1. Smith, Heather E. PhD, RN, NNP-BC, CNS

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As more Americans are succumbing to opioid abuse, neonates are innocently being affected from those pregnant opioid users. Although this is not a new phenomenan1 in history, it is estimated that today there are over 2 million people with an opioid addiction in the United States.2 Regardless of gestational age beyond viability, many of these neonates end up being cared for in the neonatal intensive care unit (NICU) due to the withdrawal period postdelivery from regular fetal opioid exposure called neonatal abstinence syndrome (NAS).3,4 Assessments of neonates with NAS have been measured using several different NAS tools over time, with the Finnegan Neonatal Abstinence Scoring System getting most use.3,5 NAS symptoms include, but are not limited to, uncoordinated feeding patterns, vomiting, diarrhea, high-pitched crying, and irritability.3 In premature infants born to opioid-addicted mothers, the risk for more frequent intermittent hypoxemia is present compared with the baseline intermittent hypoxemia common among most premature infants.6 NAS admissions have increased significantly over the last decade, which has increased length of stay and medical interventions.7 Neonatal nurses will need to continue expanding their thoughts and tools to assist in caring for this growing patient population.


One nonpharmacologic option recently researched in this patient population is the use of Reiki therapy.8 Reiki therapy is considered complementary or an alternative medicine that uses the person's own healing energy guided by a Reiki practitioner to restore the body and/or restore balance within the person.9 Thirty opioid-exposed infants underwent a 30-minute Reiki therapy session with vital signs monitored to ensure the neonate was not overstimulated. Analyses showed performing Reiki in a NAS group of neonates did not pose any adverse events and, in fact, may have caused relaxation as noted by a slight decrease in heart rate during the session.8 Although the sample size was small and much more research is needed to determine further benefit, Reiki may be a viable nonpharmacologic intervention to opioid-exposed neonates with NAS.



Fetal ultrasounds have become the main imaging go-to for over the last several decades. Fetal interventions and close management of fetal anomalies have evolved, with some radiologists questioning more utility of fetal MRI.10 Fetal MRI could allow not only for detecting the presence of a physical malformation like ultrasound, but it would take the level of information to the next level. For example, in the situation of a fetus having a congenital diaphragmatic hernia, ultrasound would be sufficient to determine its presence; however, fetal MRI would be able to detect which organs were involved.11 As medicine becomes more sophisticated and decisions are made prior to delivery, the use of fetal MRIs may become more frequent and more commonly accepted. Fetal MRI might be an added layer of imagining that will provide needed information, in very specific cases, that will outweigh the risk involved with the procedure.



Positive-pressure ventilation is occasionally needed for infants shortly after birth or during their stay in the NICU. Recently, a Cochrane Review published information covering 7 different studies that enrolled nearly 800 infants and compared laryngeal, bag and mask, and endotracheal tube delivery.12 Although often not as frequently utilized, laryngeal mask ventilation was measured as equivalent, if not more effective, compared with bag and mask ventilation and endotracheal ventilation. In the case of failed intubation, laryngeal mask ventilation was a second best option. Evidence to support, these claims were researched primarily in infants 34 weeks' gestation and older and greater than 1500 g. Therefore, making these conclusions for infants less than 34 weeks and less than 1500 g may be imprecise. In summary, laryngeal, bag and mask, and endotracheal tube ventilation are all viable options and choosing the best method may be based upon on situation at hand.




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8. Radziewicz RM, Wright-Esber S, Zupancic J, Gargiulo D, Woodall P. Safety of Reiki therapy for newborns at risk for neonatal abstinence syndrome. Holist Nurs Pract. 2018;32(2):63-70. doi:10.1097/HNP.0000000000000251. [Context Link]


9. The International Center for Reiki Training. What is Reiki. Published 1990. Accessed March 15, 2018. [Context Link]


10. Snyder E, Baschat A, Huisman TAGM, Tekes A. Value of fetal MRI in the era of fetal therapy for management of abnormalities involving the chest, abdomen, or pelvis [published online ahead of print March 12, 2018]. Am J Roentgenol. doi:10.2214/AJR.17.18948. [Context Link]


11. Radiology Business. When an ultrasound isn't enough: Making a case for fetal MRIs. Published March 17, 2018. Accessed March 17, 2018. [Context Link]


12. Qureshi K. Laryngeal mask airway versus bag-mask ventilation or endotracheal intubation for neonatal resuscitation. Published March 15, 2018. Accessed March 15, 2018. [Context Link]