The 19:3 Selected Topics issue of the Journal of Perinatal & Neonatal Nursing (JPNN) provides an array of issues for both the perinatal and neonatal caregiver. A review of the evidence on cholestasis of pregnancy is presented by Nichols. Even if cholestasis is not a common pregnancy problem, the clinical management items are critical. Although it poses minimal maternal risk, cholestasis has significant fetal risks, including preterm birth, nonreassuring fetal status, meconium staining, and perinatal mortality. Current evidence and treatment measures are discussed.
The threat of a terrorist event or bioterrorism exposure for pregnant women is the basis of the article by James. She discusses the clinical management of pregnant women exposed to bioterrorist threats such as trauma and injuries sustained from exposure to certain agents. Specific drug therapies are delineated.
The last article in the perinatal section, by Chan et al, explores issues of a culturally sensitive nature. It addresses nurses' attitudes toward perinatal bereavement by identifying profiles of nurses working in 2 obstetrics-gynecology units in Hong Kong. Relationships between nurses' attitudes and (a) bereavement supports, (b) need for bereavement education, and (c) hospital policy are explored. A descriptive, correlational survey using cluster analysis was used. The survey findings from nurses in Hong Kong have applicability for other regions, regardless of cultural differences. Although bereavement education has been in existence in the United States in both nursing and medical curricula, these study findings will prove helpful to those supporting nurses who care for childbearing families experiencing loss.
The neonatal section of this issue features 3 articles on selected topics including informed consent in the NICU, nutritive sucking, and breast milk volume.
Hurst presents the second part to the legal landscape of care for premature infants born at the margins of viability published in 19:2. In this article, she focuses on informed consent as a transparent process for healthcare professionals and parents to partner in treatment decisions and the potential benefit of this process to decrease the need for lawsuits.
Medoff-Cooper describes her program of research on nutritive sucking, which is providing important evidence on using sucking behaviors as primary indices of both maturation and development in preterm infants. She presents the clinical questions that have guided the research and suggests implications of the findings back to clinical practice. In examining sucking and developmental outcomes, a relationship was found between the 40-week postmenstrual age feeding and developmental progress at 12 months of age. One study also examined the impact of feeding practices on the development of sucking behaviors, which showed that early and more frequent bottle feeding influenced feeding behaviors at term, with earlier-fed infants demonstrating significantly more organized and mature feeding patterns.
Hill and Aldag present a study in which they found that maternal milk volume on day 4 and income were predictive of lactation adequacy at 6 weeks in a group of mothers of nonnursing preterm infants. Mothers with milk adequacy at 6 weeks were more likely to have infants with greater birth gestational age and birth weight, earlier initial breast stimulation, had decided earlier to breast-feed, had higher incomes, higher milk volume on day 4, higher breast pumping frequency on day 4, and had received kangaroo care during the first week in the NICU.
Diane J. Angelini, EdD, CNM, FACNM, FAAN, Perinatal Editor
Susan Bakewell-Sachs, PhD, RN, APRN, BC, Neonatal Editor