This issue of the Journal of Perinatal & Neonatal Nursing features complex clinical case studies in perinatal and neonatal care. Diverse clinical perinatal topics are presented and illustrated by case reports, including partial molar pregnancy, psychiatric disorders, diabetes in pregnancy, and streptococcal infection.
Drummond and Fritz present a rare case report involving a partial molar pregnancy with a coexisting fetus. The article reviews the diagnosis of this rare condition, associated characteristics, and plan of care and highlights the importance of collaborative, interdisciplinary care planning.
Psychiatric disorders present a complex clinical challenge during pregnancy and for those women who desire to breast-feed. Van Mullem and Tillett review this complex topic, for which there are no definitive answers. Guidelines for clinical assessment, a review of treatment options, and potential effects of untreated illness are described, along with a compelling case study.
McCaffrey et al discuss the impact diabetes has on childbearing women. The authors include a review of current clinical guidelines for preconception, antepartum, intrapartum, and postpartum care, as well as implications for clinical practice, and a case analysis.
Finally, Sosa examines the reemergence of group A streptococcal infections. Epidemiology, pathophysiology, assessment, and current treatment guidelines are reviewed and illustrated by a case study.
The neonatal section of this issue offers 5 complex cases that highlight neonatal nursing challenges. The case studies offer cultural, ethical, and clinically difficult situations and demonstrate necessary intelligent and compassionate nursing care. The knowledge and implications offered are transferable to other clinical cases and should, therefore, be useful to neonatal nurses.
Linder provides a CE manuscript on understanding a newborn with multiple congenital anomalies due to a complex chromosomal arrangement. Through the case study, the author traces each malformation, describing the pathophysiology, etiology, and correlating chromosome variation. Careful review of this case study offers an important opportunity to increase understanding of chromosomal anomalies and their implications in embryological development and clinical presentation in the newborn.
Kavanaugh et al present a case from a larger research study that examines "decision making and decision support needs of parents regarding life support decisions made over time (prenatally and postnatally) for extremely premature infants." Decision making during the mother's antenatal hospitalization and support the parents received are described, and advice is provided for improving care to families. The findings in this case study emphasize the importance of the nurse in facilitating communication and informing and helping parents understand treatment options and decisions.
The complex case presented by Bosque focuses on an infant born with a fatal restrictive dermopathy, her complex clinical care needs, and the needs of her Russian, non-English-speaking parents. This compassionate case study demonstrates the additional complexities involved when the diagnosis is unexpected, increasingly complex care and diagnosis require transfer to a tertiary center, and language and culture must be bridged to support the family dealing with a dying infant.
Little has been described about the experiences of Spanish-speaking, Mexican American mothers in the neonatal intensive care unit (NICU). The case study presented by Cleveland offers one such description. A qualitative methodology was utilized with an in-depth interview and content analysis. Cleveland's data reveal that the experience of a Spanish-speaking, Mexican American mother who had an infant in the NICU was one of "uncertainty, involvement, trust, and anticipating discrimination."
Pentralogy of Cantrell is a rare syndrome expressed through 5 distinct anomalies. In this complicated case presented by Meeker, the syndrome is reviewed along with interdisciplinary interventions and complex nursing care from the time of antenatal diagnosis through neonatal interventions. Nursing care is emphasized in ensuring "safe, quality, and interdisciplinary care" and in providing comprehensive parent and family education and care.
These contributing authors, through their cases, demonstrate professional commitment to learning and improving the journeys of the neonates and their families entrusted to nursing care in the NICU.
Denise Gagnon Palmer, MS, RN, CNS
Barbara J. Sittner, PhD, RN
Perinatal Guest Editors (Palmer)(Sittner)
Susan Bakewell-Sachs, PhD, RN, PNP-BC
Neonatal Editor (Bakewell-Sachs)