This issue of the Journal of Perinatal and Neonatal Nursing contains perinatal articles that describe a variety of gastrointestinal (GI) conditions and serious liver-related complications found in pregnant women. Early diagnosis and intervention, patient comfort, physiological stabilization, and improvement of maternal and neonatal outcomes are the common threads found throughout the perinatal manuscripts. Commonality of symptoms such as nausea, vomiting, and epigastric discomfort, or pain can be related to normal physiologic changes in pregnancy, diarrhea, food cravings and overindulgence, infection, preeclampsia, or liver dysfunction in cases such as intrahepatic cholestasis of pregnancy, hyperemesis gravidarum, and acute fatty liver of pregnancy. The authors have contributed the latest evidence to assist the reader in deciphering the differences.
A review of the latest management of commonly encountered GI disorders presented by Zielinski in "Gastrointestinal Distress in Pregnancy: Prevalence, Assessment and Treatment of 5 Minor Discomforts" provides assistance for clinicians in differentiating minor, but distressing, GI conditions that can occur throughout pregnancy from far more serious or life-threatening conditions that may present in a similar manner. Practical approaches to managing the disruptive effects of nausea, vomiting, heartburn, diarrhea, gas and constipation, and food cravings are explored.
The article "Hyperemesis Gravidarum: A Holistic Overview and Approach to Clinical Assessment and Management" by Castillo and Phillipi presents current evidence about hyperemesis gravidarum related to the cause(s), associated risk factors, psychosocial effects on pregnant women and families, and economic costs incurred by loss of productivity and hospitalization. It is evident from the overview that hyperemesis gravidarum, which primarily occurs during the first and second trimesters of pregnancy, is multifaceted and involves complex pathophysiology including alteration in liver function. Although further research is needed to clarify how the maternal and fetal livers are affected by dehydration and inadequate nutrition during gestation, the authors have provided a holistic approach to use best practices in addressing nursing care for women with hyperemesis gravidarum.
Dr Gabzdyl contributed the article titled "Intrahepatic Cholestasis of Pregnancy: A Critical Clinical Review." Intrahepatic Cholestasis of Pregnancy, the most common liver condition related to pregnancy, occurs in early third trimester and can produce preterm labor and intrauterine fetal demise. Elevated serum bile salts and liver enzymes levels, accompanied by various degrees of pruritis, are described to enable nurses to differentiate intrahepatic cholestasis of pregnancy from other liver complications. Nursing knowledge that is critical in caring for women with Intrahepatic Cholestasis of Pregnancy to avoid toxic levels of bile salts and intrauterine fetal demise before and during labor is presented. Controversies over fetal surveillance and timing of induction of labor are also addressed.
"Caring for the Woman With Acute Fatty Liver of Pregnancy" by Holub and Camune describes a rare but life-threatening liver condition of pregnancy. Disease awareness can contribute to liver function assessment that is needed for early differential diagnosis of acute fatty liver of pregnancy because the symptoms often present like gastroenteritis or cholecystitis. In the complicated phase of the disease, it is misdiagnosed as preeclampsia with Hemolysis, Elevated Liver Enzymes and Low Platelets syndrome. The mortality rates of fetuses and infants can be decreased by prompt recognition of acute fatty liver of pregnancy and delivery, followed by newborn screening with nutrition modification. This article captures the importance of informed nursing assessment throughout the perinatal period.
Although not all common gastrointestinal conditions or high-risk liver complications could be covered in this issue, the most current, evidence-based information presented here about selected GI problems should enhance nursing practice thereby leading to improved maternal, fetal, and neonatal outcomes.
Gastrointestinal (GI) assessment as well as the prevention, diagnosis, and treatment of GI disturbances are performed daily by neonatal intensive care unit (NICU) nurses. It is therefore essential that neonatal nurses have the latest evidence-based information regarding neonatal GI issues to provide optimal care to their vulnerable patients. The neonatal articles for this issue all focus on GI issues and provide evidence-based information, clinical tools, and state of the science regarding GI care of infants in the NICU.
Necrotizing enterocolitis (NEC) is a potentially devastating disease that vastly increases the mortality and morbidity of infants born prematurely. Each article in this issue focuses on a different aspect of GI care and also discusses this important disease process. Since bedside nurses are the hospital personnel who spend the most time with patients, they are critically important in the early detection and possibly the prevention of NEC. Therefore, these articles provide important knowledge to assist NICU nurses in caring for premature infants.
Leslie Parker et al provide the CE article, "Aspiration and Evaluation of Gastric Residuals in the Neonatal Intensive Care Unit: State of the Science." They present current evidence regarding aspiration and evaluation of gastric residuals in the NICU. The authors also provide recommendations for further research and practice guidelines to encourage the use of evidence-based practices by nurses in the NICU.
The Katherine Gregory et al article, titled, "Stooling Pattern and Early Nutritional Exposures Associated With Necrotizing Enterocolitis in Premature Infants," provides information regarding whether monitoring the stooling pattern of very premature infants is important in determining their risk of developing NEC. Monitoring for signs of NEC is an extremely important aspect of neonatal nursing care, so information regarding this topic is pertinent to improving neonatal care.
Leanne Nantais-Smith and Mark Kadrofske, in their article "Noninvasive Biomarkers of Necrotizing Enterocolitis," present current information regarding monitoring infants at risk for NEC. This article offers an overview of biomarkers that may increase the ability to recognize the development of NEC in infants prior to clinical deterioration. Neonatal nurses need to have knowledge of laboratory and other diagnostic procedures and the potential of those to predict infants at greater risk of developing NEC.
Nancy Rodriquez and Michael Caplan provide the review article "Oropharyngeal Administration of Mother's Milk to Prevent Necrotizing Enterocolitis in Extremely Low-Birth-Weight Infants: Theoretical Perspectives." The authors present evidence regarding the use of oropharyngeal administration of breast milk in very low-birth-weight infants and its potential influence on the incidence of NEC and sepsis.
Our column editors, Drs Susan Blackburn, Katherine Gregory, and Terese Verklan, once again offer informative and relevant topics and perspectives for your reading and learning pleasure.
-Barbara Camune, DrPH, CNM, WHNP-BC, FACNM
Perinatal Guest Editor
-Leslie A. Parker, PhD, RN, NNP-BC
Neonatal Guest Editor