Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Jun 2009
When neonatal ICU infants participate in research: special protections for special subjects.
Neonatal ICU research poses unique concerns for infants and parents. Children are considered a vulnerable research population. ⋯ These regulations determine the types of research approvable for children based on the balance of risks and benefit. Risk also determines whether one or both parents' consent is required for their infant's participation in research.
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Crit Care Nurs Clin North Am · Jun 2009
Living with grief following removal of infant life support: parents' perspectives.
Research findings reported in the literature about making life and death decisions for critically ill infants in the neonatal ICU focus primarily on the experiences of health care providers and the ethical dilemmas surrounding these decisions. Fewer studies focus on parents' experiences in making decisions about discontinuing life support for their infant, and even fewer address what life is like for parents following the deaths of their infants. This article expands on the concepts identified by parents as factors in their decision making and on the facilitators and barriers parents faced, and continue to face, in their grieving process.
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Hyperbilirubinemia is the most common condition requiring evaluation and treatment in newborns. The clinical manifestation of hyperbilirubinemia-jaundice-occurs in 60% of normal newborns and nearly all preterm infants. Compared with conditions that require advanced pharmacologic and technologic treatment strategies, hyperbilirubinemia seems to be overshadowed and may lose the attention it deserves as a condition that has potentially devastating effects. Nurses must be vigilant when caring for babies with "just jaundice" by monitoring bilirubin levels, identifying infants at risk for developing severe hyperbilirubinemia, and implementing prescribed treatment effectively when indicated.
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The subspecialty of pediatric cardiology has rapidly progressed in the past few years with more children with heart defects surviving to adulthood. With newer diagnostic tools and improved surgical techniques, many heart defects are being approached with surgery. Although the more complicated lesions are never "completely repaired" and may require heart transplant in the long-term, there is an approach to "palliation." Most of the congenital heart malformations are detected in the perinatal period and this article gives the reader a general picture of the diagnostic approach to a multitude of heart defects.
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In the neonatal intensive care unit, critical care nurses who are not advanced practice nurses cannot make the medical diagnosis of infection/sepsis in the neonate. Even so, the critical care nurse has a critical role in dealing with sepsis infection. The nurse must (1) have a high index of suspicion about the risk of infection, (2) be able to recognize septic/infected newborns, (3) report related concerns to the physician or advanced practice nurse, and (4) advocate on behalf of the infant to ensure a timely diagnostic workup and empiric antibiotics. This article is a guide for understanding issues related to sepsis in the neonatal intensive care unit.