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Neonatal Intensive
Care Nursing
2nd edition

Thoroughly revised and updated, this new edition of Neonatal Intensive Care
Nursing is a comprehensive, evidence-based text for nurses and midwives caring
for sick newborn babies.
Written by and for nurses, it concentrates on the common problems occurring
within the neonatal intensive care unit. This user-friendly text will enable nurses
to recognise, rationalise and remedy these problems using both a multi-systems
and an evidence-based approach. Individual chapters include:

EVIDENCE-BASED PRACTICE • DEVELOPMENTALLY FOCUSED NURSING CARE • FAMILIES IN NICU

• RESUSCITATION OF THE NEWBORN • MANAGEMENT OF THERMAL STABILITY • MANAGEMENT
OF RESPIRATORY DISORDERS •MANAGEMENT OF CARDIOVASCULAR DISORDERS • NEONATAL
BRAIN INJURY • MANAGEMENT OF HAEMATOLOGICAL DISORDERS • MANAGEMENT OF
NEONATAL PAIN • FLUID AND ELECTROLYTE BALANCE • NUTRITIONAL MANAGEMENT IN NICU
• NEONATAL INFECTION • DIAGNOSTIC AND THERAPEUTIC PROCEDURES • NEONATAL
ANAESTHESIA • NEONATAL SURGERY • NEONATAL TRANSPORT • MEDICATION IN THE
NEWBORN • BEREAVEMENT IN THE NICU • ETHICS AND NEONATAL NURSING

Neonatal Intensive Care Nursing will be essential reading for experienced

nurses and midwives caring for sick newborn babies within the neonatal
intensive care unit, for nurses undertaking qualifications in the specialism of
neonatal nursing and for pre-registration students undertaking relevant modules
or placements.

Glenys Boxwell (Connolly) is an Advanced Neonatal Nurse Practitioner for

Plymouth Hospitals NHS Trust. She was previously a senior lecturer at
Homerton College, Cambridge.
Neonatal Intensive
Care Nursing
Second Edition

Edited by
■ Glenys Boxwell
 First published 2010
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Simultaneously published in the USA and Canada
by Routledge
270 Madison Avenue, New York, NY 10016
Routledge is an imprint of the Taylor & Francis Group, an informa business

This edition published in the Taylor & Francis e-Library, 2010.

To purchase your own copy of this or any of Taylor & Francis or Routledge’s
collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.

© 2010 Glenys Connolly; the contributors, their chapters

All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying and recording,
or in any information storage or retrieval system, without permission
in writing from the publishers.
The publishers have made every effort to contact authors/copyright holders of
works reprinted in Neonatal Intensive Care Nursing. This has not been
possible in every case, however, and we would welcome correspondence
from those individuals/companies whom we have been unable to trace.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
Neonatal intensive care nursing / edited by Glenys Boxwell. — 2nd ed.
p. ; cm.
Includes bibliographical references and index.
1. Neonatal intensive care. 2. Newborn infants—Diseases—Nursing.
3. Intensive care nursing. I. Boxwell, Glenys, 1957-
[DNLM: 1. Intensive Care, Neonatal—methods. 2. Neonatal Nursing—methods.
3. Infant, Newborn, Diseases—nursing. 4. Infant, Premature,
Diseases—nursing. WY 157.3 N438 2010]
RJ253.5.N467 2010
618.92’01—dc2 2009034680

ISBN 0-203-85707-0 Master e-book ISBN

ISBN10: 0-415-47755-7 (hbk)

ISBN10: 0-415-47756-5 (pbk)
ISBN10: 0-203-85707-0 (ebk)

ISBN13: 978-0-415-47755-0 (hbk)

ISBN13: 978-0-415-47756-7 (pbk)
ISBN13: 978-0-203-85707-6 (ebk)
Contents

List of figures xv Practice-based evidence/

nursing-based evidence 11
List of tables xvii
Conclusion 12
Notes on contributors xix References 13
Preface xxiii
2 Developmentally Focused
Acknowledgements xxv
Nursing Care 16
List of abbreviations xxvii T ILLY R EID AND
Y VONNE F REER
Glossary xxxiii
Introduction 17
1 Exploring Evidence-based Theoretical approaches to
Practice (EBP) in Neonatal developmentally focused
Care 1 care 17
F IONA H UTCHINSON Sensory overload/deprivation 18
Introduction 2 Parent–infant attachment 19
What is evidence-based Behaviour 20
practice (EBP)? 2 Sleep–wake state scoring
Propositional knowledge systems 22
(scientific knowledge) 3 Behavioural assessment 24
Knowledge gained through The NICU environment 24
practice experience 6 Sound hazard 26
Personal experience 6 Light hazard 27
Knowledge from patients, Handling 28
clients and carers 7 Contingent care 29
Knowledge from a local context Postural support 30
(audit and evaluation) 8 Equipment 32
The use of evidence in Prone position 33
clinical decision-making 9 Supine position 33

v
CONTENTS

Side-lying position 34 Breathing 70

Developmental models of care 34 Circulation 72
Conclusion 36 Drugs 73
References 37 Meconium stained liquor 78
Evaluation of resuscitation 79
3 Families in NICU 40 How long should resuscitation
S UE T URRILL AND continue? 80
L IZ C RATHERN Conclusion 80
Case study 80
Introduction 41
References 81
Historical context of family
involvement 41
5 Management of
The environment 43
Thermal Stability 87
Becoming a parent 44
P AULINE F ELLOWS
Being a mother in NICU 44
Being a father in NICU: role Introduction 88
transition and role identity Embryology 88
– the forgotten parent 46 Mechanisms of heat gain 89
Fathers’ changing roles 46 Non-shivering thermogenesis 89
Signs of parental stress and Brown adipose tissue (BAT) 89
coping 48 Gluconeogenesis 91
Family nursing and support: Insulin 91
caring for the whole family 49 Noradrenaline 91
Family systems and assessment 51 The thyroid 91
Strategies for support: Thermal receptors 92
anticipating and reducing Vasoconstriction 92
stress 52 Thermoneutrality 92
General principles 52 Mechanisms of heat loss 93
More specific strategies 53 Radiation 93
Communication 54 Evaporation 93
Conclusion 57 Convection 94
Case studies 58 Conduction 94
Web-based resources for Heat exchanged through the
parents 60 respiratory tract 94
Acknowledgements 60 Surface area 94
References 61 Immature skin 95
Transepidermal water loss
4 Resuscitation of the (TEWL) 95
Newborn 65
Hypothermia 96
G LENYS C ONNOLLY
Cold stress 97
Introduction 66 Neonatal cold injury 98
Asphyxia 66 Re-warming in severe
Anticipation 68 hypothermia 98
The ABC (D and E) of Hyperthermia 99
resuscitation 69 Management of thermal
Airway 70 stability at delivery 99

vi
 CONTENTS

The healthy infant 100 Pneumonia 128

Delivery by Caesarean section 100 Congenital pneumonia 128
The infant with birth suppression 100 Early onset pneumonia 128
Meconium stained liquor 101 Late onset pneumonia 128
Infants with congenital Meconium aspiration
anomalies 101 syndrome (MAS) 129
The vulnerable infant, e.g. Persistent pulmonary
preterm or VLBW 101 hypertension of the
Management of thermal newborn 131
stability in NICU 103 Inhaled nitric oxide (iNO) 133
Radiant warmers 103 ECMO 133
Incubators 103 Trends in neonatal respiratory
Radiant warmers vs. incubators 104 care 134
Handling and temperature 105 Acid–base balance, gas
Humidity 105 transport and monitoring 135
TEWL and phototherapy 106 Non-invasive respiratory
Skin 107 support 138
Heated water-filled mattresses 107 Continuous positive airways
Thermal status during transport 108 pressure (CPAP) 138
Temperature measurement 108 CPAP delivery 138
Continuous monitoring 108 Modes of invasive ventilation 139
Intermittent temperature Continuous mandatory
recordings 109 ventilation (CMV) 140
Hypothermia as a treatment for Volume control (VC) 142
neonatal encephalopathy 109 Assist control ventilation (A/C) 142
Conclusion 110 Synchronised intermittent
Case studies 110 mandatory ventilation
References 111 (SIMV) 142
Pressure support ventilation
6 Management of (PSV) 143
Respiratory Disorders 121 High frequency oscillation
S IMONE J OLLYE AND ventilation (HFOV) 143
D AVID S UMMERS Weaning from invasive
ventilation 144
Introduction 122
Nursing care of the ventilated
The development of the
infant 144
respiratory system 122
Conclusion 146
Fetal lung fluid and fetal
Case study 146
breathing movements 123
References 147
Surfactant 123
Respiratory changes at birth 123
7 Management of
Respiratory distress
Cardiovascular Disorders 153
syndrome (RDS) 124
R OSARIE L OMBARD
Pulmonary interstitial
emphysema (PIE) 126 Introduction 154
Pneumothorax 126 Embryology of the
Pulmonary haemorrhage (PH) 127 cardiovascular system 154

vii
CONTENTS

Development of the primitive 8 Neonatal Brain Injury 185

heart 154 A NJA H ALE
Septation of the heart 155
Introduction 186
Blood vessels 156
Vulnerability of the neonatal
Cardiac conduction 157
brain 186
Fetal circulation 158
Germinal matrix and
Transitional neonatal circulation 158
intraventricular
Normal physiology 160
haemorrhage 187
Cardiac cycle 160
Aetiology 187
Cardiac output 160
Post-haemorrhagic
Regulation of neonatal
hydrocephalus (PHH) 190
circulation 161
Periventricular haemorrhagic
Neural regulation 161
infarction (PVHI) 190
Hormonal regulation 162
Pereventricular leukomalcia
History and clinical
(PVL) 190
examination 162
Hypoxic-ischaemic brain
History 163
injury in the term infant 191
Physical examination 163
Hypothermia for
Investigations 165
neuroprotection 194
Pathophysiology of common
Neonatal seizures 195
and relevant neonatal
Causes of seizures by time
conditions 166
of onset 196
PDA 166
Continuous brain function
Hypotension 168
monitoring 198
Persistent pulmonary
Other mechanisms of brain
hypertension of the
injury 199
newborn (PPHN) 170
Chorioamnionitis and brain
Arrhythmias 172
injury 199
Congestive heart failure
Hypoglycaemic injury to the
(CHF) 172
brain 199
Congenital heart defects
Conclusion 199
(CHD) 173
Case studies 200
Nursing considerations 177
References 202
Maximise oxygenation 177
Reduce oxygen
9 Management of
requirements 177
Haematological
Maximise comfort 177
Disorders 204
Maximise nutritional status 178
J ACKIE D ENT AND
Minimise infection risk 178
K ATIE M C K ENNA
Safe administration of drugs 178
Provide family support 179 Introduction 205
Innovative strategies and Jaundice 205
ongoing research 179 Bilirubin encephalopathy
Case study 180 and kernicterus 205
References 180 Physiology of bilirubin
Further reading 184 production 206

viii
 CONTENTS

Bilirubin metabolism and 10 Pain and Its

excretion 206 Management in NICU 230
Physiological K AYE S PENCE
jaundice 206
Introduction 231
Other causes of
Development of the pain
jaundice 207
pathways 231
Rhesus incompatibility 208
Outcomes of pain 232
ABO incompatibility 209
Early pain experiences 233
G6PD deficiency 209
NICU environmental influences 233
Jaundice associated with
Surgery 233
breastfeeding 210
Chronic pain 233
Measurement of jaundice 210
Expression of pain 234
Management of jaundice 211
Physiological response to pain 234
Phenobarbital 213
Behavioural responses to pain 234
Intravenous immunoglobulin
Endocrine/metabolic
(IVIG) 213
manifestations of pain 235
Metalloporphyrin 213
Assessment of pain 235
Phototherapy 214
Behavioural states 236
Methods of administration
Guidelines for a pain
of phototherapy 215
assessment 238
Exchange transfusion 216
Ensuring the reliability of staff
Vitamin K deficient
in using a pain assessment
bleeding (VKDB) 217
score 239
Coagulation 217
Management of pain 239
Sources of vitamin K 217
Comfort 239
Characteristics of vitamin K
Non-pharmalogical
deficient bleeding 218
interventions 240
Vitamin K prophylaxis 219
Pharmacological interventions 242
Disseminated intravascular
Post-operative pain
coagulation (DIC) 220
management 245
Management of DIC 220
Professional issues 246
Anaemia 221
Clinical guidelines and practice 246
Physiological anaemia 221
Caregiver knowledge and
Anaemia of prematurity 221
response to newborn pain 246
Causes of pathological
Ethical aspects of neonatal pain 246
anaemia 221
Families 247
Red blood cell
Conclusion 248
haemolysis 222
Case study 248
Signs and symptoms of
References 249
anaemia 223
Management of
11 Fluid and Electrolyte
anaemia 223
Balance 255
Conclusion 224
D EE B ERESFORD AND
Case studies 224
G LENYS C ONNOLLY
Acknowledgements 225
References 225 Introduction 256

ix
CONTENTS

Embryological development 256 Enteral nutrition 289

Physiology of urine production 256 Methods 290
Sodium balance 257 Specific problems in NICU 292
Hyponatraemia 258 Family support 293
Hypernatraemia 259 Conclusion 295
Potassium balance 259 Case studies 295
Hypokalaemia 259 References 296
Hyperkalaemia 260
Chloride balance 261 13 Neonatal Infection 302
Calcium and phosphate G LENYS C ONNOLLY
balance 261
Introduction 303
Water management 262
Acquisition of antenatal
Fluid requirements 262
Monitoring fluid balance 263 infection 303
Accurate measurement of body Acquisition of intrapartum
weight 263 (vertical) infection 305
Measurement of urine volume 263 Late onset and nosocomial
Urinalysis 264 infection 306
Glucose homeostasis 265 The susceptible host 308
Renal handling of glucose 267 Signs of neonatal sepsis 311
Hypoglycaemia 267 Respiratory signs 312
Management of hypoglycaemia 267 Thermal signs 312
Hyperglycaemia 268 Cardiovascular signs 312
Skin signs 312
Acute renal failure 269
Gastrointestinal signs 313
Investigations 270
Neurological signs 313
Management of ARF 271
Investigations 313
Dialysis 272
Surface swabs and site cultures 315
Peritoneal dialysis (PD) 272
Haematological tests 315
Continuous arteriovenous
Cerebrospinal fluid 316
haemofiltration (CAVH) 273
Urine 317
Conclusion 275
Management of the infected
Case studies 275
newborn 317
Acknowledgements 276
General supportive therapy 317
References 276
Acid base balance 318
12 Nutritional Management Fluid and electrolyte balance 319
of the Infant in NICU 279 Haematological management 319
K AYE S PENCE Antimicrobial therapy 319
Penicillins 320
Introduction 280 Aminoglycosides 321
The gastrointestinal system 280 Aztreonam 321
Outcomes of nutrition 282 Cephalosporins 321
Growth 283 Vancomycin and teicoplanin 321
Assessment 285 Metronidazole 322
Feeding the NICU infant 287 Chloramphenicol 322
Requirements 287 Adjunctive therapies 322
Parenteral nutrition 287 Conclusion 323

x
 CONTENTS

Case study 323 Associated congenital/

References 324 chromosomal anomalies 366
Familial anaesthetic problems 366
14 Diagnostic and Pre-operative investigations
Therapeutic Procedures 329 and preparation 367
E LIZABETH H ARLING AND Investigations 367
G LENYS C ONNOLLY Preparation 369
Premedication 369
Introduction 330
Transfer to the operating
General issues surrounding
theatre 370
procedures 330
Intra-operative management 370
Pain management 330
Induction of anaesthesia 370
Skin preparation 330
Intravenous induction 370
Gastric tube placement 331
Inhalation induction 371
Naso/oro-gastric tube 331
Airway management 371
Transpyloric tube 333
Maintenance of anaesthesia 372
Blood sampling 334
Oxygen and retinopathy of
Capillary blood sampling 334
prematurity 372
Venous blood sampling 336
Emergence from anaesthesia
Arterial blood sampling 337
and extubation 372
Peripheral artery cannulation 339
Analgesia 372
Peripheral vein cannulation 340
Opioids 373
Percutaneous venous longline 343
Morphine 373
Umbilical vessel
Fentanyl 373
catheterisation 345
Remifentanil 374
Umbilical artery
Paracetamol 374
catheterisation 345
Non-steroidal anti-
Umbilical vein catheterisation 348
inflammatory drugs 374
Lumbar puncture 349
Local anaesthesia 374
Urine sample collection 351
Wound infiltration 375
Urethral catheterisation 351
Peripheral nerve blocks 375
Suprapubic aspiration 352
Central (neuro-axial) blocks 375
Endotracheal tube placement 353
Caudal epidural anaesthesia 376
Chest drain placement 356
Lumbar and thoracic epidural
Case study 359
anaesthesia 376
Acknowledgements 361
References 361 Spinal anaesthesia 377
Fluid therapy 377
Maintenance of fluid 377
15 Neonatal Anaesthesia 363
Replacement of fluid lost by
B EVERLEY G UARD ,
evaporation/sequestration 378
L IAM B RENNAN AND
Replacement of blood loss 378
R ACHEL H OMER
Anaesthetic equipment 379
Introduction 364 Airway equipment 379
Pre-operative assessment 364 Other equipment 381
Problems of prematurity Equipment for maintenance
affecting anaesthesia 364 of body temperature 382

xi
CONTENTS

Equipment for intravenous Hirschsprung’s disease 404

fluid administration 383 Anorectal anomalies 405
Anaesthetic monitoring 384 Congenital diaphragmatic
Cardiovascular monitoring 384 hernia (CDH) 406
Blood pressure 384 Abdominal wall defects 410
Precordial and oesophageal Hydrocoele 413
stethoscope 384 Most commonly encountered
Respiratory monitoring 385 acquired disorders 413
Pulse oximetry 385 Necrotising enterocolitis (NEC) 413
Capnography 385 Spontaneous bowel perforation 415
Temperature monitoring 385 Miscellaneous disorders 415
Post-operative care 385 Cystic hygroma 415
Post-operative apnoeas 386 Teratoma 416
Post-extubation stridor 386 Ovarian cyst 417
Assessing the need for Testicular torsion 417
post-operative ventilation 386 Biliary atresia 417
Signs of respiratory distress 387 Conclusion 418
Conclusion 387 Case study 418
Case study 388 Acknowledgements 419
Acknowledgements 388 References 419
References 388
17 Neonatal Transport 425
16 Neonatal Surgery 392 S TEVIE B OYD AND
S TEVIE B OYD AND A NNE M ITCHELL
A NNE A SPIN
Introduction 426
Introduction 393 Personnel and training 427
General principles of Equipment 429
management 393 Mode of transport 430
Thermoregulation 394 Risk management 432
Respiratory function 394 The emergency transport
Gastric decompression 394 process 433
Fluid and electrolyte balance 394 At the referring unit 434
Pharmacological support 395 In the receiving unit 436
Transportation 396 Legal aspects of transport 437
Post-operative considerations 396 Areas for development 437
Most commonly encountered Conclusion 438
congenital disorders 396 Case study 438
Oesophageal atresia (OA) Acknowledgements 439
and tracheo-oesophageal References 439
fistula (TOF) 396
Mechanical intestinal
18 Medication in the
obstruction 400
Newborn 441
Duodenal atresia 401
C ATHERINE H ALL AND
Small bowel atresia 401
P ETER M ULHOLLAND
Malrotation with volvulus 403
Meconium ileus 404 Introduction 442

xii
 CONTENTS

Unlicensed medicines 442 Registering the birth and

Nurse prescribing 444 death 467
Pharmacokinetics 444 Perinatal autopsy 467
Therapeutic drug monitoring Funerals 468
(TDM) 449 Remembering 468
Drug administration 450 Conclusion 469
Conclusion 451 References 469
Case study 451
Acknowledgements 452 20 Ethics and Neonatal
References 452 Nursing 472
H ELEN F RIZELL
19 Bereavement in
Introduction 473
NICU 455
Ethical theories: an overview 473
J OAN C AMERON
Utilitarianism or
Introduction 456 consequentialism 474
Defining loss 456 Deontological or Kantian
Context of neonatal loss in theory 474
the UK 456 Virtue-based theory 474
Grief, bereavement and Rights-based theory 474
mourning 457 Ethical principles 476
Bereavement 457 Respect for autonomy 476
Mourning 457 Non-maleficence 477
Grief 458 Beneficence 478
Fathers’ experience of loss 458 Justice 478
Anticipatory grief 459 Fetal rights 480
Remembering anniversaries 460 Should fetal rights exist? 481
Theory and loss 460 Respecting parental autonomy:
‘Stages’ or ‘phase’ models 460 the giving of informed
‘Grief work’ models 461 consent 482
‘Continuing bonds’ model 461 Ethics in practice 483
Cultural elements of loss 462 Conclusion 485
Caring for the dying baby 462 Case study 486
Interventions 462 Legal references 487
Special circumstances 463 Cases cited 487
Multiple births 463 Statutes 488
Withholding and withdrawing References 488
active treatment 464
Sharing information 466 Appendix: Normal values
Supporting parents 466 in the neonate 491

Index 493

xiii
Figures

Figure 2.1 Postural support: (a, b) prone position; (c, d) supine position;
(e) side-lying position 31
Figure 2.2 Family-centred developmental model of care 36
Figure 3.1 Parents required to ‘gown up’ to hold their baby, circa 1970 42
Figure 3.2 The whirlpool of parents’ feelings on admission to NICU 49
Figure 5.1 The mechanisms of non-shivering thermogenesis 90
Figure 5.2 The regression of transepidermal water loss at different
postnatal ages 96
Figure 5.3 The effects of cold stress 98
Figure 5.4 The thermal problems facing vulnerable infants 102
Figure 6.1 Ventilation loop 140
Figure 6.2 Ventilation wave form 1 140
Figure 6.3 Ventilation wave form 2 141
Figure 7.1 The heart tubes fuse to form a single heart tube 155
Figure 7.2 (a) The spiral form of the aorticopulmonary septum 156
(b) The spiral effect allows the vessel to twist upon itself
as it divides to form the aorta and pulmonary artery 156
Figure 7.3 Schematic illustration of the fetal circulation 159
Figure 9.1 Physiology of bilirubin production 207
Figure 9.2 Suggested treatment levels of jaundice 211
Figure 9.3 Disseminated intravascular coagulation 220
Figure 10.1 A noxious stimulus such as a heel lance produces a variety
of measurable responses in infants 232
Figure 10.2 Algorithm for the management of procedural pain 242
Figure 11.1 Diagram of an infant receiving peritoneal dialysis 273
Figure 11.2 Continuous arteriovenous haemofiltration 274
Figure 14.1 Capillary blood sampling; shaded area indicates ‘safe’ area
for heel prick 335
Figure 14.2 Arterial puncture sampling right radial artery 338

xv
FIGURES

Figure 14.3
Venous cannulation dorsum of left hand 341
Figure 14.4
Endotracheal intubation, head in mid-line with slight extension 355
Figure 14.5
(a) Chest X-ray (b) Abdominal X-ray 359–60
Figure 15.1
Profile view of an infant with Pierre-Robin syndrome 366
Figure 15.2
Insertion of a caudal epidural block 376
Figure 15.3
Anaesthetic face masks 379
Figure 15.4
Tracheal tubes 381
Figure 15.5
T-piece breathing system 382
Figure 16.1
General post-operative considerations following major surgery 397
Figure 16.2
Radiograph showing a classic ‘double bubble’ 402
Figure 16.3
Radiograph showing a left-sided diaphragmatic hernia shortly
after birth 407
Figure 16.4 Chest radiograph following surgical repair of diaphragmatic
hernia 409
Figure 20.1 Ethical decision-making using Gibb’s reflective cycle 484

xvi
Tables

Table 2.1 Sleep–wake state scoring systems 23

Table 2.2 Stress and stability signals 25
Table 3.1 General principles of support 52
Table 3.2 COPE (Creating Opportunities for Parent Empowerment)
intervention programme for reducing parental stress and
improving parent–infant relationships 55
Table 5.1 Comparison of incubators and radiant warmers 104
Table 5.2 Guidelines for humidity settings 106
Table 6.1 Acceptable blood gas results for infants requiring respiratory
support 135
Table 6.2 Relationships between blood gas parameters and acid–base
status 136
Table 7.1 Most common environmental triggers and specific defects
associated with each 157
Table 8.1 Mechanisms of injury 192
Table 8.2 Neonatal seizures (in order of decreasing frequency) 197
Table 8.3 Classification of aEEG traces in full-term infants 198
Table 9.1 Causes of jaundice 208
Table 9.2 Investigations of jaundice related to timing of onset 212
Table 9.3 Blood clotting factors 218
Table 10.1 Some frequently used pain assessment tools 237
Table 10.2 Suggested wording for parents’ information brochure to
support their infants during a painful procedure 247
Table 11.1 Reasons for sodium imbalances 258
Table 11.2 Reasons for potassium imbalances 260
Table 11.3 Infants at risk of hypoglycaemia 267
Table 11.4 Infants at risk of hyperglycaemia 269
Table 11.5 Causes of renal failure in infants 270
Table 11.6 Indices of renal failure in infants 271
Table 12.1 Considerations for feeding readiness 285

xvii
TABLES

Table 12.2 Effects of neonatal diseases on specific nutrient requirements 288

Table 13.1 Definitions used in neonatal infection 303
Table 13.2 Risk factors for nosocomial infection 308
Table 13.3 The likelihood ratios of clinical findings for neonatal
bacterial infections 314
Table 14.1 Gastric tube length estimation in centimetres 332
Table 14.2 Percutaneous longline length measured in centimetres 343
Table 14.3 Umbilical arterial catheter length 346
Table 14.4 Umbilical venous catheter length 348
Table 14.5 Anatomical reference points seen on chest and abdominal
X-rays relevant to the procedures 353
Table 14.6 Endotracheal tube size estimation 354
Table 15.1 Pre-operative fasting times for neonates and infants 369
Table 15.2 Size and length of tracheal tubes for neonates 380
Table 16.1 Causes of intestinal obstruction 401
Table 18.1 A comparison of serum theophylline in children and adults 449
Table 18.2 Plasma elimination half-lives (in hours) of some drugs given
to neonates 450

xviii
Contributors

Anne Aspin has been Nurse Consultant for Neonatal Surgery within the
Yorkshire Neonatal Network and Leeds Teaching Hospitals NHS Trust since
October 2004.
Dee Beresford is Editor of the Journal of Neonatal Nursing and has affiliation
with the Neonatal Nurses Association.
Stevie Boyd was a Senior Staff Nurse in the Neonatal Intensive Care Unit,
Norfolk and Norwich Healthcare NHS Trust. She was also an editorial adviser
to the Journals Infant and the Journal of Neonatal Nursing.
Liam Brennan is a Consultant Paediatric Anaesthetist at Addenbrooke’s
Hospital, Cambridge. He trained in paediatric anaesthesia at the Hospital for
Sick Children, Great Ormond Street, London. He has published in the areas of
pre-operative assessment of children, day case anaesthesia and post-operative
nausea and vomiting.
Joan Cameron is a Lecturer in Nursing and Midwifery at the University of
Dundee.
Glenys Connolly is an Advanced Neonatal Nurse Practitioner for Plymouth
Hospitals NHS Trust.
Liz Crathern has been a Neonatal Nurse since 1980 and in neonatal education
since 1992. Her research interests focus on the family in NICU, she is writing
up her doctoral study on the experiences of first-time fathers in NICU.
Jackie Dent is a former Nurse Teacher at the University of Nottingham School
of Nursing and was Course Leader for the Neonatal Nursing programmes.
Pauline Fellows is Neonatal Project Facilitator (NSC Network and Cambridge)
at Cambridge University Hospitals Trust, UK.

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