4th Edition
Neonatal Intensive Care Nursing
Introduction
JULIA PETTY AND LISA KAISER
Section 1- An overview of neonatal care
1 The context and organisation of neonatal care
JULIA PETTY
Guidance on how to enhance personal learning from this chapter
Introduction and background
Categories of neonatal care
Transitional care
Special care
High dependency care
Intensive care
Levels of service provision
Neonatal transport
The role of operational delivery networks
Staffing of neonatal units
The neonatal nurse
Education and continuous professional development
Career progression
Extended nursing roles
The multidisciplinary team
Neonatal outcomes
The global perspective
Chapter takeaways
Case Studies
References
2 Antenatal and perinatal aspects of care
RADICA HARDYAL, JULIA PETTY, SARAH FITCHETT AND RHIAN SMITH
Guidance on how to enhance personal learning from this chapter
Introduction and background
Impact of maternal health on the fetus and neonate
Hypertensive disorders of pregnancy
Diabetes
Cardiac conditions
Maternal infections
Maternal obesity
Maternal smoking
Maternal mental health disorders
Maternal medication and recreational substance use
Multiple pregnancy
Antenatal care and screening
Antenatal counselling and decision-making
Genetic counselling
Perinatal Care
Perinatal management of high-risk conditions in pregnancy
Perinatal optimisation for premature birth
Further early care interventions for the preterm neonate
The importance of interprofessional teamwork
Inequalities in maternal and neonatal outcomes
Chapter takeaways
Case studies
References
3 Continuing care beyond the neonatal unit
JO BENNETT, DEANNA GIBBS, ELEN ELIAS AND PHILLIP HARNIESS
Guidance on how to enhance personal learning from this chapter
Introduction and background
Discharge planning
Supporting parent wellbeing in the transition to home
Safe sleep advice for parents
Neonatal outreach
Developmental follow-up
Complex neurodevelopmental disability
Transition to paediatrics or the paediatric intensive care unit
Chapter takeaways
Case studies
References
4 Assessment of the neonate
LINDA McDONALD
Guidance on how to enhance personal learning from this chapter
Introduction and background
History taking
Parental involvement in the assessment process
Maternal conditions and their potential impact
Assessment at birth
Physical assessment after birth – a systems approach
Respiratory system
Cardiovascular system
Hepatic system
Gastrointestinal system
External genitalia
Renal system
Neurological system
Skin and general appearance
Thermoregulation
Metabolism
Assessment of the deteriorating neonate
Newborn Infant Physical Examination
Chapter takeaways
Case studies
References
5 The premature and low birthweight infant
LESLEY KILBY AND KATY POWIS
Guidance on how to enhance personal learning from this chapter
Introduction and background
Assessment of gestational age
Long-term outcomes of prematurity
The low birthweight infant
Factors contributing to fetal growth restriction
Care in the delivery setting
Pre-delivery considerations
Corticosteroid and magnesium sulphate administration
Delivery room management
Common conditions associated with prematurity
Surfactant insufficiency
Chronic lung disease
Retinopathy of prematurity
Anaemia of prematurity
Intraventricular haemorrhage and periventricular leukomalacia
Necrotising enterocolitis
Suboptimal postnatal growth
Immunological immaturity
Skin integrity issues
The moderate to late preterm infant
The impact of prematurity and/or low birthweight on parental bonding
Discharge planning
Chapter takeaways
Case studies
References
Section 2- The physical and emotional wellbeing of neonate and family
6 Nurturing supportive family relationships in neonatal practice
JULIA COOPER, REBECCA CHILVERS AND KELLY PHIZACKLEA
Guidance on how to enhance personal learning from this chapter
Introduction and background
The neonatal care experience as an adverse childhood experience
What is family integrated care?
The origins of FiCare
The benefits of FiCare to babies
The benefits of FiCare to the family
The benefits of FiCare to healthcare professionals
The benefits of FiCare to neonatal facilities
The benefits of FiCare to society
Recent developments of the FiCare model
The implications of FiCare on the role of a neonatal nurse
Working with other healthcare professionals in the multi-disciplinary team
How FiCare differs from family-centred care
Tools and aids for FiCare implementation
Barriers & facilitators of FiCare
Practical, physical and systems barriers
Psychological barriers to FiCare: key areas to consider and formulating how to help
Coproduction with parents, peer support and the role of veteran parents
Peer support
How peer support is provided
Types of peer support
Peer support vs service user voice
Tackling health inequalities and meeting the needs of all families in neonatal care
Safeguarding in the neonatal unit
Chapter takeaways
Case studies
References
7 Developmentally focused neonatal care
DEANNA GIBBS
Guidance on how to enhance personal learning from this chapter
Introduction and background
Theoretical approaches to developmental care
Principles of Infant- and Family-Centred Developmental Care
Family engagement
Developmentally supportive environment
A Holistic care approach
Communication and behavioural understanding
Evidence-based practices in developmental care
Protecting and promoting sleep
Strategies to reduce pain and stress
Supporting early feeding experiences
Managing the sensory environment
Handling and positioning
Developmental Models of Care
Chapter takeaways
Case Studies
References
8 Management of pain and stress in the neonatal unit
JENNI JONES
Guidance on how to enhance personal learning from this chapter
Introduction and background
Development of pain pathways
Pain and stress
Early pain experiences and long-term outcomes
Family involvement in pain management
Assessment of neonatal pain
Management of pain, stress and discomfort
Comfort/non-pharmacological interventions
Pharmacological interventions
Clinical practice
Clinical guidelines
Caregiver attitude to infant pain assessment and management
Ethical aspects of neonatal pain
Chapter takeaways
Case Studies
References
9 Neonatal Palliative care; recognising uncertainty and enhancing the family experience
ALEX MANCINI and JO BENNETT
Guidance on how to enhance personal learning from this chapter
Introduction and background
Terminology and language used in neonatal palliative care
Recognising babies and their families who may benefit from palliative care
Key principles of Neonatal Palliative Care
Principles of neonatal palliative care
Addressing diverse cultural needs of families
Care planning in neonatal palliative care
Holistic family support
Choices in location of care
Discharge planning
Specific aspects of palliative care
Caring for families with twins and multiple births
Delivery room cuddle or birthday cuddle
Breast care choices after loss
Non-tangible memories and meaning making
Fresh air therapy and access to nature
Self-awareness and wellbeing for the healthcare team
A global perspective
Chapter takeaways
Case Studies
References
10 Neonatal bereavement care
JO COOKSON
Guidance on how to enhance personal learning from this chapter
Introduction and background
Bereavement, mourning and grief
Bereavement
Mourning
Grief
Models of grief and loss
Responding to loss
Death in the neonatal unit – providing holistic and inclusive care
Cultural elements of loss
Communication
Verbal communication
Nonverbal communication
Caring for the dying baby
Spiritual and religious considerations
Memory making
Photographs
Postnatal care following a loss
Multiple pregnancies
Fathers and same sex partners
Extended family
Challenging issues to consider
Perinatal autopsy
Organ donation
Support and training for professionals
Chapter takeaways
Case studies
References
11 Legal and ethical issues in neonatal care
DEBORAH NICHOLSON AND KATHERINE NOBLE
Guidance on how to enhance personal learning from this chapter
Introduction and background
The nurse's role in legal and ethical issues in the neonatal unit
Legal principles
Fetal rights, personhood, peri-viability and age of viability
Ethical principles
Autonomy
Beneficence and non-maleficence
Justice
Withholding and withdrawing treatment
Conflict
Decision making and the ‘best interests’ standard
Moral distress
Tissue and organ donation
Family integrated principles of inclusive, ethical care
Chapter takeaways
Case studies
References
Section 3- Clinical aspects of neonatal care
12 Transition to extrauterine life: delivery room and early care practices
SARAH FITCHETT
Guidance on how to enhance personal learning from this chapter
Introduction and background
The golden hour
Attendance at delivery and team role assignment
Supporting the respiratory system: preventing hypoxia
Resuscitation
Anticipation
Preparation of environment and equipment
The ABC (D and E) of resuscitation
Assessment at birth
Airway
Breathing
Circulation
Resuscitation drugs
When to stop resuscitation
Meconium-stained amniotic fluid
Witnessed resuscitation at birth
Communication with parents
Record keeping
Post-resuscitation care
Resuscitation training, education and debrief
Prevention of hypothermia/temperature maintenance
Chapter takeaways
Case studies
References
13 Thermal care of the neonate
TRACEY JONES AND CASSIE SWIRE
Guidance on how to enhance personal learning from this chapter
Introduction and background
Physiology of thermoregulation in the neonate
Risk factors for impaired thermoregulation
Consequences of thermal instability
Hypothermia
Hyperthermia
Long-term complications
Thermoregulation management strategies at birth
Assessment of neonatal temperature
Preparing for birth
Optimal cord management
Immediate interventions at birth >32 weeks of gestation
Immediate interventions at birth <32 weeks of gestation
In the neonatal unit
Humidified gases in respiratory support
Skin-to-skin
Post-resuscitation care
Internal transfer and thermal care outside of neonatal care settings
External transport
Out-of-hospital birth
Resource-limited settings
Nursing roles and responsibilities
Family education and family integrated care
Quality improvement with multidisciplinary working
Chapter takeaways
Case studies
References
14 Management of neonatal respiratory disorders
Dr SABIN ROY AND LISA KAISER
Guidance on how to enhance personal learning from this chapter
Introduction and background
The physiological basis of neonatal respiratory care
Fetal lung development
Respiratory changes at birth
Respiratory conditions in the neonate
Respiratory distress syndrome
Bronchopulmonary dysplasia
Transient tachypnea of the newborn
Pulmonary interstitial emphysema
Pneumothorax
Pulmonary haemorrhage
Pneumonia
Meconium aspiration syndrome
Persistent pulmonary hypertension of the newborn
Trends in neonatal respiratory care
Acid–base balance, gas transport and monitoring
Respiratory support strategies in neonatal care
Oxygen therapy
Non-invasive respiratory support
Modes of invasive ventilation
Inhaled nitric oxide
Extracorporeal membrane oxygenation
Weaning from ventilation
Family integrated care in the context of neonatal respiratory disorders
Nursing care of the infant and family receiving respiratory care
Chapter takeaways
Case studies
References
15 Management of neonatal cardiovascular disorders
NICOLA McCARTHY AND JONATHAN O’KEEFFE
Guidance on how to enhance personal learning from this chapter
Introduction and background
Embryology of the heart
Physiology
Fetal circulation
Cardiac cycle
Cardiac output
Heart rate
Blood pressure
Congenital heart disease
Classification and types
Pathophysiology of congenital heart disease
Clinical presentation
Diagnosis of congenital heart disease
Management principles
Specific congenital heart defects
Duct dependent pulmonary and systemic circulation
Duct-dependent systemic lesions
Duct-dependent pulmonary and systemic circulation
Non-duct dependent lesions
Other cardiovascular disorders and their management
Hypotension
Hypertension
Patent ductus arteriosus
Persistent pulmonary hypertension of the newborn
Dysrhythmias
Chapter takeaways
Case studies
References
16 Neonatal brain injury
Rebecca Drescher
Guidance on how to enhance personal learning from this chapter
Introduction and background
Vulnerability of the neonatal brain
Intraventricular haemorrhage and periventricular haemorrhagic infarction
Aetiology
Diagnosis
Periventricular leukomalacia and white matter injury
Prevention of preterm brain injury
Management of preterm brain injury
Brain injury in the term infant
Hypoxic-ischaemic encephalopathy
Pathophysiology
Treatment
Cerebral function monitoring
Outcome
Other mechanisms of brain injury
Subdural haemorrhage
Neonatal stroke
Metabolic disorders
Neonatal seizures
Nursing care of the infant with neurological compromise
Chapter takeaways
Case studies
References
17 Management of neonatal haematological disorders
LYNNE WAINWRIGHT
Guidance on how to enhance personal learning from this chapter
Introduction and background
Jaundice
Physiology of bilirubin metabolism
Physiological Jaundice
Pathological Jaundice
Measurement of bilirubin
Treatment
Prolonged jaundice
Jaundice associated with breastmilk/breastfeeding
Polycythaemia
Coagulation disorders
Coagulation physiology
Vitamin K deficiency bleeding
Thrombocytopenia
Disseminated intravascular coagulation
Thrombosis
Anaemia
Physiological anaemia
Anaemia of prematurity
Pathological anaemia
Neonatal white cell abnormalities
Nursing care of the infant with haematological conditions
Chapter takeaways
Case studies
References
18 Management of neonatal fluid and electrolyte balance
Natalie Anders
Guidance on how to enhance personal learning from this chapter
Introduction and background
Physiological basis of fluid and electrolyte balance
Fluid and electrolyte management
Fluid requirements
Electrolyte requirements
Sodium
Potassium
Chloride
Calcium and phosphate
Magnesium
Glucose requirements
Glucose homeostasis
Assessment and monitoring of fluid and electrolyte balance
Fluid balance
Accurate measurement of body weight
Measurement of urine volume
Urinalysis
Acid-base balance
Acute kidney injury
Investigations
Management of acute kidney injury
Chapter takeaways
Case studies
References
19 Nutritional and feeding management in the neonatal unit
REBECCA MURPHY, ALEXANDRA CONNOLLY AND LYNETTE FORSYTHE
Guidance on how to enhance personal learning from this chapter
Introduction and background
Supporting the feeding relationship
Feeding development in utero
Aims of nutritional management in neonatal care
Nutritional requirements
Parenteral nutrition
Enteral nutrition
Breastmilk
Preterm infant formulas
Probiotics
Methods of feeding
Sucking, swallowing, breathing coordination
Nutritive sucking patterns
Growth monitoring
Co-morbidities and impact on feeding
Feeding during non-invasive respiratory support
Gastro-oesophageal reflux
Supporting the feeding journey
Cue-based feeding
Initiating suck feeding
Feeding readiness
Disengagement cues
Supportive strategies for suck feeding
Preparing for home
Chapter takeaways
Case studies
References
20 Neonatal infection
LISA KAISER
Guidance on how to enhance personal learning from this chapter
Introduction
Neonatal immunity
Neonatal infection
Early onset infection
Late onset infection
Viral infections
Vaccination
Signs of neonatal infection
Investigations
The nurse’s role in neonatal infection
Chapter takeaways
Case Studies
References
Section 4- Practices and procedures in neonatal care
21 Medication practice in the neonatal unit
PETER VENABLES
Guidance on how to enhance personal learning from this chapter
Introduction and background
Pharmacodynamics
Pharmacokinetics
Absorption of drugs
Distribution of drugs
Metabolism of drugs
Excretion of drugs
What is the difference between a drug and a medicine?
Routes of drug administration
Therapeutic drug monitoring
Excipients in medicine formulations
Drug toxicity
Drugs and breast feeding
Unlicensed medications
Medication errors
Preventing medication errors
Non-medical prescribing
Chapter takeaways
Case studies
References
22 Neonatal surgical care
LISA KAISER AND Dr RAMON FERNANDEZ
Guidance on how to enhance personal learning from this chapter
Introduction and background
Pre-operative management
Antenatal considerations and delivery room management
Pre-operative assessment
Peri- and intraoperative management
Specific considerations for anaesthesia in neonates
The operating environment
Intraoperative care
Anaesthetic agents
Postoperative care
Recovery from anaesthesia
Return to the neonatal unit
Congenital surgical conditions
Oesophageal atresia and tracheo-oesophageal fistula
Intestinal obstruction
Congenital diaphragmatic hernia
Abdominal wall defects
Hydrocele
Biliary atresia
Congenital pulmonary airway malformation
Acquired surgical conditions
Necrotising enterocolitis
Spontaneous bowel perforation
Neonatal tumours
Ovarian cyst
Testicular torsion
Family integrated care in the context of neonatal surgery and anaesthesia
Chapter takeaways
Case studies
References
23 Neonatal diagnostic procedures
JENNI JONES
Guidance on how to enhance personal learning from this chapter
Introduction and background
Blood sampling
Capillary sampling
Venous sampling
Arterial sampling
Nursing considerations for skin-breaking procedures
Common blood tests and considerations for sample collection
Blood culture
Blood gas
Coagulation studies
Full blood count / complete blood count
Transfusion-related studies
Biochemistry
Radiography
Common radiographic images
Abnormal findings on a chest x-ray
Abnormal findings on an abdominal x-ray
Contrast studies
Fluoroscopy
Nursing considerations for neonatal radiography
Lumbar puncture
Nursing considerations during lumbar puncture
Point-of-care ultrasound scan
Clinical application of point-of-care ultrasound scanning
Procedural application of point-of-care ultrasound scanning
Nursing considerations during point-of-care ultrasound scanning
Magnetic resonance imaging
Nursing considerations during magnetic resonance imaging
Chapter takeaways
Case studies
References
MARINA LOARCE MONTERO, PATRICK TURTON AND JULIA PETTY
Guidance on how to enhance personal learning from this chapter
Introduction and background
The neonatal transport service
Working on the transport team
Equipment and vehicles for neonatal transport
Neonatal transfers not undertaken by the Transport team
Intra-hospital transfers
Aeromedical transfers
Safety during transport
Governance
The patient journey
Referral and triage
Arrival and stabilisation
In-transit care
Handover at the receiving unit
Return to base
Clinical considerations in neonatal transport
Extreme prematurity
Temperature control
Skin integrity
Respiratory support
The impact of vibration and noise
Surgical transfers
Cardiac anomalies
Hypoxic-ischaemic encephalopathy and therapeutic hypothermia
Palliative and end-of-life transfers
Parents and neonatal transport
Communication
Travelling in the ambulance
Chapter takeaways
Case studies
References
25 Final comments and the importance of evidence-based neonatal practice
JULIA PETTY
Guidance on how to enhance personal learning from this chapter
Introduction and background
Neonatal knowledge and evidence-based practice
Knowledge derived from research
Knowledge from critical appraisal and practical application
Knowledge from national and international data resources
Knowledge from national and global clinical guidance and standards
Knowledge from clinical audit and data collection
Knowledge from professionals and service users
Knowledge from professional organisations
Education and application of knowledge to practice
Chapter takeaways
Case studies
References
Biography
Julia Petty is an adult, paediatric and neonatal nurse who trained and worked as a practice educator at Great Ormond Street hospital before becoming a Senior Lecturer at City University, London, UK. There, she co-led the neonatal nursing education portfolio for 12 years before moving to University of Hertfordshire in 2013. Her current role is Associate Professor (learning and teaching) and Senior Lecturer in Children’s nursing.
Lisa Kaiser has been a neonatal nurse in the UK since 2008, having gained her paediatric nursing diploma in Vienna in 2007. During this time, Lisa has developed extensive clinical expertise across Level 1, 2, and 3 neonatal units, including specialist surgical neonatal care. She qualified as an Advanced Neonatal Nurse Practitioner in 2014 and gained her MSc in 2019.
Glenys Boxwell (Connelly) was an Advanced Neonatal Nurse Practitioner for Plymouth Hospitals NHS Trust. She was previously a senior lecturer at Homerton College, Cambridge and has now retired from clinical practice. Glenys was the editor of Neonatal Intensive Care Nursing for the 1st and 2nd editions in 2000 and 20210 respectively, continuing as part of the editing team for the 3rd edition, published in 2020. We are very grateful to Glenys for the original development of this key, widely reputed neonatal nursing care textbook, that has formed the basis of this revised 4th edition.
