Sandra A. Banta-Wright

Tandem mass spectrometry in newborn screening: a primer for neonatal and perinatal nurses.

Since 1961, newborn screening for errors of metabolism (EM) has improved the diagnosis, treatment and outcome of newborns with an EM. Recently, advances in laboratory technology with tandem mass spectrometry (MS/MS) has increased the identification of newborns with an EM. With a single dried filter paper blood spot (Guthrie R, Susi A. A simple phenylalanine method for detecting PKU in large populations of newborn infants. Pediatrics. 1963;32:338-343), MS/MS can identify more than 30 disorders of metabolism. This review will explore MS/MS to provide a better understanding of the development and application of this technology to newborn screening for perinatal and neonatal nurses.

Neonatal Skin Disorders: A Review of Selected Dermatologic Abnormalities

The skin serves many purposes, acting as a barrier to infection, protecting internal organs, contributing to temperature regulation, storing insulating fats, excreting electrolytes and water, and providing tactile sensory input. This article focuses on a review of normal skin structure and function and selected neonatal skin disorders. The disorders reviewed are Staphylococcal scalded skin syndrome, epidermolysis bullosa, and the ichthyoses. The basis for each skin disorder is presented. Nursing management and skin care are incorporated into the review of each selected disorder.

Breast-feeding Success Among Infants With Phenylketonuria

Breast milk is the nutrition of choice for human infants (American Academy of Pediatrics, 2005; American Association of Family Physicians, 2008; Association of Womens Health Obstetric and Neonatal Nurses, 2005; Canadian Paediatric Society, 2005; U.S. Preventive Services Task Force, 2008; World Health Organization, 2009). In comparison to standard commercial formula, human breast milk has a lower concentration of protein and a lower content of the amino acid phenylalanine (Phe). For infants with phenylketonuria (PKU), these attributes of human breast milk make it ideal as a base source of nutrition. The purpose of this study was to compare the incidence and duration of breast-feeding and corresponding Phe levels of breast-fed and formula-fed infants with PKU in the caseload of a pediatric metabolic clinic at an urban tertiary-care medical center. Charts were reviewed for infants diagnosed with PKU beginning with 2005 and ending with 1980, the year no further breast-feeding cases were identified in the PKU population. During the first year of life, most of the infants, whether breast-fed or formula-fed, had similar mean Phe levels. However, the frequency distributions revealed that more breast-fed infants with PKU had Phe levels within the normal range (120-360 μmol/L) and were less likely to have low Phe levels (<120 μmol/L) than formula-fed infants with PKU. Further research is needed to understand how mothers manage breast-feeding in the context of PKU.

Minimizing infant exposure to and risks from medications while breastfeeding.

The advantages of breastfeeding to the mother and newborn are many. Lactating mothers frequently ask about the safety of taking medications and the risk to their newborn. It is well established that all drugs are excreted into breast milk. However, most medications appear in only small amounts within the breast milk. With the availability of numerous resources on drug use while breastfeeding, a medication can be identified as contraindicated or compatible with breastfeeding. By understanding the anatomy of the breast, principles of lactation, and drug passage into breast milk, an approach to minimize the transfer of the medications in the breast milk to the newborn can be developed. The plan should usually support and encourage the mother to continue to breastfeed her infant.

Combining the roles of clinical nurse specialist and neonatal nurse practitioner: the experience in one academic tertiary care setting.

The roles of clinical nurse specialist (CNS) neonatal nurse practitioner (NNP) have originated and evolved to meet specific needs in the nursing and medical community. The CNS role was developed in response to the perception that patient care needed to be improved; the NNP role resulted from an acute shortage of physicians to provide neonatal medical management. While on the surface these two roles may appear to be vastly different, many facets of each may be effectively interfaced. The NNP-CNS practice at Doernbecher Neonatal Care Center is an example of successful convergence of the two roles. The implementation of the combined practice is described in this article.

Not So Rare: Errors of Metabolism during the Neonatal Period

Abstract During the neonatal period, the diagnosis of an error of metabolism (EM) was once thought to portend a poor prognosis or lethality. Over the past two decades, the prognosis of many EMs has changed. The critical aspect of the metabolic evaluation in a sick newborn is to rapidly identify whether there may be a metabolic problem. If there is a metabolic problem, the goal is to minimize the sequelae of the specific disorder. This review will explore how to approach and evaluate a newborn suspected of having an EM. A discussion of clinical and laboratory findings that often accompany EM will be included.