1. Section Editor(s): Smith, Heather E.

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The American Academy of Pediatrics has a new book that is available now titled Understanding the NICU: What Parents of Preemies and Other Hospitalized Newborns Need to Know. Several professional neonatal intensive care unit (NICU) staff partnered with 14 families with the primary intention to provide hope and guidance to other parents of NICU babies. These family stories cover various scenarios and experiences of having children in the NICU. For example, one story covers 24-week twin daughters, Holland and Eden, and their long journey not only during their NICU stay but some of the realistic struggles at home for many months and years after their births. Another story shares a late preterm birth and a much shorter stay in the NICU. The book not only includes family stories but chapters covering basic NICU information to educate parents during their time in a new environment. Topics covered in the instructive chapters review topics including parenting, feeding, and common medical problems. The book is 288 pages long and has a retail price less than $20, which makes it an inexpensive option to consider having around your NICU to help educate and uplift parents during their downtime in the NICU.



Earlier this year the American Academy of Ophthalmology wrote a clinical statement expressing concern for other infants exposed to the Zika virus in utero due to multiple ophthalmic issues including macular pigment mottling, optic nerve hypoplasia, and iris coloboma discovered in previous Zika-exposed infants.1,2 A recent article published in the Ophthalmology journal discusses a new finding of glaucoma 3 months after birth in a Zika-exposed infant during gestation.3 Glaucoma results in damage to the optic nerve due to increased ocular pressure and is often caused by the inability for the eye to drain ocular fluid properly. Glaucoma is considered a rare occurrence in pediatric patients,4 but those individuals caring for infants known to be potentially exposed to the Zika virus in utero should be aware of glaucoma as well as the other potential ophthalmic issues that can present themselves during their hospital stay. Common signs of pediatric glaucoma include increased tearing,3,4 swelling and pain,3 and a dullness of the iris upon visual assessment.4 Once glaucoma is detected, the primary goal is to reduce intraocular pressure and secondarily, treat any signs of vision loss due to the aggressiveness of this disease. In the NICU, premature infants are routinely scheduled for eye exams. In addition to the premature infants, those infants who have a known or suspected history of Zika virus exposure are scheduled for an initial eye examination within the first month of life to reduce long-term sequelae.5



It goes without saying that parent teaching before sending an infant home should include information about and methods to reduce sudden infant death syndrome (SIDS). Along with potential health issues of an infant, environmental factors may also contribute to a SIDS occurrence. After videotaping parents and full-term infants at home one night when the infant was 1, 3, and 6 months of age, researchers at Penn State recognized a disconnect between parental knowledge and actions. Parents were aware of the videotaping and yet 14% of infants were placed in a position other than supine and 21% of infants laid on a sleep surface not recommended,6 which often includes soft surfaces such as couches, pillows, and waterbeds.7 What was more surprising to learn was over 90% of these infants had items within their environment like stuffed animals, pillows, and loose blankets. Although parents who participated in this study were considered above average on educational level and socioeconomic status, parents infrequently followed SIDS prevention methods.6 These results highlight the realistic force neonatal nurses are up against in teaching parents the importance of preventing SIDS. Considerations for new approaches to teach SIDS prevention are urgently needed to reduce infant mortality once infants are discharged home. The next time SIDS education is reviewed in your NICU, what changes would you propose to increase compliance with safety measures to reduce SIDS?




1. de Paula Freitas B, de Oliveira Dias JR, Prazeres J, et al Ocular findings in infants with microcephaly associated with presumed Zika virus congenital infection in Salvador, Brazil. JAMA Ophthalmol. 2016;134(5):529. doi:10.1001/jamaophthalmol.2016.0267. [Context Link]


2. Ventura CV, Maia M, Bravo-Filho V, Gois AL, Belfort R. Zika virus in Brazil and macular atrophy in a child with microcephaly. Lancet Lond Engl. 2016;387(10015):228. doi:10.1016/S0140-6736(16)00006-4. [Context Link]


3. de Paula Freitas B, Ko AI, Khouri R, et al Glaucoma and congenital Zika syndrome. Ophthalmology. 2016;pii:S0161-6420(16)31055-31057. doi:10.1016/j.ophtha.2016.10.004. [Context Link]


4. American Association of Pediatric Ophthalmology and Strabismus. Glaucoma for Children. https:// Accessed December 5, 2016. [Context Link]


5. Staples JE, Dziuban EJ, Fischer M, et al Interim Guidelines for the Evaluation and Testing of Infants with Possible Congenital Zika Virus Infection-United States, 2016. MMWR Morb Mortal Wkly Rep. 2016;65(3):63-67. doi:10.15585/mmwr.mm6503e3. [Context Link]


6. Batra EK, Teti DM, Schaefer EW, Neumann BA, Meek EA, Paul IM. Nocturnal video assessment of infant sleep environments. Pediatrics. 2016;138(3):e20161533. doi:10.1542/peds.2016-1533. [Context Link]


7. National Institute of Child Health and Human Development. Ways to reduce the risk of SIDS and other sleep-related causes of infant death. https:// Published December 5, 2016. [Context Link]