A female infant born at 23 0/7 weeks' gestation with a birth weight of 570 g was admitted to the NICU due to extreme prematurity, extremely low birth weight, and respiratory distress syndrome. At approximately 2 weeks of life, she underwent an evaluation for late-onset sepsis because of escalating respiratory support requirements. Empiric antibiotics were initiated while awaiting culture results. Sequential broadening of antibiotic coverage occurred in response to worsening clinical status. Despite maximal medical therapy, the infant continued to deteriorate and ultimately died following an acute bradycardic/desaturation event requiring CPR. Blood culture results returned after her death revealed Gram-negative bacteremia. This case emphasizes the treatment challenges of late-onset sepsis in periviable infants, in whom rapid decompensation from infection can occur even with aggressive antimicrobial therapy.

This is a descriptive cross-sectional study that aimed to determine the factors that affect suboptimal breastfeeding practices among mothers, assess the nutritional status of infants 1-6 months of age, and determine the association between suboptimal breastfeeding practices and the nutritional status of infants. The study was done at various pediatric wards and outpatient departments of the All India Institute of Medical Sciences, Bhubaneswar, Odisha, India. A total of 258 mother-child dyads participated in this study. Suboptimal breastfeeding practices (which means delayed initiation of breastfeeding, discarding colostrum, giving prelacteal feeding, or nonexclusive breastfeeding) and their associated factors (maternal, socioeconomic, environmental, and infant characteristics) were assessed, as well as the nutritional status of infants and its association with suboptimal breastfeeding. The prevalence of suboptimal breastfeeding was 45.7%. Significant factors included outborn delivery (prevalence ratio [PR] = 1.50, p = 0.003), cesarean delivery (PR = 1.38, p = 0.03), preterm birth (PR = 1.47, p = 0.01), and lack of postnatal breastfeeding assistance (PR = 1.56, p = 0.02). Finally, suboptimal breastfeeding practices were associated with being underweight (p = 0.04) and with stunting (p = 0.01).

In 2023, 53% of 300 patients in our NICU developed diaper dermatitis during their hospital stay. Literature indicates that providing effective skin care to patients can help prevent diaper dermatitis. The purpose of this project was to answer the following clinical question: Does application of Cavilon No Sting Barrier with reapplication every 3 days to high-risk newborns, either experiencing neonatal withdrawal due to maternal drug use or who were under observation for suspected infections and were noted to have blanchable redness on their buttocks on admission, prevent diaper dermatitis? This is an evidence-based project using a pre- and post-approach to reducing diaper dermatitis in a Level III NICU unit in Central Texas. Since the project started, there has been no more than a 10% rate of development of diaper dermatitis during the stay of patients who met the inclusion criteria. The recommendation is that every patient admitted to the NICU receives Cavilon applied on admission and with reapplication every 72 hours and/or after bath.

Multiple imaging modalities are used to diagnose, care for, and manage infants in the NICU. Each modality provides unique benefits; however, radiography remains the most common. This article aims to highlight the use of x-rays by reviewing indications, applications, and a systematic interpretation-guiding process. Evaluation, common pathologies, and considerations are discussed to bridge the gap between fundamental concepts and clinical practice, thereby enhancing neonatal care. This article is designed as an educational resource for all neonatal providers and trainees. Finally, a case study allows readers to practice applying concepts in a real-world, clinically relevant context.

Social and community context, the final domain in the Centers for Disease Control and Prevention's determinants of health framework, influences the health and well-being of neonates and their families in many ways that may not always have been considered in neonatal intensive care settings. Building on previous columns, here the impacts of social and community context are described, focusing on community cohesion, justice-related issues, and discrimination and stigma. In this column, we encourage neonatal nurses to consider how the social environment impacts neonates and families during their NICU stay and after discharge. Actions that nurses can take within the NICU setting and externally are described and resources are provided.

Neonatal sepsis continues to be a leading cause of mortality, frequently presenting with vague clinical characteristics. Rarely, it might present with hyperleukocytosis, which closely resembles congenital leukemia and creates a diagnostic difficulty. A preterm male neonate born at 34 weeks' gestation with a birth weight of 1.8 kg was delivered to a 27-year-old G2, P1 woman in a nonconsanguineous marriage. The neonate developed respiratory distress shortly after birth. Laboratory evaluation revealed a total leukocyte count of 108 × 10[3]/µL (108 × 10[9]/L), raising concern for congenital leukemia. However, peripheral blood smear showed cytoplasmic vacuolation and toxic granules without any blast cells, and flow cytometry excluded malignancy and leukocyte adhesion deficiency. Blood culture grew Acinetobacter baumannii A diagnosis of sepsis-induced hyperleukocytosis was made. The leukocyte count normalized with broad-spectrum antibiotics, and the neonate recovered fully. Hyperleukocytosis in neonates is not always indicative of congenital leukemia. Differentiating between malignant and reactive causes is crucial as management and prognosis differ widely.

The Baby-Friendly Hospital Initiative strives to increase exclusive breastfeeding rates. Research findings suggest that NICU nurses' actions and support may be a key factor in increasing breastfeeding rates. Our needs and feasibility assessment identified a NICU lacking a NICU-specific breastfeeding policy, and a review of the electronic health record (EHR) showed nurses did not assist patients with breastfeeding. We conducted a quality improvement project that included the creation of a NICU-specific breastfeeding policy, educational inservices, and real-time coaching for nurses. Additionally, pre-post questionnaires were administered to the nurses, and a review of the EHR was performed to assess nurse-assisted breastfeeding attempts pre and post project implementation. Thirty-six (80%) nurses attended the inservice. Almost two thirds of nurses (63%) had adequate breastfeeding knowledge prior to the inservice. Nurses' knowledge gained from the inservice was not statistically significant from pre/post implementation of the project (t = 0.48, p = 0.32). We identified 11 nurse-assisted breastfeeding attempts in our 10-day review of the NICU EHR after project implementation. This result was compared with zero nurse-assisted attempts in our EHR review prior to this project. We conclude that a multimodal approach to support breastfeeding in the NICU may be beneficial to increase breastfeeding rates by ensuring nurses have the knowledge and skills to promote breastfeeding.

Hypoglycemia, a common infant disorder caused by maternal antihypertensive medications, is a rare but serious complication. Increasing awareness of this potential side effect is crucial for all infant health care providers to facilitate early recognition and treatment, thereby mitigating risks of adverse infant outcomes. In this unique case, maternal metoprolol was prescribed for dysautonomia during pregnancy, which resulted in hypoglycemia in the infant. Born at 39 weeks' gestation, male infant presented with signs of hypoglycemia in the first 12 hours of life. After persistent prompting from the mother, a bedside glucose test was performed, with a "low" result. The infant received glucose gel and formula supplementation after breastfeeding, but persistent hypoglycemia necessitated a 4-day admission to the NICU. The diagnosis was hypoglycemia related to maternal prenatal metoprolol use. In addition to standard treatment for hypoglycemia, this infant's parents chose to cease breastfeeding to avoid potential adverse effects of hypoglycemia is understandable but should be of concern to all infant providers. Treatment of maternal hypertensive disorders utilizing beta-blocker medications during pregnancy is common. Increased awareness of hypoglycemia as a rare but potential complication can lead to early recognition by infant providers to reduce the risk of NICU admission.

Iron is an essential element for fetal and neonatal development. It is an important component of hemoglobin and plays an important role in delivering oxygen to the body. Iron also plays a critical role in brain development, and iron deficiency can be described on a spectrum, from mild to severe. The role of iron in fetal and neonatal development, iron deficiency, indices for monitoring iron, indications for and dosing of enteral iron, and contraindications are described in this column.

Because of the novelty and complexity of the construct of enjoyment in preterm infants, an exploration of insights from clinical and research perspectives is warranted. The purpose of this article is threefold: (a) to describe the clinical and research-based indicators of enjoyment, (b) to promote clinical strategies that may facilitate enjoyment, and (c) to identify potential benefits of enjoyment for preterm infants in the NICU. We conducted a comprehensive literature review to explore the clinical and research perspectives of enjoyment in preterm infants in the NICU. Articles were selected for full-text review if they discussed the potential clinical and research-based indicators of enjoyment, clinical strategies that may facilitate enjoyment, or benefits of enjoyment. There is a limited description of this construct for preterm infants in the NICU. Our synthesis of the literature highlights the relative value of enjoyment in preterm infants and its clinical and research implications. A conceptual framework was developed to guide further exploration of the construct of enjoyment in preterm infants and aimed at sparking deeper discussions among neonatal researchers and clinicians. Enjoyment in preterm infants remains an underrecognized construct in the literature. Initiating discussions on its meaning and potential impact to transform NICU care and research is essential. Further research is warranted to develop and test validated measures to assess enjoyment in preterm infants. Clinicians are encouraged to reflect on their practice and consider strategies to foster enjoyable experiences for preterm infants in the NICU.

This article explores the barriers leading to the decline in enrollment in neonatal nurse practitioner (NNP) programs. It also identifies gaps and offers evidence-based strategies to improve recruitment and retention in the NNP workforce. These gaps in the literature involve issues of diversity within the NNP workforce, marketing approaches, and undergraduate exposure. Effective strategies include mentorship programs, academic-practice collaborations, and wellness initiatives. The findings highlight the need to invest in NNP education, implement policy support for workforce sustainability, and foster collaboration among academia, practice settings, and organizations to secure the future of neonatal advanced practice nursing. Without coordinated efforts, the NNP role may decline, potentially harming neonatal outcomes.

Gastroschisis is a congenital anomaly that results in the presentation of various portions of the bowel and abdominal contents outside of the body through a defect or opening in the abdominal wall. The absence of a protective membrane around the bowel is a hallmark sign of gastroschisis, in which prior to birth the bowel floats freely in the amniotic fluid. The anomaly is detectable via ultrasound, occurring early in embryologic development, but is not identified prior to 12 weeks' gestation, when the bowel fails to involute to the abdomen. Gastroschisis occurs in 4-4.5/10,000 live births in the United States. The greatest risks identified are maternal age <20 years, low body mass index, and primigravida. Classified as simple or complex, management of gastroschisis requires a multidisciplinary collaborative approach that includes obstetrics, maternal-fetal medicine, pediatric surgery, nutrition, and neonatology. Simple gastroschisis is closed with primary or staged reduction and closure, while complex gastroschisis requires surgical intervention to address associated complications, including bowel atresia, necrosis, perforation, or volvulus, leading to long-term management. This article presents a case report of a 37 3/7 weeks' gestation female who presented with simple gastroschisis managed with staged silo reduction and sutureless closure. This article reviews the embryology, epidemiology, pathophysiology, and classifications of gastroschisis, with a focus on sutureless closure involving the use of the preserved umbilical cord. Nursing management of surgical and postsurgical care and long-term concerns for the family are discussed.