Extrauterine growth restriction: a continuing problem in the NICU.

Extrauterine growth restriction (EGR) is an identifiable marker of severe nutritional deficit during the first weeks of life. Infants with EGR have growth values at or below the 10th percentile of intrauterine growth expectation based on estimated gestational age. Although all preterm sick infants are at risk for EGR, risk is greatest for those infants <1500 g at birth. As estimated gestational age and birthweight decrease, the incidence of extrauterine growth restriction increases. The duration of initial weight loss also increases as birthweight decreases, compounding the difficulty of attaining appropriate growth. To decrease the incidence and consequences of nutritional deficit, NICU caregivers should learn more about EGR, implement assessment protocols to identify EGR, seek opportunities to decrease energy needs of at-risk infants, and work toward enhancing nutritional status of VLBW infants through innovative nutritional management.

Evaluation of perinatal care management programs: an integrated review.

Nursing care management has become a popular method to integrate health care systems with goals of decreasing costs and improving quality. As high-risk pregnancies and newborn intensive care unit (NBICU) costs generate some of the highest costs in health care, care management has been a strategy introduced in perinatal medicine to accomplish the same goals. Consistent with other areas of nursing, perinatal care management currently has no agreed upon model of practice or method of evaluating how and whether the goals have been achieved. The purpose of this project was to evaluate various perinatal care management programs found in the literature. Electronic and manual searches of current data were performed locating 31 relevant articles. From these articles, nine met the inclusion criteria and were reviewed. While some care management programs were able to decrease costs and improve outcomes, other programs did not. There are possibly two reasons for the varied results in the literature. The first is that there are differences in program designs, decreasing the likelihood of identifying specific interventions that can make a difference. Second, thus far researchers have used ineffective study designs in evaluating care management programs. More research needs to be completed before a conclusion can be drawn whether perinatal care management can decrease costs while improving quality.

First time mothers' views of breastfeeding support from nurses.

PURPOSE: To gain insights into the perceptions of first-time mothers regarding nurses' support of breastfeeding. STUDY DESIGN: Phenomenology. METHOD: Audiotaped interviews were conducted with 20 primiparous breastfeeding mothers within the first month after giving birth vaginally to healthy term infants. Data analysis was concurrent with data collection, and trustworthiness of the data was established. RESULTS: Nurses provided emotional, informational, and tangible support. Nonsupportive behaviors were also identified, including a sense that the nurse was in a hurry, failed to offer breastfeeding assistance, and was inflexible while working with the mother and infant. CLINICAL IMPLICATIONS: Nurses can contribute significantly to the successful initiation of and continuation of breastfeeding, and provide new mothers with the confidence and reassurance critical for breastfeeding success.