The 18:4 issue of The Journal of Perinatal & Neonatal Nursing features gastrointestinal (GI) disorders and includes a broader GI approach to both nutrition and feeding. From the perinatal perspective, 3 manuscripts are presented, which focus on common GI-related pregnancy complaints and more serious medical and surgical GI complications in pregnancy.
Davis provides an extensive review of the evidence as well as the clinical management of hyperemesis in pregnancy. She reviews the incidence, symptoms, proposed causes, pharmacologic therapy, and nursing care indicated for women with nausea and vomiting of pregnancy. Specific suggestions for therapeutic interventions are outlined.
Woodard addresses gastric surgery for morbid obesity and the concerns it places on future childbearing. The nutritional challenges brought about by the surgery can have a profound impact on maternal health and pregnancy outcome. She reviews the classifications of surgical procedures and the resulting implications in pregnancy.
Irritable bowel syndrome and inflammatory bowel disease are GI disorders affecting young adults and thus are encountered in pregnant women. Bruno presents the life-altering adjustments that need to be made with these diseases and their effect on fertility, pregnancy, and delivery.
The neonatal section of this issue features 3 articles, 1 research-focused, 1 literature review, and 1 on clinical programs, on the important and complex clinical topic of infant feeding. The initiation and progression of oral feedings (breast and bottle) for preterm and high-risk infants present numerous challenges for the neonatal intensive care unit (NICU) professional staff and parents. Nurse researchers have contributed significant evidence to the literature on various clinical questions regarding feeding and clinicians now have more scientific information upon which to develop evidence-based feeding practices. We now know that feeding these infants is a developmental process requiring knowledge, skills, and an emphasis on individualized approach.
McGrath and Braescu present a literature review on bottle-feeding readiness in preterm infants. She reviews 2 theoretical frameworks as well as the clinical literature on determining readiness for initiating and continuing feedings. The complexity of infant feeding is demonstrated by research. Although many clinical questions remain to be answered, sufficient evidence exists to allow for clinical application of principles and select practices. Of particular interest is the importance of individualizing feeding experiences, utilizing knowledge of infant behavioral state, and semi on-demand feedings instead of strict schedules.
Premji, McNeil, and Scotland provide an exciting evidence-based oral feeding protocol that will be implemented in 5 hospitals beginning this fall in Calgary. The protocol is a synthesis of research evidence and expert opinion pertaining to the introduction and management of oral feedings for high-risk infants in NICUs. A highlight is the process of development of the protocol itself, involving multiple disciplines and nurseries and a wonderful representation of commitment to improving practice.
Breast-feeding in the NICU, though considered important, presents special challenges for staff and parents and often is not strongly supported. Spatz describes an evidence-based 10-step plan for promoting breast-feeding for vulnerable infants in the intensive care nursery. She offers helpful information in terms of program elements and structure, information for parents, the importance of establishing lactation early, progression from human milk tube feedings to breast-feeding, and program evaluation.