1. Rolando, April MN, MNP, RNC

Article Content

Comprehensive Neonatal Nursing: A Physiologic Perspective, 3rd ed, by Carole Kenner and Judy Wright Lott. St. Louis, Mo: Saunders, 2003. 960 pages, hardcover.


Comprehensive Neonatal Nursing provides an all-inclusive resource for neonatal staff nurses, advanced practice nurses, and other healthcare professionals involved in the care and management of neonates. Although the title denotes a physiologic perspective, the authors have written a book that is holistic in the management of neonates. High-risk pregnancies, fetal therapy, family dynamics, developmentally supportive care, and long-term neonatal care are discussed in depth, as well as complete chapters on neonatal systems and the assessment and management of neonatal disorders.


The book is divided into 9 units and 47 chapters. The 9 units are (I) Neonatal nursing care in the new millennium: in the NICU and beyond; (II) Family dynamics; (III) The prenatal environment: maternal-fetal interactions; (IV) The intrapartal environment: maternal-child interactions; (V) Developmentally supportive care; (VI) Physiologic adaptation of the neonate; (VII) Neonatal and infants diagnostic tests and laboratory values; (VIII) Pharmacologic and nonpharmacologic therapies; and (IX) Long-term newborn and infants care.


The first unit (chapters 1-5) includes important areas of discussion regarding the practice of neonatal nursing. Content on the advancement of nursing is provided, including the history on the development and impact advanced practice nurses have had on neonatal care over the past decades. Evidence-based practice has become the gold standard for both medical and nursing models of practice. The authors include both the importance of evidence-based nursing practice as a whole and models of collaborative research, especially needed in the neonatal setting, within separate chapters. Research and evidence-based practice offer the best model of practice and develop a solid foundation for neonatal management. They also discuss, in chapter 5, competency-based education in neonatal nursing.


Family centered care is a common theme to neonatal care in today's society and the emphasis of Unit II (chapters 7-9). Inclusion of a section on family dynamics in the beginning of the book stresses the importance the entire family has on the care of the neonate. A compassionate dialogue on beaverment, hospice, and palliative care is contained within an entire chapter, in addition presenting the necessary information to provide the best possible care to a grieving family. The authors return to the theme of family at the conclusion of the book in Unit IX (chapters 45-47) with chapters on long-term neonatal care, issues relating to transitioning to home, and need monitoring that may be necessary to switch from hospital life to life at home as a family.


Units III (chapters 10-13) and IV (chapters 14 and 15) focus on a perinatal perspective with content related to interactions within the prenatal and intrapartum environment. Topics include genetics, fetal development, fetal therapy, effects of labor in the fetus and neonatal, and resuscitation and stabilization.


Unit V (chapters 16-19) focuses on developmentally supportive care, with chapters on the management of the NICU environment, newborn and infants' neurobehavioral development, and integrating neonatal monitoring within a developmentally supportive environment. This unit also discusses use of computer technology in neonatal care.


An impressive aspect to this book is the systematic outline of each neonatal system within each chapter in Unit VI (chapters 20-40). These chapter cover general newborn and infant assessment as well as specific assessment and management of the respiratory, cardiovascular, gastrointestinal, metabolic, endocrine, immune, hematologic, neurologic, musculoskeletal, genitourinary, integumentary, auditory, and ophthalmic systems. Other chapters in this unit focus on fluid and electrolyte and nutritional management. In addition, several chapters focus on care of infants with unique needs, including infants during transport, surgical care, substance-exposed infants, and the extremely-low-birth-weight infant.


An orderly description of embryologic development begins each chapter, supplying the necessary background to begin a thorough assessment of each system. Physical assessment parameters are included, highlighting specific areas to evaluate and important normal and abnormal findings relating to each neonatal system. To assist with diagnosis, the authors have provided system-specific diagnostic procedures, including advances in new technology as applicable. Within each chapter, defects or abnormal dysfunction are defined and information is supplied about possible risk factors, differential diagnosis, clinical manifestations, prognosis, and collaborative management.


The authors devote an entire chapter (Unit VII, chapter 41) to diagnostic procedures utilized in the assessment of neonates and possible disease processes. X-ray procedures, use of radioisotopes in the neonate, ultrasound technology, and magnetic resonance imaging are common instruments of assessment used in management of neonates, not all benign and without complications. Specific procedures utilized in neonates are explained in detail, including potential risks and the pertinent nursing care of the neonate undergoing these procedures.


Unit VII (chapters 42-44) describes principles of neonatal drug therapy and identification and management of infant pain. Chapter 44 focuses on a growing area of interest in many units, the use of complementary and alternative medicine, and encourages more nursing research into use of these therapies.


Included in the book is a wonderful multimedia resource. Each chapter in the book is supplemented by information contained on a CD-ROM. Integrated within the CD are competencies, case studies, and critical thinking questions. Study questions and answers and other supplemental resources are also provided, followed by correct answers and rationale for each question related to neonatal systems. In addition to being a great resource for neonatal care and management, this is a great study tool for staff nurses and advance practice nurses studying for certification exams, as few study resources provide case studies and study questions.


Overall, this is a wonderful book for the practice of neonatal nursing. Both neonatal staff nurses and advance practice nurses will find needed information in a concise, logical manner. The holistic approach, including the embryologic foundation, and diagnostic evaluation, assessment, and management discussions, give neonatal nurses a solid foundation and direction in the complex care of neonates.