Implementation of the Neonatal Nurse Practitioner Role in a Community Hospital's Labor, Delivery, and Level 1 Postpartum Unit.

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.

Fetus in fetu: an unusual case study for the neonatal nurse practitioner.

Fetus in fetu is an extremely unusual occurrence where a rare congenital tumor containing a vertebral axis, often containing parts of other organs or limbs, is identified. Normally identified in the newborn period, the size and location of the mass may result in significant multiorgan compromise. This article presents the challenges encountered by the neonatal intensive care unit team in providing care for a late preterm female infant presenting with gross abdominal distension. Description of the case includes preoperative management along with management of severe coagulopathy and hemorrhage that arose during the intraoperative and postsurgical course of care. A brief overview of abdominal masses in the newborn is presented. The importance in determining the final diagnosis of fetus in fetu and its differentiation from teratoma is discussed.