Clinical predictors

In the management of NEC, the nurse plays a vital and important role since “nurses are best able to observe clinical changes in preterm newborns because they spend the most time providing care and therefore must be vigilant in observing for subtle signs to effect early diagnosis and treatment” (Yeo, 2006, p. 47). Therefore, it is also important that the nurse has knowledge of the types of medical and surgical intervention to enable the bedside nurse to provide the best care for an newborn with NEC and guide and help his or her family throughout the disease process (Yeo, 2006, p. 47).

Interventions usually employed by a nurse in the management of NEC preterms include physical assessments of all newborns to detect early and subtle changes in the newborn’s condition. Therefore, frequent and thorough head-to-toe assessments are essential to the successful detection and management of NEC (Carter, 2007, p. 382; Yeo, 2006, p. 49). “The nurse must pay particular attention to the gastrointestinal system and the infant’s feeding tolerance, as changes associated with NEC may initially be quite minuscule.

Small changes in the abdomen (color, increase in girth, changes in firmness or tenderness) should be reported immediately for further evaluation by a physician or neonatal nurse practitioner” (Carter, 2007, p. 382). Furthermore, the nurse must pay particular attention to preterm infants who experience perinatal and neonatal events involving compromised oxygenation and/or blood flow and these NEC risk factors: abruptio placentae, low Apgar scores, apnea, and bradycardia (Carter, 2007, p. 382). In addition, nurses must also employ pain assessment and reduction strategies when caring for NEC neonates (Yeo, 2006, p. 49).

It is important to decrease the level of stress experienced by the infant. Cluster care activities with designated periods of rest, removal of noxious environmental stimuli, and careful handling in order to decrease stress and facilitate healing. The nurse must also be proactive in using pain scores. If the infant is intubated, suction the endotracheal tube only as needed to maintain patency. Suctioning an unstable infant can contribute to episodes of oxygen desaturation, shifts in blood pressure, and increases in pain scores (Carter, 2007, p. 383).

It is also important that the nurse maintains the chain of sterility or asespsis in caring for NEC patients. Therefore, handwashing and unit cleanliness, glove removal immediately after use, not touching equipment and then the newborn, and frequent handwashing before, during, and after newborn care must be strictly observed (Yeo, 2006, p. 49). It is also important that nurses police all those who have contact with the preterm infant to ensure that proper hand washing techniques are performed (Carter, 2007, p. 382).

Lastly, the nurse must be able to recognize emotional, psychologic, and financial needs of the NEC patient. Nurses should help guide parents and find support systems when necessary and make certain that the parents are frequently updated on the infant’s medical condition (Carter, 2007, p. 383; Yeo, 2006, p. 49). The nurse must be aware that complications interfere with initial attachment between the parent and the child which makes it important to include the parents in their newborn’s care and promote breast pumping to help empower the mother.

It is essential that the nurse is able to listen to parents and encourage them to discuss their fears and stresses so that parents could be encouraged to engage with their newborn, as tolerated, to promote attachment and parent care skills (Yeo, 2006, p. 49). References Aly, H. , Massaro, A. N. , Patel, K. and El-mohandes, A. A. E. (2005). Is It Safer to Intubate Premature Infants in the Delivery Room? Pediatrics 115(6):1660-1665. American Academy of Pediatrics. Bell, E. F. (2004). Preventing Necrotizing Enterocolitis: What works and how safe?

Pediatrics 173-174. American Academy of Pdiatrics. Carter, B. M. (2007). Treatmnt outcomes of Necrotizing Enterocolitis for preterm infants. JOGNN 36(4):377-384. Association of Women’s Health, Obstetric and Neonatal Nurses. Carter, B. M. , Holditch-Davis D. (2008). Risk factors for Necrotizing Enterocolitis in preterm infants – how race, gender, and health status contribute. Advancs in Neonatal Care 8(5):285-290. Gregory, K. E. (2008). Clinical predictors of Necrotizing Enterocolitis in premature infants. Nursing Research 57(4): 260-270.

Lippincott Williams and Wilkins. Kawase, Y. , Ishii, T. , Arai, H. and Uga, N. (2006). Gastrointstinal perforation in very low-birthweight infants. Pediatrics International 48:599-603. Thompson, A. M. and Bizzarro, M. J. (2008). Necrotizing Enterocolitis in newborns – pathogenesis, prevention and management (review). Drugs 68(9):1227-1238. Adis Data Information BV. Yeo, S. L. (2006). NICU Update: State of the Science NEC. Journal of Perinatal & Neonatal Nursing 20(1):46-50. Lippincott Williams and Wilkins, Inc.

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