NEONATAL NURSING

Neonatal nursing is a subspecialty of nursing care for newborn infants up to 28 days after birth.
The term neonatal comes from neo, "new", and natal, "pertaining to birth or origin". Neonatal
nursing requires a high degree of skill, dedication and emotional strength as the nurses care
for newborn infants with a range of problems, varying between prematurity, birth
defects, infection, cardiac malformations and surgical problems. Neonatal nurses are a vital part
of the neonatal care team and are required to know basic newborn resuscitation, be able to
control the newborn's temperature and know how to initiate cardiopulmonary and pulse oximetry
monitoring.[1] Most neonatal nurses care for infants from the time of birth until they are
discharged from the hospital. Approximately 40,000 low-birth-weight infants are born annually in
the United States.

Levels
There are four different levels of neonatal nursery where a neonatal nurse might work.[2] The
updated classification of neonatal levels by the American Academy of Pediatrics (AAP) includes
a Level IV.
 Level I consists of caring for healthy newborns. Level I nurseries are now uncommon in the
United States. Healthy babies typically share a room with their mother, and both patients are
usually discharged from the hospital quickly.[3]
 Level II provides intermediate or special care for premature or ill newborns. At this level, infants
may need special therapy provided by nursing staff, or may simply need more time before being
discharged.
 Level III, the Neonatal intensive-care unit (NICU), treats newborns who cannot be treated in the
other levels and are in need of high technology to survive, such as breathing and feeding tubes.
Nurses comprise over 90 percent of the NICU staff.[4]
 Level IV includes all the skills of the level III but involves the extensive care the most critically
and complex newborns. This facility will have 24-hour resident neonatologists and surgeons.
They are involved with intricate surgical repairs like congenital cardiac issues and acquired
malformations.[5]

Changes in neonatal care

Neonatal care became a specialty in the United States in 1960 and that is the same year that
the first NICU was established in the United States. There have been some major changes in
the Neonatal Care over the past 120 years. Some of these changes include the invention of the
incubator, changes in respiratory care, and the development of surfactants.
 The incubator
 In 1880, Dr. Tarnier was convinced that the maintenance of internal temperature was key to the
premature infant's survival. This led him to introduce the first human incubator. He saw an
incubator in use for hatching dogs

by a zookeeper, and asked the zoo keeper to design a similar

incubator for premature infants.

 Dr. Delee expanded the use and function of the incubator by incorporating an oxygen chamber
and an electric controlled thermostat which allowed the incubator to be transported in
ambulances.

Respiratory care
 The survival rate of neonates has greatly improved since the discovery of oxygen use in preterm
infants.
 Oxygen administration began with a metal forked device in the nostrils, it is now administered
through thin plastic tubes in the nostrils, also known as a nasal cannula.
 The first ventilation of an infant was in 1961 in a positive pressure situation, and mechanical
ventilation was improved in 1971.
 CPAP masks were first used in 1973 as an alternate less invasive form of support.

Surfactants
 In 1980, the first study of the use of surfactants on infants took place in Japan.
 Surfactant therapy since has improved the infant morality rate by 50%.
 Surfactants combined with the least invasive respiratory therapy (bubble CPAP or nasal CPAP)
has greatly improved the infant mortality rate in the US.

Qualifications and requirements

United StatesEdit
Healthcare institutions have varying entry-level requirements for neonatal nurses.
Neonatal nurses are Registered Nurses (RNs), and therefore must have an Associate of
Science in Nursing (ASN) or Bachelor of Science in Nursing (BSN) degree. Some countries
or institutions may also require a midwifery qualification.[6] Some institutions may accept
newly graduated RNs who have passed the NCLEX exam; others may require
additional experience working in adult-health or medical/surgical nursing.[2]
Some countries offer postgraduate degrees in neonatal nursing, such as the Master of
Science in Nursing (MSN) and various doctorates. A nurse practitioner may be required to
hold a postgraduate degree.[6] The National Association of Neonatal Nurses
recommends two years' experience working in a NICU before taking graduate
classes.[2]
As with any registered nurse, local licensing or certifying bodies as well as employers
may set requirements for continuing education.[2]
There are no mandated requirements to becoming an RN in a NICU, although neonatal
nurses must complete the Neonatal Resuscitation Program. Some units prefer new
graduates who do not have experience in other units, so they may be trained in the
specialty exclusively, while others prefer nurses with more experience.
Intensive care nurses receive intensive didactic and clinical orientation, in addition to
their general nursing knowledge, to provide highly specialized care for critical patients.
Their competencies include the administration of high-risk medications, management of
high-acuity patients requiring ventilator support, surgical care, resuscitation, advanced
interventions such as extracorporeal membrane oxygenation or hypothermia therapy for
neonatal encephalopathy procedures, as well as chronic-care management or lower acuity
cares associated with premature infants such as feeding intolerance, phototherapy, or
administering antibiotics. NICU RNs undergo annual skills tests and are subject to
additional training to maintain contemporary practice.

Roles and responsibilities

Duties of a neonatal nurse usually include supplying vital nutrients to newborns, changing
feeding tubes, administering medication, observing vital signs, performing intubations and using
monitoring devices. In the common situation where premature and sick newborns' lungs are not
fully developed, they must be certain infants are breathing and maturing properly. Neonatal
nurses work together with upper-level nurses and physicians and facilitate treatment plans and
examinations. They have regular interaction with patients' families, therefore are required to
educate parents or relative on the infant's condition and prepare care instructions after the infant
is discharged from the hospital. If parents have questions which neonatal nurses are incapable
of answering, they may direct them to another medical staff member who is able to.

Academy of Neonatal Nursing

The Academy of Neonatal Nursing was founded in 2001 and serves as a professional
organization for neonatal nurses. Nurses who belong to the organization have the ability to
locate continued education, apply for scholarships and awards, and receive other benefits. They
can also receive the Academy's healthcare journal.

APGAR scoring
All nurses working in a birthing centre have an important role in assessing the newborn
immediately after birth. The assessment of the neonate's appearance (colour), pulse
(heart rate), grimace (in response to unpleasant stimuli such as bulb suctioning the
pharynx), activity (muscle tone and/or movement), and respiratory effort via the APGAR
scoring system is essential to guide the baby's care (see Understanding
the APGARscoring system). The nurse is often directly responsible for assigning the
APGAR scores at 1 and 5 minutes of life. Each of the five assessment areas is given a
score of 0, 1, or 2. The maximum score possible is 10. Scores of 7 or above are
 considered normal for full-term newborns. If the total score is below 7, or any area is
scored 0 at 5 minutes of life, resuscitation efforts and scoring should continue every 5
minutes until 20 minutes of life.
Beyond assessing the five components that make up the APGAR score, it's essential to
understand its meaning. The APGAR score assigned at 1 minute of life reflects how the
fetus tolerated the in utero environment and/or the labor and delivery process. All
subsequent APGAR scores reflect the newborn's response to interventions during the
transition from intrauterine to extrauterine life. These nursing interventions include
keeping the baby warm, stimulating the baby to breathe, giving breaths to the baby who
isn't breathing well, and performing chest compressions if needed.

References
1. Pieron, Petri. "Nursing made incredibly easy!". Neonatal nursing care 101. Lippincott Williams
and Wilkins. 10 (5). doi:10.1097/01.NME.0000418034.61512.67.
2. ^ a b c d "Neonatal Nurse". Nurses for a Healthier Tomorrow. Nurses for a Healthier Tomorrow.
Retrieved October 26, 2010.
3. ^ Selga, Anna May A. "Hospital Length of Stay and Readmission Rates for Normal Deliveries: a
controlled evaluation". Ilocos Training and Regional Medical Center. Manila: Department of
Health, Republic of the Philippines. Archived from the original on April 23, 2007.
Retrieved October 26, 2010.
4. ^ Whitfield, Jonathan M.; Peters, Beverly A.; Shoemaker, Craig (July 2004). "Conference
summary: a celebration of a century of neonatal care". Proceedings. Dallas: Baylor University
Medical Center. 17 (3): 255–258. PMC 1200660. PMID 16200108.
5. ^ "Levels of Neonatal Care". Committee on Fetus and Newborn. American Academy of
Pediatrics. 2012. Retrieved June 5, 2013.
6. ^ a b "Frequently Asked Questions". Global Unity for Neonatal Nurses. Boston: Council of
International Neonatal Nurses. 2009. Retrieved October 26, 2010.
7. ^ "Neonatal Nurse". Plotr. Retrieved 16 May 2016.
8. ^ "Neonatal Nurse Salary". Salary Voice. 2015. Retrieved 16 May2016.
9. ^ "Neonatal Nursing". ACNN.
10. ^ "What Are the Duties of a Neonatal Nurse?". learn.org. Retrieved 2016-05-17.
11. ^ "NICU RN: Job Description, Requirements and Duties". Study.com. Retrieved 2016-05-17.

External links
 Association of Women's Health, Obstetric and Neonatal Nurses
 The Academy of Neonatal Nursing
 Pre Conception& Neonata