The Journal of Perinatal & Neonatal Nursing (JPNN) offers another volume to its readers during its 30-year Anniversary Celebration. This year, 2016, marks a landmark for our publication, which blends perinatal and neonatal contents in a combined format. We at JPNN are happy to present the 30:2 issue, Sepsis and Infections, for your perusal. In addition, watch for the 30:3 upcoming Anniversary Issue of the "Pink Journal"!
Readers are also encouraged to peruse JPNN's departments in this issue: Lisa Miller's Expert Column on Legal Issues and Risk Management presents advice on giving expert testimony. Jackie Tillett's expert Opinion column reviews eating and drinking in labor.
In "Sepsis in Pregnancy: Identification and Management," the authors discuss how the normal physiological changes of pregnancy present challenges in the diagnosis and treatment of sepsis. Although there is a lack of evidence on the best management strategies, goal-directed therapy is the key to treatment and includes early fluid resuscitation and appropriate antimicrobial therapy. The authors also stress the need for the development of illness severity scoring systems and validated treatment algorithms for sepsis management in pregnancy.
Equally challenging for obstetric nurses, midwives, and physicians is the diagnosis of chorioamnionitis at term. In the review article, "Chorioamnionitis at Term: Definition, Diagnosis, and Implications for Practice," the authors review the sensitivity and specificity for the symptoms commonly found in a suspected intrauterine infection. In many cases, these typical symptoms are not indicative of actual chorioamnionitis; however, a high index of suspicion with prompt antibiotic therapy and delivery is needed to reduce perinatal morbidity and mortality.
Foodborne illness such as listeriosis and toxoplasmosis can also have devastating effects on fetal outcome. The authors of "Listeriosis and Toxoplasmosis in Pregnancy: Essentials for Healthcare Providers" present readers with an excellent overview of each of these infections. Incidence, transmission, diagnosis, and management are discussed. Strategies for safe food handling are also included.
The article "Group A Streptococcal Infection in Pregnancy and the Puerperium" highlights this infection that has been a major contributor to maternal morbidity and mortality around the world. Incidence, transmission, and early recognition of signs and symptoms during pregnancy are discussed. Management of Group A Streptococcal sepsis follows the "Surviving Sepsis Campaign" model,1 and timely intervention utilizing treatment bundles is outlined in this informative article.
Methicillin-resistant Staphylococcus aureus (MRSA) infections of the skin and soft tissue, as well as sepsis, pneumonia, and wound infections, remain a risk to mothers and their newborns. In the article "Staphylococcus Infections in Pregnancy: Maternal and Neonatal Risks," the author discusses the epidemiology, disease spectrum, diagnosis, and management of MRSA infections in the obstetric patient. Invasive MRSA during pregnancy, postpartum, and newborn sepsis are also included in this comprehensive discussion of these serious antibiotic-resistant infections.
Infection is a long-standing major threat to infants in the neonatal intensive care unit (NICU), contributing significantly to morbidity and mortality, increased treatment costs and length of stay, and previously accepted as a reality. In recent years, there is a growing paradigmatic shift away from tolerance and acceptance of infection as inevitable toward embracing emphatic infection prevention. Nurses must be knowledgeable about and vigilant in evidence-based care practices that prevent infection, not accepting it as inevitable. The neonatal content for this issue on sepsis/infection is focused on global care to prevent infection in the NICU, the use of care bundles for preventing central line-associated bloodstream infections (CLABSIs), and a historical review of the use of antibiotics in the NICU.
The CE article is by Linda LeFrak. The article titled, "Infection Risk Reduction in the Neonatal Intensive Care Nursery: A Review of Patient Care Practices That Impact the Infection Risk in Global Care of the Hospitalized Neonates," emphasizes the importance of global care in preventing infection. Readers will appreciate the article and references to current practice guidelines from national organizations that can help them lead quality improvement measures in their units.
Dr Monika Pogorzelska-Maziarz is an epidemiologist. Her article titled, "The Use and Effectiveness of Bundles for Prevention of Central Line-Associated Bloodstream Infections in Neonates: A Review of the Literature," provides a comprehensive review of published central line bundles. While all studies show that such bundles have significantly reduced CLABSI rates, methodological limitations prevent evaluation of specific bundle components in terms of their effectiveness.
Dr Katherine Gregory offers an expanded Expert Opinion column in this issue on antibiotic use in the NICU, from historical perspective of routine use to the more recent focus on stewardship.
This compilation targets major aspects of infection prevention and treatment considerations.
-Linda Hunter, EdD, CNM, FACNM
-Cyndy Krening, MS, RNC-OB, C-EFM
Perinatal Guest Editors
-Susan Bakewell-Sachs, PhD, RN, PNP-BC, FAAN
Neonatal Editor
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