Mixed blessings: an essay.

It has been 12 years since Robert and Peggy Stinson chronicled the brief life of their prematurely born son in The Long Dying of Baby Andrew. Their story examined the ethical dilemmas involved in providing neonatal intensive care to marginally viable infants. Although much has changed in neonatal intensive care in 12 years time, issues regarding treatment of marginal infants remain unresolved. Further, neonatal intensive care has provided society a window through which to observe the growing fetus, with potentially profound implication for women's reproductive decision-making. The unintended and unanticipated consequences of neonatal intensive care are examined according to Roger's change model, as described in his book Diffusion of Innovations.

Holoprosencephaly: a case presentation.

Holoprosencephaly is a rare, potentially catastrophic genetic defect involving the midfacial region and brain. The most severe expressions of the disorder are fatal. Approximately 20 percent of individuals with holoprosencephaly have normal brains and mild facial deformities. As adults, these individuals have the potential of producing severely affected offspring. Therefore, accurate health histories for purposes of case finding and referral for genetic counseling are important components of nursing care for any obstetric patient. NICU nurses should be aware of this rare disorder. When it presents in its most severe forms, it is important that NICU nurses provide accurate information and emotional support while diagnosis is confirmed. It is crucial that parents and families of affected infants be referred for genetic counseling so they can make informed decisions about future pregnancies.

A national survey of neonatal intensive-care units: criteria used to determine readiness for oral feedings.

OBJECTIVE: To describe criteria used to determine readiness for oral feedings in stable, preterm infants. DESIGN: A 25-item survey questionnaire was mailed to hospitals having level II or level III NICUs. SETTING: Nurseries identified in the 1987 National Perinatal Directory (576 in all) as level II or level III NICUs. PARTICIPANTS: Head nurses (HN) and staff nurses (SN) at 420 hospitals comprised 73% of the sample surveyed. PROCEDURES: Survey items were predominantly multiple choice and included an "other" option to encourage comments. MAIN OUTCOME MEASURES: Respondents described clinical practice in their nurseries relative to feeding policies, use of traditional decision criteria, or behavioral cues and related interventions. RESULTS/CONCLUSIONS: Fewer than 50% of nurseries identified a specific feeding policy for the initiation of oral feedings. Seventy-five percent used either gestational age or weight criteria in deciding when to start oral feedings. Eighty-six percent considered infant behavior as well when determining feeding readiness. Findings suggest an emerging emphasis on infant behavioral cues in addition to gestational age and weight criteria when making feeding decisions.

Daniel's story: congenital central hypoventilation syndrome.

Central hypoventilation syndrome (CHS) is a disorder characterized by little or no ventilatory or arousal sensitivity to hypercapnia and variable reactivity to hypoxemia, with little or no hypoxic arousal responsiveness. CHS may be congenital or acquired and can be idiopathic or secondary to a known central nervous system abnormality. Infants often present with life-threatening apnea during quiet sleep and develop severe respiratory acidosis because of the inadequate response to hypercapnia and hypoxia. Long-term treatment usually involves use of mechanical ventilation during sleep.