Neuroprotection in the Preterm Infant: Further Understanding of the Short- and Long-term Implications for Brain Development

Neuroprotection is not a new term; it has been around for a considerable length of time in the laboratory and scientific world. It is, however, a new term in the clinical environment of the neonatal intensive care unit. Over time, the definition of neuroprotection has become more global, and as such, many of the developmental supportive activities now found in many neonatal intensive care units can be said to be neuroprotective. As we learn more about how the brain develops, we are more able to support and enhance its appropriate development in ways that lead to optimal outcomes. Neuroprotective strategies are one such avenue that needs further attention in the clinical setting.     

Understanding the Inflammatory Response of the Neonate: Clinical Implications for Caregivers in the Neonatal Intensive Care Unit

Nurses who care for preterm infants within the neonatal intensive care unit (NICU) face a multitude of challenges. An issue of major importance is supporting the immature immune response that when left unchecked makes young and preterm infants especially vulnerable to infection. Research has shown that the neonate's inflammatory response is moderately effective yet not well differentiated, which can lead to additional tissue destruction. This article examines the pathophysiology of the inflammatory process and discusses the influence that inflammation has on the infant before and after birth. Links between neonatal sepsis and neurologic insults such as intraventricular hemorrhage and periventricular leukomalacia are discussed. These insults have been associated with poor neurodevelopmental outcomes. Nursing interventions and management strategies are provided to best support the infant during this critical process. An understanding of the infant's immune system and the inflammation process will enhance the neonatal caregiver's ability to consider and provide preventative measures in routine care practices.     

Transforming Health Care from the Inside Out: Advancing Evidence-Based Practice in the 21st Century

Health care is in need of change. Major professional and health care organizations as well as federal agencies and policy-making bodies are emphasizing the importance of evidence-based practice (EBP). Using this problem solving approach to clinical care that incorporates the conscientious use of current best evidence from well designed studies, a clinician's expertise, and patient values and preferences, nurses and other health care providers can provide care that goes beyond the status quo. Health care that is evidence-based and conducted in a caring context leads to better clinical decisions and patient outcomes. Gaining knowledge and skills in the EBP process provides nurses and other clinicians the tools needed to take ownership of their practices and transform health care. Key elements of a best practice culture are EBP mentors, partnerships between academic and clinical settings, EBP champions, clearly written research, time and resources, and administrative support. This article provides an overview of EBP and offers recommendations for accelerating the adoption of EBP as a culture in education, practice and research.