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Background: The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease., Methods and Results: A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin-twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease., Conclusions: Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care., (© 2014 American Heart Association, Inc.)

Objective: To explore parents' experience and satisfaction with care in the Neonatal Intensive Care Unit (NICU)., Design: Qualitative design using an interpretive description method., Setting: A tertiary-level care 69-bed NICU., Participants: Ten parents (nine mothers and one father) were interviewed., Method: Parents were interviewed in person or via telephone, either following or close to discharge. Interviews were recorded, transcribed, and then analyzed using an evolving coding guide., Results: All parents indicated that the relationship they developed with the bedside nurse was the most significant factor affecting their satisfaction with their NICU experience. All parents described nursing actions of perceptive engagement, cautious guidance, and subtle presence, which facilitated the development of this relationship. Further analysis of the data revealed that parents portrayed nurses in ideal nurse/parent interactions as fulfilling the roles of teacher, guardian, and facilitator., Conclusion: Developing a collaborative and effective nurse/parent relationship is the most significant factor affecting parents' satisfaction with their NICU experience. Providing nursing care in a manner that optimizes consistency and continuity of care facilitates the ability of both parties to develop this relationship., (© 2010 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Ongoing technological advances in pediatrics are improving the survival rates among babies born with life-threatening anomalies. For these neonates, surgeries like brain shunts, trachea, gut and heart reconstruction, and organ transplants are replacing palliative care. Although parents and health care professionals alike are celebrating the successes, advancing technology also raises issues for everyone involved. This paper incorporates Dunst and Trivette's Effective Helpgiving framework and the Calgary Family Intervention Model to recommend nursing care that moves beyond life-saving highly technical surgical procedures and responds to the challenges parents face with their children with complex congenital heart disease, for example, who have "beat the odds."