1. Section Editor(s): Kendrick, Jo M. MSN, WHNP-BC
  2. Coordinator Perinatal Diabetes Program
  3. Philbin, M. Kathleen PhD, RN
  4. Neonatal Guest Editor
  5. Lynch, Mary MS, MPH, RN, PNP-BC, FAAN
  6. Neonatal Guest Editor

Article Content

Management of neurologic disease complicating pregnancy poses a challenge for a healthy outcome for mothers and infants. This issue of the Journal of Perinatal & Neonatal Nursing provides insight into the maternal, fetal, and neonatal impact of certain neurologic conditions encountered during pregnancy.


Epilepsy is neurologic complication that is frequently seen in pregnancy. Most women with epilepsy have a normal pregnancy, but there are some fetal and obstetrical complications to be considered. Ruth and Barnett provide an overview of the types of seizure disorders and the antiepileptic drugs used to treat different types of seizure disorders.


The most common chronic neurologic condition encountered during pregnancy is multiple sclerosis. Dalton and Baird recommend preconception counseling in women with multiple sclerosis to help women and families understand what can be expected during the perinatal period and to review the safety of medications for pregnancy. Some women experience fewer exacerbations of multiple sclerosis during pregnancy.


Spinal cord injury affects a significant number of women of reproductive age. These women will require special considerations in order for a successful pregnancy outcome. Camune promotes a multidisciplinary approach that includes a team of specialists in addition to the obstetric provider. Unique needs of women with spinal cord injury during the perinatal period are defined and discussed.


The discussion of neurologic complications in pregnancy would not be complete without including a discussion of the genetics of neuromuscular disease. Frazer, Porter, and Goss discuss the potential impact from a genetic perspective for pregnancies affected by myotonic dystrophy, Duchenne and Becker muscular dystrophies, limb-girdle muscular dystrophy, Charcot-Marie-Tooth disease, and spinal muscular dystrophy. The authors offer considerations for genetic testing, diagnosis, maternal and fetal risks, and treatment and counseling for both patients and offspring affected with these specific disorders.


The neonatal focus of this issue is infant neurology. Each of the 3 articles has different aims and observes the interrelationships of infant brain-behavior-physiology in differing circumstances with distinct methods. Yet, each arrives, essentially, at the same conclusion about the effects of handling and the need for neuroprotection in everyday nursing care.


The study from Strasbourg by Aurelia et al examines the beneficial and supportive end of handling. This study uses careful, responsive handling and illustrates its effects on behavior and physiology. The authors examined infants' physiologic responses both to staff handling before and after and to parent's holding during skin-to-skin care of small preterm infants. A special contribution of this study is the inclusion of very low-birth-weight infants, some who are ventilated and have central lines. There are few studies of skin-to-skin care with this population, and the absence of objective information leads clinicians to deny it for fear of deleterious physiologic consequences and accidental dislocation of devices. Aurelia et al will make a solid contribution to this limited literature.


The Sweeney and Blackburn study documents the effects of a gentle and expertly administered neurologic examination in which the infant's neurobehavioral organization is challenged by minimal to fairly demanding movements. Data from physiologic monitoring and systematic behavioral observation show that many preterm infants 32 to 41 weeks postmenstrual age experience significant disturbances in physiology, behavior, and state control as a consequence of even carefully executed handling. A valuable contribution of these authors is their comprehensive, detailed explanation of the brain-behavior-physiology interrelationships of developing systems and the effects of clinical care, particularly nursing care, on their function. This CE article is an excellent resource for both novice and experienced clinicians seeking to better understand or explain nursing care that supports the infant's developing brain-behavior-physiology.


Axelin et al used video-EEG (electroencephalographic) monitoring to continuously document sleep activity in a single infant over several days. There is no attempt to control the infant's handling, but, rather, it proceeds as usual with the ongoing nursing activities for a sick term infant in a busy intensive care unit. Not surprisingly, nurse handling is found to continually disrupt sleep in both timing and character. As with the Sweeney and Blackburn study, the results give nurses pause to reflect on everyday care routines and their organization across the 24-hour spectrum.


These 3 studies, in quite separate ways, show the consequences to vulnerable term and preterm infants of nurse handling: the subtle, minimalist handling documented by Aurelia et al; the gentle, but challenging handling of a complete neurologic examination; and the unregulated handling and organization of everyday nursing activity in an intensive care unit. Each study encourages reflection on the unintended consequences of common activities that seem benign on the surface.


-Jo M. Kendrick, MSN, WHNP-BC


Coordinator Perinatal Diabetes Program


High Risk Obstetrical Consultants


University of TN Medical Center


Knoxville, Tennessee


-M. Kathleen Philbin, PhD, RN


Neonatal Guest Editor




Moorestown, New Jersey


-Mary Lynch, MS, MPH, RN, PNP-BC, FAAN


Neonatal Guest Editor


Clinical Professor


Department of Family Health Care Nursing


Program Director


Advanced Practice in Neonatal Nursing


University of California, San Francisco