Guest Editorial

Article Outline

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Issues related to the gastrointestinal (GI) system are an integral aspect of providing optimal care to infants in both the neonatal intensive care unit and during the first year of life. Abnormalities of the GI tract can include congenital abnormalities, iatrogenic disorders, and conditions associated with immaturity. The presence of a GI tract abnormality is associated with a significantly increased mortality and morbidity during the neonatal period.

The provision of optimal nutrition is another critical component of quality neonatal care. Although the typical very low-birth-weight infants are born average for gestational age, by the time they are discharged from the intensive care unit, most will be small for gestational age. Less than adequate nutrition can be associated with or can exacerbate other conditions such as infection and chronic lung disease and can negatively impact an infant's future growth and development. This issue of Neonatal and Infant Nursing Reviews covers many of the important elements surrounding both nutrition and nursing care of infants with diagnosed abnormalities of the GI system.

The lead article by Jennifer Harris provides an in depth overview of short-gut syndrome. Currently, short-gut syndrome is a significant cause of mortality and morbidity in infants after GI surgery due to necrotizing enterocolitis (NEC) and other abnormalities of the GI system. Several new and innovative therapies are currently being investigated; and these articles provide information on pathophysiology, treatment controversies, and current standards of care. Many of these treatments may ultimately increase the long-term survival rate for these unfortunate infants.

The most common cause of short-bowel syndrome is NEC. This is a poorly understood condition associated with a significantly increased mortality and morbidity. After decades of research, the etiology of this condition remains poorly understood. The article by Katherine Gregory provides an interesting overview of the risk factors potentially related to the development of NEC. To truly impact the incidence of short-bowel syndrome, it is critical that we decrease the incidence of NEC. Such a decrease is only possible if neonatology develops a clear understanding of the risk factors, etiology, and pathophysiology of NEC.

Hirshsprung disease is one of the most common causes of intestinal obstruction in both the neonate and older infant. When properly recognized and treated, the prognosis for this condition is excellent. However, if the condition goes unrecognized, the consequences can be life threatening. Nurses caring for both newborns and older infants need to understand the pathophysiology, etiology, risk factors, and treatment of this condition to avoid potentially devastating results.

The provision of enteral nutrition is an often complicated process in the low-birth-weight infant but is necessary for discharge purposes and is an important part of the parent-child relationship. Feeding infants is not only associated with the provision of nutrition but is an important feature associated with nurturing and caring. Safe and developmentally appropriate feeding can be difficult to accomplish in the low-birth-weight infant. The article by Susan Ludwig and Kara Ann Waitzman provides an original and innovative feeding scale to assist both nurses and parents in the assessment of safe and developmentally appropriate oral feeding skills in these vulnerable infants.

There is overwhelming evidence that breast milk is the optimal form of nutrition for all infants and may be especially beneficial for the preterm infant. Unfortunately, breastfeeding premature infants can be a challenging and frustrating experience for parents. The final article of this issue examines how the provision of supplemental nutrition may affect the intake of breast milk in the first 6 months of life.

Nurses are in the unique position to positively affect the outcome of vulnerable neonates. Knowledge related to various pathologic conditions potentially affecting the infant as well as the provision of optimal nutrition is a critical component of quality neonatal care. This issue of Neonatal and Infant Nursing Reviews provides both the expert and novice nurse with a wealth of knowledge to provide the best quality of care to his or her patients.