic Review of the Literature.

BACKGROUND: Cerebral near-infrared spectroscopy (cNIRS) is a noninvasive technology used to trend cerebral perfusion at the bedside. cNIRS has potential as a valuable tool in the evaluation of infants with suspected hypoxic-ischemic encephalopathy (HIE). Trending cerebral perfusion with cNIRS can provide information regarding cerebral metabolism as HIE is evolving, which may offer insight into the extent of brain injury. PURPOSE: The purpose of this systematic review is to investigate the use of cNIRS as a neurocritical tool in the management of neonatal HIE by evaluating its ability to detect acute neurological compromise, including acute brain injury and seizure activity, as well as its potential to identify infants at high risk for long-term neurodevelopmental impairment. METHODS: A literature search was conducted using PubMed, CINAHL, and Web of Science databases to review articles investigating cNIRS technology in the acute management of HIE. RESULTS: Eight studies were identified and included in this systematic review. Correlations were observed between cNIRS trends and neurological outcomes as later detected by MRI. cNIRS has potential as a bedside neuromonitoring tool in the management of HIE to detect infants at high risk for brain injury. IMPLICATIONS FOR PRACTICE: Existing research supports the value of trending cNIRS in HIE management. Documented normal cNIRS values for both term and preterm infants in the first few days of life is approximately 60% to 80%. A steadily increasing cNIRS reading above an infant's baseline and a value of more than 90% should prompt further evaluation and concern for significant neurological injury.

Evaluation of Social Determinants of Health in Nursing Education through Service Learning.

Background: This manuscript describes an in-state nursing student global health-care experience. The 2021 Rio Grande Valley service learning team at Louise Herrington School of Nursing at Baylor University traveled from Dallas to McAllen, Texas to volunteer in a COVID vaccination clinic and refugee respite center on the U.S.-Mexican border. Method: A competency-based evaluation utilized the American Association of Colleges of Nursing's The Essentials: Core Competencies for Professional Nursing Education Featured Concepts, with a focus on social determinants of health, as a framework. Results: The evaluation of the service learning trip through the lens of social determinants of health and the Core Competencies can serve as a guideline for the design of future trips. Conclusion: The Rio Grande Valley service learning trip contributed to nursing students' self-reports of competency in global health education, in identifying the social determinants of health that characterized the immigrants and refugees, and in service and advocacy.

Color Does Matter: Nursing Assessment of Varying Skin Tones/Pigmentation.

BACKGROUND: The observation of color is an integral part of the nursing assessment. However, the current understanding of individual skin qualities and pigmentation has not yet been integrated thoroughly into foundational assessment courses, clinical education, simulation, and textbooks. EVIDENCE ACQUISITION: Literature is scarce regarding racial groups, skin color, and physical assessment for patients across the lifespan, but even more so for the neonatal population. Historically, many nursing textbooks did not provide visual pictures or observational assessment strategies for the assessment of the Black, Indigenous, and people of color (BIPOC) population. This is improving in some nursing textbooks; however, the descriptors of and visual differences and anticipated assessment findings for the BIPOC population are not comprehensive. RESULTS: Evidence-based assessment findings, which may occur in newborns with varying skin tones/pigmentations, are presented. IMPLICATIONS FOR PRACTICE AND RESEARCH: The most essential step to having an accurate assessment is acknowledging the importance of color awareness. Color blindness, while thought to support inclusivity, only contributes to exclusion of one of the most important components of a person's being-their color.

Strategies for Working With Parents With Vaccination Hesitancy.

The purpose of this article is to provide an overview of effective strategies for working with parents' vaccination hesitancy or refusal. An overview of historical and current trends in vaccination hesitancy and factors that contribute to and strategies for addressing vaccine hesitancy are discussed. This includes an emphasis on the critical role played by health care providers, as trusted advisors and a primary source of health care information, in encouraging vaccine acceptance. Legal and ethical implications are also considered. Vaccination hesitancy strategies are most effective if they are timely, multifaceted, and collaborative.

Call for a More Specific Diagnosis of Infant of a Diabetic Mother to Optimize Neonatal Care.

Hyperglycemia is the diagnostic feature of diabetes mellitus (DM), and during pregnancy, hyperglycemia has numerous serious implications for organogenesis and fetal growth. Each type of DM has different neonatal implications based on pathogenesis, length of disease, and comorbidities. Currently, limited attention is given to the woman's type of DM when evaluating risks for neonates. The diagnosis of infant of a diabetic mother is not sufficient because of the varying pathophysiology of diabetes classifications and associated neonatal outcomes. By expanding the diagnosis to include the woman's classification and glucose control, maternity and neonatal care providers could develop plans of care based on potential neonatal outcomes, including anticipatory guidance for families. In this commentary, we propose a more specific diagnosis, rather than infant of a diabetic mother, to better serve these infants.

Methicillin-Resistant Staphylococcus aureus Pneumatoceles in a Neonate With Sotos Syndrome : A Case Report.

BACKGROUND: Necrotizing pneumonia caused by methicillin-resistant Staphylococcus aureus can lead to the formation of pneumatoceles in the lungs. Standard treatment guidelines are not available due to the rarity of pneumatoceles in neonates. CLINICAL FINDINGS: Baby H. required prolonged respiratory support and supplemental oxygen to maintain appropriate oxygen saturation parameters for infants more than 34 weeks' gestation corrected. He was found to have multiple pneumatoceles in both lungs on different radiological modalities. PRIMARY DIAGNOSIS: Baby H. was a former 32.2-week gestation male infant diagnosed with pneumonia caused by necrotizing methicillin-resistant Staphylococcus aureus leading to pneumatocele formation in both lungs. INTERVENTIONS: Baby H. was managed with aggressive antibiotic therapy and then was conservatively managed until he received a tracheostomy tube on day of life (DOL) 75 to prepare for discharge home. OUTCOMES: Baby H. was discharged from the neonatal intensive care unit (NICU) on DOL 113 with a tracheostomy tube for prolonged mechanical ventilatory support and a gastrostomy tube for nutrition. Numerous follow-up appointments with specialists have occurred since discharge. PRACTICE RECOMMENDATIONS: While methicillin-resistant Staphylococcus aureus pneumatoceles are uncommon in the NICU setting, it is important for neonatal care providers to be aware of the causes and treatment choices currently available. Although conservative therapy is commonly utilized, it is important that nurses learn other available management strategies such as the ones highlighted in this article to best advocate for their patients.

Education standards, accreditation, certification, and regulation of nurse practitioner practice.

ABSTRACT: Many organizations play a role in creating, supporting, clarifying, and certifying the foundational documents for nurse practitioner (NP) education and practice. Quality standards for NP education are promulgated by the American Association of Colleges of Nursing (AACN) and the National Organization of Nurse Practitioner Faculties (NONPF). Competency-based education, in the form of interactive learning, helps bridge the gap between theory and practice. In 2021, AACN released new competencies that correspond to 10 domains which reflect the uniqueness of the nursing profession and guide professional nursing education. The NONPF and AACN are co-facilitators of a multi-organizational group called the National Task Force (NTF) on quality nurse practitioner education that standardizes the general evaluation of NP education. In 2022, the NTF updated the evaluation standards in response to the new competencies. Schools are accredited by one of three agencies: The Commission on Collegiate Nursing Education, The Accreditation Commission for Education in Nursing, and The National League for Nursing Commission for Nursing Education Accreditation. The eight NP specialties each have their own certifying bodies. The National Council of State Boards of Nursing is involved in regulation of NPs. The purpose of this article is to update stakeholders, including NPs, preceptors, and nurse faculty, about the various agencies and guidelines that inform education standards, accreditation, certification, and regulation of NP practice. A review of recently published guidelines with a summary of implications is also presented.

Disseminating MSSA Infection in a Preterm Infant With Rare Finding of Spinal Epidural Abscess: A Case Report.

BACKGROUND: Methicillin-susceptible Staphylococcus aureus (MSSA) occurs more frequently in the neonatal intensive care unit (NICU) than methicillin-resistant S. aureus (MRSA) and can result in comparable morbidity and mortality in the neonatal population. MSSA infection may present as pustulosis or cellulitis and evolve into bacteremia, pneumonia, endocarditis, brain abscesses, and osteomyelitis. There is a paucity of literature regarding the treatment and long-term outcomes in the premature infant. CLINICAL FINDINGS: A 32-week twin developed MSSA sepsis with presentation of pain, decreased movement of upper extremities, and global hypotonia. Blood cultures remained positive despite antibiotic coverage. PRIMARY DIAGNOSIS: The infant was admitted to the level IV NICU with the diagnosis of MSSA bacteremia, with concern for dissemination and osteomyelitis. INTERVENTIONS: Diagnostic studies included laboratory testing for sepsis evaluation, radiologic studies to evaluate for dissemination, immunologic testing to rule out complement deficiency, and hematology testing to rule out hypercoagulable conditions. OUTCOMES: Diagnostic testing showed extensive cellulitis, osteomyelitis, multiple liver abscesses, and epidural abscesses suggestive of spinal epidural abscess (SEA). Abscess debridement and irrigation on the left distal femur, left elbow, and right tibia were performed. The infant completed 8 weeks of IV antibiotic therapy. Immunologic and hematology testing was within normal limits. PRACTICE RECOMMENDATIONS: Prompt recognition and follow-up for clinical signs of sepsis are vital when caring for premature infants. Inclusion of pediatric subspecialist recommendations to assure all diagnostic studies and treatments are completed can significantly impact the patient's outcome. Long-term follow-up is needed for premature infants with the diagnosis of SEA.

Racial and Ethnic Composition of Neonatal Nurse Practitioner Faculty and Students in the United States.

BACKGROUND: Neonatal nurse practitioners have a strong presence in the neonatal intensive care unit and are primed to lead efforts to induce change related to health disparities. Underrepresented minority nurse practitioners offer valuable perspectives in the care of underrepresented minority patients. However, there remains a current racial and ethnic discordance between neonatal providers and patients. Efforts to eliminate health disparities must begin before nursing school. The current racial and ethnic composition of neonatal nurse practitioner faculty in comparison to students in the United States is unknown. PURPOSE: The purpose of this study was to determine the racial and ethnic composition of neonatal nurse practitioner faculty and students in the United States and contrast this data with available data for the racial and ethnic composition of the neonatal intensive care unit patient population. METHODS: This cross-sectional study used a nonexperimental survey to describe the racial and ethnic composition of neonatal nurse practitioner faculty and students in the United States. RESULTS: There was no significant difference in the racial and ethnic composition between neonatal nurse practitioner faculty and students. There were significant differences for all race distributions between neonatal nurse practitioner students and neonatal intensive care unit admissions. IMPLICATIONS FOR PRACTICE AND RESEARCH: The discordance between neonatal nurse practitioner students and neonates in the neonatal intensive care unit is important in addressing disparities and begins before nursing school. Identification of barriers and strategies for recruitment and retention of underrepresented minority nursing students and faculty is needed. VIDEO ABSTRACT AVAILABLE AT: https://journals.lww.com/advancesinneonatalcare/pages/video.aspx?v=62.

Neonatal Sepsis: A Review of Pathophysiology and Current Management Strategies.

BACKGROUND: Early-onset sepsis, occurring within 72 hours of birth, and late-onset sepsis, occurring after this time period, present serious risks for neonates. While culture-based screening and intrapartum antibiotics have decreased the number of early-onset cases, sepsis remains a top cause of neonatal morbidity and mortality in the United States. PURPOSE: To provide a review of neonatal sepsis by identifying its associated risk factors and most common causative pathogens, reviewing features of the term and preterm neonatal immune systems that increase vulnerability to infection, describing previous and the most current management recommendations, and discussing relevant implications for the neonatal nurse and novice neonatal nurse practitioner. METHODS/SEARCH STRATEGY: An integrative review of literature was conducted using key words in CINAHL, Google Scholar, and PubMed. FINDINGS/RESULTS: Group B streptococcus and Escherichia coli are the most common pathogens in early-onset sepsis, while Coagulase-negative staphylococci comprise the majority of cases in late-onset. The neonatal immune system is vulnerable due to characteristics including decreased cellular activity, underdeveloped complement systems, preferential anti-inflammatory responses, and insufficient pathogenic memory. Blood cultures remain the criterion standard of diagnosis, with several other adjunct tests under investigation for clinical use. The recent development of the sepsis calculator has been a useful tool in the management of early-onset cases. IMPLICATIONS FOR PRACTICE: It is vital to understand the mechanisms behind the neonate's elevated risk for infection and to implement evidence-based management. IMPLICATIONS FOR RESEARCH: Research needs exist for diagnostic methods that deliver timely and sensitive results. A tool similar to the sepsis calculator does not exist for preterm infants or late-onset sepsis, groups for which antibiotic stewardship is not as well practiced.Video Abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=40.

The Pathophysiology, Diagnosis, and Management of Wolff-Parkinson-White Syndrome in the Neonate.

BACKGROUND: Wolff-Parkinson-White (WPW) is a congenital defect of the cardiac conduction system (CCS), with proliferation of extra embryologic conduction pathways and rapid conduction of electrical impulses. The estimated neonatal incidence of 0.1% to 0.2% may be misrepresented secondary to missed or misdiagnosis. Undiagnosed WPW can result in sudden cardiac death. PURPOSE: To discuss the pathogenesis, manifestations, diagnosis, management, and lifespan implications of WPW in the prenatal and postnatal periods. METHODS/SEARCH STRATEGY: A literature review was conducted using PubMed, CINAHL, and Google Scholar (2013-2019). Search terms included (newborn OR infant), wolff parkinson white, pathogenesis, management, and ventricular preexcitation. After removal of duplicates, 267 references were identified, abstracts reviewed, and 30 publications fully evaluated. FINDINGS/RESULTS: Separation of the heart chambers begins around 7 weeks' gestation with formation of the annulus fibrosis complete after term. The unknown external environmental influence on the development of the preterm infant's CCS places neonates at risk for persistent atrioventricular reentrant tachycardia with WPW development. Ensuring an appropriate diagnosis is crucial, as an incorrect diagnosis could mean death. IMPLICATIONS FOR PRACTICE: Due to the rarity of WPW, any fetal or neonatal supraventricular tachycardia requires further evaluation with an electrocardiogram and involvement of an experienced cardiologist for diagnosis. One episode of supraventricular tachycardia warrants evaluation for WPW, as recurring episodes may result in irreversible damage. IMPLICATIONS FOR RESEARCH: The recommendations for treatment of WPW in the prenatal and immediate postnatal periods are based heavily on standards of care for the adult population. A paucity of evidenced-based literature exists and future research is crucial to understand the true incidence, physiologic effects, and lifespan implications of WPW on neonates.

Neonatal Alloimmune Thrombocytopenia: A Concise Review.

BACKGROUND: Neonatal alloimmune thrombocytopenia (NAIT) is defined as an uncommon platelet disorder caused by maternal alloimmunization to human-specific antigens (HPAs) that are paternally inherited, resulting in low fetal/neonatal platelet levels and debilitating effects on the newborn. The incidence of NAIT is 1 in every 1000 live births within the United States; it is the most common cause of severe thrombocytopenia (<30 × 109/L) and intracranial hemorrhage in term newborns. PURPOSE: The purpose of this article is to discuss the pathophysiology, clinical manifestations, diagnosis, and treatment of NAIT and its implications upon the lifespan of the neonate. METHODS: A literature review was conducted using PubMed, CINAHL, and Google Scholar (2014-2019). Search terms included NAIT, neonatal/fetal alloimmune thrombocytopenia, newborn platelets, and intracranial bleeding and NAIT. RESULTS: NAIT can affect first pregnancies and often goes undiagnosed until delivery. Universal screening tools with a focus on HPA-1a typing via noninvasive testing have been successfully trialed and have yielded promising results indicating a 75% reduction in risks associated with NAIT; however, none have been incorporated into practice and prophylactic treatment remains unavailable. IMPLICATIONS FOR RESEARCH: Adopting a universal screening tool and prophylaxis for NAIT would allow for early diagnosis and treatment in utero. IMPLICATIONS FOR PRACTICE: Many healthcare providers are not familiar with NAIT often focusing on other causes of thrombocytopenia as a potential diagnosis.

Glucose-6-Phosphate Dehydrogenase Deficiency and the Benefits of Early Screening.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common enzymopathy worldwide, is an insufficient amount of the G6PD enzyme, which is vital to the protection of the erythrocyte. Deficient enzyme levels lead to oxidative damage, hemolysis, and resultant severe hyperbilirubinemia. If not promptly recognized and treated, G6PD deficiency can potentially lead to bilirubin-induced neurologic dysfunction, acute bilirubin encephalopathy, and kernicterus. Glucose-6-phosphate dehydrogenase deficiency is one of the three most common causes for pathologic hyperbilirubinemia. A change in migration patterns and intercultural marriages have created an increased incidence of G6PD deficiency in the United States. Currently, there is no universally mandated metabolic screening or clinical risk assessment tool for G6PD deficiency in the United States. Mandatory universal screening for G6PD deficiency, which includes surveillance and hospital-based risk assessment tools, can identify the at-risk infant and foster early identification, diagnosis, and treatment to eliminate neurotoxicity.

System Specific Effects of Therapeutic Hypothermia with Neonatal Encephalopathy: Pearls for Clinicians.

Neonatal encephalopathy (NE) is defined as a condition of impaired neurological function often caused by a peripartum event that impairs gas exchange resulting in hypoxia, hypercapnia, cerebral ischemia, and metabolic acidosis. NE is a significant cause of neonatal morbidity and mortality. Therapeutic hypothermia (TH) is the standard of care for the treatment of moderate and severe NE and has significantly improved long-term outcomes for affected infants. There are extensive systemic physiologic effects associated with TH that clinicians need to be aware of to optimize care for these infants. There is a paucity of literature that comprehensively identifies causal relationships between the physiologic and biochemical effects of TH. This can leave neonatal clinicians devoid of a comprehensive understanding of the medical management of NE. Therefore, this article seeks to help fill this gap, improve clinician knowledge base, and ultimately improve the care of infants undergoing TH.

Intussusception in the Neonate: A Case Study.

Intussusception is the most common cause of intestinal obstruction in infants and toddlers; however, it is a rare entity in neonates. During intussusception, a proximal portion of the bowel pushes inside the adjacent, distal segment of the bowel in a telescoping fashion leading to obstruction, strangulation of the mesentery, ischemia, and necrosis. The etiology of intussusception is often unknown and there are currently no preventive techniques. Intussusception often mimics other common disease processes affecting neonates; this can result in detrimental delays in diagnosis and treatment. Intussusception is considered a surgical emergency and a delay in treatment results in significant morbidity and mortality. With proper education on this rare complication, neonatal nurses play a vital role in early diagnosis. To improve the care of neonates affected, it is imperative that intussusception remain a differential diagnosis for clinicians.

Understanding the Pathophysiology, Implications, and Treatment Options of Patent Ductus Arteriosus in the Neonatal Population.

BACKGROUND: Patent ductus arteriosus (PDA) is the persistence of a fetal shunt between the pulmonary artery and the aorta. This structure normally closes in the first 3 days after birth; however, closure is delayed in up to 80% of infants born at 25 to 28 weeks of gestation. Persistent PDA results in pulmonary overcirculation and systemic hypoperfusion. PURPOSE: The purpose of this article is to review pathophysiology and treatment options for PDA. METHODS: A literature review was conducted using PubMed, CINAHL, and Google Scholar (2013-2018). Search terms included neonate, PDA, pathophysiology, pharmacotherapy, nursing, ligation, indomethacin, ibuprofen, and acetaminophen (paracetamol). RESULTS: Optimal treatment remains contentious. Options include conservative/medical, pharmacologic, and surgical management. Conservative/medical management includes mild fluid restriction, increased airway pressures, and supportive care. Pharmacologic treatment is accomplished using indomethacin, ibuprofen, or acetaminophen. Surgical intervention is by direct closure or by percutaneous ligation. Treatment may be prophylactic, presymptomatic, or symptomatic. Long-term morbidities associated with PDA include chronic lung disease, retinopathy of prematurity, and neurodevelopmental delay. IMPLICATIONS FOR RESEARCH: Absence of a universal scoring system for severity of PDA limits accuracy of comparisons among research studies. Lack of a consistent definition also makes it difficult to aggregate data for meta-analyses. Adoption of a consistent scoring system for hemodynamic significance would facilitate comparisons of outcomes among research studies. IMPLICATIONS FOR PRACTICE: Clinicians should be aware of treatment options for PDA and their implications on neonatal outcomes. For nurses, anticipation of possible side effects is important for performance of focused assessments.

Gestational Alloimmune Liver Disease: A Case Study.

Gestational alloimmune liver disease (GALD) is initiated by maternal antibodies that attack fetal hepatocytes. The fetal immune response to the antibodies causes liver damage. The incidence of GALD is four per 100,000 live births in the United States. Frequently, liver injury leads to fetal loss or neonatal demise; nonetheless, the presentation of GALD has a wide range of severity. Survival rates have increased from 20 to 80 percent changes in treatment and understanding of GALD. Current treatment is focused on supportive care with intravenous immunoglobulin (IVIG) and exchange transfusions. Mortality risk is positively associated with the timing of diagnosis. Although there has been an increase in understanding this disease, the discovery of the specific alloantigen is still needed. Relevant embryology, pathophysiology, clinical manifestations, diagnosis, medical treatment, and prognosis are discussed to aid health care professionals in the early identification and treatment for the neonate and family unit.

Atrioventricular Canal and Dextrocardia: A Case Report with Implications for Community-Based Providers.

Congenital heart defects (CHD) are the most common congenital malformation reported in the literature, with a global incidence of eight per every 1,000 live births. In the United States approximately 40,000 infants are born each year with a CHD. Of the infants diagnosed with a CHD, one in every four heart defects are life threatening in origin. Early identification and treatment of congenital heart lesions, beginning with a comprehensive physical assessment after birth, are critical. For infants delivered at community-based hospitals, the importance of the physical assessment, timing of diagnostic strategies, anticipatory planning, and interprofessional collaboration among referring and accepting centers cannot be understated. This article presents a rare case of an infant with atrioventricular canal complicated by dextrocardia. Embryology, pathophysiology, epidemiology, symptomology, cardiac assessment, diagnostics, treatment, and nursing strategies for facilitating transfer of care from community-based hospitals to tertiary medical centers are discussed.