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Hyperbilirubinemia, jaundice, is a common problem in babies born at or near term. More than 60% of the babies born in the US develop jaundice and it is difficult to tell the difference between that which comes from pathologic sources and that which is physiologic. Knowing that bilirubin may be beneficial as an antioxidant has brought new interest jaundice management. There are new guidelines from the American Academy of Pediatrics for management. A number of theories exist on bilirubin production and clearance and on techniques to assess jaundice and care for it as well as to prevent it.

The article focuses on a quality improvement project designed to reduce the exposure of very preterm infants (VPIs) to hyperoxia as evidenced by oxygen saturation levels (SpO2) values within the established target range in a level three neonatal intensive care unit (NICU). Results showed improved caregiver knowledge of hyperoxia following the educational intervention, but such knowledge did not reduce the time VPIs spent with SpO2 readings above the target range.

The article discusses the nursing care for infants of diabetes mothers (IDMs). Clinical information on gestational diabetes mellitus (GDM) is presented, including its prevalence in the U.S. and the risk for newborn morbidity and mortality associated with GDM. The assessment of neonates born to mother with diabetes is explained. The article also describes the therapeutic management of pregnant women with diabetes and IDMs. INSETS: Case Study;Case Study Outcomes.

In the upheavals of its long history, India's traditions and mores have been continuously evolving. India has absorbed, adopted, and adapted outside cultures and influences, which have merged into Indian society. This article describes the traditional practices of childbearing and neonatal care in India today. The impact of 850 million people on the health care system along with the educational process for the Indian nurse is discussed. The author reports on her neonatal care experiences over the past 9 years in India. [ABSTRACT FROM PUBLISHER]

Unlabelled: Supplemental oxygen plays a critical role in the care of infants born at the lower limits of viability, but not without the risk of morbidity resulting from high levels or prolonged exposure., Purpose: The purpose of this quality improvement project was to reduce exposure to hyperoxia as evidenced by SpO2 values within the established target range (88%-92%) among very preterm infants (VPIs) in a level 3 neonatal intensive care unit (NICU). Reducing exposure to hyperoxia in this population of exquisitely vulnerable infants has been associated with reduced morbidity, including retinopathy of prematurity, chronic lung disease, and brain injury., Subjects: Two populations of interest were identified: VPIs receiving supplemental oxygen and NICU clinicians., Design: Interventions were employed to (1) improve knowledge regarding hyperoxia and associated outcome sequelae in an interdisciplinary sample of clinicians (pretest posttest design) and (2) reinforce content of the educational intervention by triggering caregiver behaviors to reduce time the VPIs is above target SpO2 range while receiving supplemental oxygen (cohort design)., Methods: : Retrospective chart review, baseline clinician knowledge assessment, education, posteducation assessment, collaborative rounds with regular feedback citing time VPIs spent above target oxygen saturation levels (SpO2), and evaluation of impact on time infants spent above target SpO2 range aligned with the project purpose., Outcome Measures: Pre- and postintervention dependent variables included clinician knowledge of hyperoxia and related evidence as measured by a 24-item multiple-choice Knowledge Assessment Tool before and after attending an educational presentation. Time VPIs were exposed to hyperoxia was evaluated using SpO2 readings and calculating the percentage of time readings were above target range before and after the introduction of educational and behavioral interventions., Principal Results: Outcome 1 was to increase knowledge about hyperoxia among clinician caregivers. Paired-samples t test showed a significant difference between preintervention and postintervention Knowledge Assessment Tool scores (P = .000). Outcome 2 measured reduction in time spent with SpO2 readings above target range. An independent-samples t test was used to compare outcomes in preintervention and postintervention VPI cohorts. Mean time spent with SpO2 greater than target range increased in the postintervention cohort, reaching statistical significance with P = .047., Conclusions: Knowledge acquisition on the subject of hyperoxia in VPIs was achieved. Decreasing the percent time VPIs were exposed to hyperoxia was not attained. The postintervention VPI cohort spent more time above the target saturation range despite greater knowledge among clinicians.

Objective: To propose and implement a family-centered systems approach to manage newborn jaundice for safer outcomes., Design: Observational study for known adverse outcomes., Setting: Semiprivate urban birthing hospital., Patients/participants: 31,059 well babies discharged as healthy from a cohort of 41,961 live births (1990-2000)., Interventions: Incremental implementation of a systems approach that incorporated a hospital policy to (a) authorize nurses to obtain a bilirubin (total serum/transcutaneous) measurement for clinical jaundice, (b) universal predischarge total serum bilirubin (at routine metabolic screening), and (c) targeted follow-up, using the bilirubin nomogram (hour-specific, percentile-based total serum bilirubin/transcutaneous bilirubin)., Main Outcome Measures: Known adverse outcomes assessed for early- and late-onset severe hyperbilirubinemia before, during, and after systems approach implementation., Results: Adverse outcomes decreased for well babies: exchange transfusion, intensive phototherapy, and readmission. During the study period, there were no "never events" (total serum bilirubin greater than or equal to 30 mg/dl), while "close calls" (total serum bilirubin greater than or equal to 25 mg/dl) were 1 in 15,000 as compared to a reported incidence of 1 in 625., Conclusions: Reduced adverse events, significant reduction in close calls, and no never events met family expectations for safer experiences with this approach.