Carole Kenner • Leslie B. Altimier • Marina V. Boykova
EDITORS
SIXTH EDITION
COMPREHENSIVE
NEONATAL
NURSING CARE
, Comprehensive Neonatal Nursing Care
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, Carole Kenner, PhD, RN, FAAN, FNAP, ANEF, is the Carol Kuser Loser Dean/Professor of the School of
Nursing, Health, and Exercise Science at The College of New Jersey. Dr. Kenner received a bachelor’s of science
in nursing from the University of Cincinnati and her master’s and doctorate in nursing from Indiana University.
She specialized in neonatal/perinatal nursing for her master’s and obtained a minor in higher education for her
doctorate. She has authored more than 100 journal articles and 30 textbooks.
Her career is dedicated to nursing education and to the health of neonates and their families, as well as educa-
tional and professional development of healthcare practices in neonatology. Her dedication includes providing a
healthcare standard for educating neonatal nurses nationally and internationally. Her passion led her to begin the
journal Newborn and Infant Nursing Reviews, in which she served as editor and then associate editor. She worked
with the National Coalition on Health Professional Education in Genetics (NCHPEG) and the American Nurses
Association to develop genetic competencies. She helped develop the End-of-Life Nursing Education Consortium
(ELNEC) Neonatal/Pediatric modules. She served as the co-chair of the Oklahoma Attorney General’s Task Force on End of Life/Palliative
Care. She also helped develop program recommendations for perinatal/neonatal palliative care as part of a family-centered/developmental
care project sponsored by the National Perinatal Association. She serves on the Consensus Committee of Neonatal Intensive Care Design
Standards, which sets recommendations for Neonatal Intensive Care Unit designs, and serves on the March of Dimes Nursing Advisory
Committee. She is a fellow of the American Academy of Nursing (FAAN), a fellow in the National Academies of Practice, a fellow in the
Academy of Nursing Education, past president of the National Association of Neonatal Nurses (NANN), and founding president of the
Council of International Neonatal Nurses (COINN), the first international organization representing neonatal nursing-setting standards
globally. She is the 2011 recipient of the Audrey Hepburn Award for Contributions to the Health and Welfare of Children Internationally.
Leslie B. Altimier, DNP, RNC, MSN, NE-BC, is the director for clinical innovation and research for Phillips
HealthTech, where she is responsible for developing clinical analytic support algorithms and research tools for
future NICU technology. She received her BSN from Kent State University, MSN from the University of North
Carolina, DNP from Northeastern University in Boston, and she completed a postdoctoral fellowship in compas-
sionate healthcare through the Northeastern University in collaboration with the Schwartz Center for Compas-
sionate Healthcare and the Jonas Center for Nursing and Veterans Healthcare. In her 30-year nursing career, she
has worked in a variety of neonatal, pediatric, and adult intensive care units, and has been a clinical director of
nursing for a hospital network consisting of a 50-bed level III NICU and multiple level II NICUs.
Dr. Altimier is a renowned clinician who lectures internationally and has published over 100 articles, chapters,
and books on topics related to the care of neonates and families, NICU design, and organizational leadership.
She was the editor-in-chief of Newborn and Infant Nursing Reviews (NAINR) journal and most recently is the
editor-in-chief of the Journal of Neonatal Nursing (JNN), the official journal of the Neonatal Nurses Association (NNA). She is a member
of NANN (the National Association of Neonatal Nurses), COINN (Council of International Neonatal Nurses, Inc.), and INANE (the Inter-
national Academy of Nurse Editors). She also holds a nursing executive certification by the AANC (American Nurses Credentialing Center).
Dr. Altimier has contributed to nursing through practice, education, leadership, research, and publications. She is passionate about
neuroprotective developmental care, family-integrated care, and compassionate care and has earned the Neonatal Developmental Care
Specialist Designation from NANN. Her goal is to create a culture of change in healthcare worldwide.
Marina V. Boykova, PhD, RN, is an assistant professor of nursing in the School of Nursing and Allied Health
Professions, Holy Family University, Philadelphia, Pennsylvania. Dr. Boykova received her Diploma in N ursing
Practice from the School of Nursing #3, Saint Petersburg, Russia; a Certificate in Theory and Practice of Nurse
Education, Medical College #1, Saint Petersburg, Russia; a Certificate in Theory and Practice of Nurse E
ducation,
Chester, United Kingdom; Bachelor of Science with Honours in Professional Practice (Nursing), University of Liv-
erpool, Chester, United Kingdom; Diploma of Higher Education in Nursing, Novgorod University of Y. Mudrogo,
Novgorod, Russia; Master of Science in Health Promotion (Distinction), University of Liverpool, Chester, United
Kingdom; and Doctor of Philosophy in Nursing, University of Oklahoma, Oklahoma City, Oklahoma. She is a
member of Sigma Theta Tau International. She serves as a nonexecutive director for the Council of International
Neonatal Nurses, Inc. (COINN). Dr. Boykova’s clinical background is neonatal intensive care nursing. Her re-
search interests center on transition from hospital to home and to primary care for parents of preterm infants.
She has published in this area as well as neonatal care topics. She coauthored a policy brief on Reducing Preterm Births for the American
Academy of Nursing.
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, Comprehensive Neonatal Nursing Care
Sixth Edition
Carole Kenner, PhD, RN, FAAN, FNAP, ANEF
Leslie B. Altimier, DNP, RNC, MSN, NE-BC
Marina V. Boykova, PhD, RN
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, Copyright © 2020 Springer Publishing Company, LLC
All rights reserved.
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ISBN: 978-0-8261-3909-2
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DOI: 10.1891/9780826139146
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The author and the publisher of this Work have made every effort to use sources believed to be reliable to provide information that is accurate and com-
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Carole Kenner: https://orcid.org/0000-0002-1573-5240
Leslie B. Altimier: https://orcid.org/0000-0001-8558-3011
Marina V. Boykova: https://orcid.org/0000-0002-9065-3704
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, I wish to first express my appreciation, love, and support for
my dad, who died in 2017 at the age of 105½. He always
got excited when a new edition published.
—Carole
I would like to thank my children, Jen, Julie, and Kevin, for their love,
support, and encouragement for me as a mom and as a professional.
—Leslie
For my mom, whose love and support were endless.
—Marina
Together we would like to express our appreciation for the assistance of
Margaret Zuccarini, from Springer Publishing Company, who is a
longtime trusted colleague who guided this project, along with
Elizabeth Nieginski, who took over from Margaret, to a successful
birth. Thank you for believing in this project. A special thank-you
goes to Joanne Jay from Springer for all the assistance and
guidance through the development and publication. We really
enjoyed working with all of you. Finally, we want to thank
the professionals across the globe who take care of the babies
and their families.
—Carole Kenner, Leslie Altimier, and Marina Boykova
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,Kenner39092__PTR_FM_I-XXIV_07-22-19.indd 6 26-Jul-19 6:20:36 PM
, Contents
Contributors ix 10. Endocrine System 233
Past Contributors to the Fifth Edition xv Susan Kau and Stephanie Hoe
Foreword Linda S. Franck, PhD, RN, FRCPCH, FAAN xvii
Preface xix 11. Immune System 257
Acknowledgments xxiii Mary Beth Bodin and Jacqueline Hoffman
Share Comprehensive Neonatal Nursing Care
12. Integumentary System 281
Carolyn Houska Lund and Joanne McManus Kuller
UNIT I. PRENATAL CONSIDERATIONS
AND CARE 13. Hematologic System 315
Gail A. Bagwell and Deborah K. Steward
1. Fetal Development: Environmental Influences
and Critical Periods 1 14. Musculoskeletal System 355
Carole Kenner Ashlea D. Cardin
2. Prenatal, Intrapartal, and Postpartal Risk Factors 21 15. Neurologic System 373
Dolores R. Dzubaty Georgia R. Ditzenberger and Susan Tucker Blackburn
UNIT II. INTRAPARTAL AND NEWBORN CARE 16. Auditory System 417
Kathleen Haubrich
3. Resuscitation and Stabilization of the Newborn
and Infant 49 17. Ophthalmic System 429
Gail A. Bagwell Lori Baas Rubarth and Debra M. Parker
4. Assessment of the Newborn and Infant 65 18. Genitourinary System 449
Terri A. Cavaliere Leslie A. Parker
5. Normal Term Newborn 105
Cheryl Riley, Becky Spencer, and Lyn S. Prater UNIT IV. SPECIAL CONSIDERATIONS
19. Fluids, Electrolytes, and Acid–Base Balance 481
UNIT III. SYSTEMS ASSESSMENT AND Shreyas Arya and Vivek Narendran
MANAGEMENT OF DISORDERS
20. Nutrition Management of Premature Infants 497
6. Respiratory System 127
Diane M. Anderson
Samuel Gentle, Colm Travers, and Waldemar A. Carlo
21. Neonatal and Infant Pharmacology 515
7. Cardiovascular System 147
Beth Shields
Donna A. Goff
8. Gastrointestinal System 179 22. Emerging Technologies in Neonatal Care:
Khiet D. Ngo and Manoj Shah Healthcare Simulation for Neonatal Care 527
Carole Kenner
9. Metabolic System 211
Susan Kau and Stephanie Hoe
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, viii ■ CONTENTS
23. Pain in the Newborn and Infant 539 39. Neonatal Care Using Informatics 831
Marlene Walden and Carol Turnage Spruill Susan K. Newbold
24. Fetal Therapy 557 40. Human Genetics and Genomics: Impact
Taryn M. Edwards and Tamara M. Meeker on Neonatal Care 843
Robin Dawn Clark
25. Surgical Considerations in the Newborn and Infant 575
Kaye Spence 41. Trends in Neonatal Research and
Evidence-Based Practice 853
26. Emerging Infections 587 Jana L. Pressler and Valerie Boebel Toly
Kathryn R. McLean and Tami Wallace
42. Legal and Ethical Issues in Neonatal Care 873
Carole Kenner
UNIT V. VULNERABLE POPULATIONS
27. Newborn or Infant Transplant Patient 611 43. Neonatal Care From a Global Perspective 879
Kathleen P. Juco-Purdy Carole Kenner and Marina V. Boykova
28. Extremely Low Birth Weight (ELBW) Infant 631 44. Competency-Based Education and Continued
Abhay Lodha, Jenna L. Dobry, and Shahirose S. Premji Competency 887
Geralyn Sue Prullage
29. The Late Preterm Infant 655
Maureen F. McCourt
UNIT VIII. NEONATAL DIAGNOSTIC
30. Neonatal Abstinence Syndrome 663 AND CARE PROTOCOLS
Gail A. Bagwell
I. Diagnostic Processes 897
Samual Mooneyham
UNIT VI. ENVIRONMENTAL HEALTH
AND FAMILY-CENTERED CARE IN II. Guidelines for Supporting Skin-to-Skin Contact
THE NICU AND BEYOND in the NICU 935
Raylene M. Phillips
31. Neurobehavioral Development 675
Leslie B. Altimier and Diane Holditch-Davis III. Developmental Care for the Sick and
Preterm Infant 939
32. The Neonatal Intensive Care Unit Caitlin Bradley and Christina Mahoney
(NICU) Environment 713
Leslie B. Altimier and Robert D. White IV. Neonatal Transport 947
Dorothy M. Mullaney
33. The NICU—Through a Mother’s Eyes 727
Kelley Benham French and Leslie B. Altimier V. Introduction to Vascular Access 955
Elizabeth L. Sharpe
34. Touch a Life, Impact a Lifetime: Trauma-Informed
Care in the NICU 733 VI. Newborn Whole-Body Cooling Protocol 961
Mary E. Coughlin McNeil and Amy D’Agata Georgia R. Ditzenberger and Susan Tucker Blackburn
35. Family: Essential Partner in Care 753
VII. Neuroprotective Intervention 963
Jacqueline M. McGrath and Dorothy Vittner
Leslie B. Altimier and Raylene M. Phillips
36. Palliative and End-of-Life Care 785
Appendix A: Neonatal Nurses and Interconception Care 979
Carole Kenner and Donna J. Ryan
Merry-K. Moos
Appendix B: Conversion Table to Standard
37. Postdischarge Care of the Newborn, Infant,
International (SI) Units 981
and Families 795
Appendix C: Frequently Used Reference Values
Marina V. Boykova, Carole Kenner, Karen Walker, and
and Conversions 985
Deborah A. Discenza
Appendix D: International Standards for Newborn Weight,
Length, and Head Circumference by Gestational
UNIT VII. NEONATAL CARE IN THE Age and Sex 987
NEW MILLENNIUM: CHALLENGES AND Index 991
OPPORTUNITIES
38. Trends in Neonatal Care Delivery 823
Carole Kenner and Jana L. Pressler
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, Contributors
Leslie B. Altimier, DNP, RNC, NE-BC Caitlin Bradley, MS, NNP-BC, RN
Director of Clinical Innovation and Research Neonatal Nurse Practitioner
Phillips Research and Development Boston Children’s Hospital
Cambridge, Massachusetts Boston, Massachusetts
Diane M. Anderson, PhD, RD Ashlea D. Cardin, OTD, OTR/L, BCP
Associate Professor Assistant Professor of Occupational Therapy
Department of Pediatrics, Section of Neonatology Missouri State University
Baylor College of Medicine Springfield, Missouri
Houston, Texas
Waldemar A. Carlo, MD
Shreyas Arya, MD, MBBS Edwin M. Dixon Professor of Pediatrics
Clinical Fellow Division Director, Neonatoloygy
Division of Neonatology and Pulmonary Biology UAB Division of Neonatology
Cincinnati Children’s Hospital Medical Center University of Alabama at Birmingham
Cincinnati, Ohio Birmingham, Alabama
Gail A. Bagwell, DNP, APRN, CNS Terri A. Cavaliere, DNP, NNP-BC, RN
Clinical Nurse Specialist—Perinatal Outreach Clinical Associate Professor
Nationwide Children’s Hospital Stony Brook University
Columbus, Ohio Stony Brook, New York
Neonatal NNP Cohen Children’s Hospital at North Shore
Manhasset, New York
Susan Tucker Blackburn, PhD, RN, FAAN
Professor Emeritus
Robin Dawn Clark, MD
Department of Family and Child Nursing,
Professor of Pediatrics in Medical Genetics
School of Nursing
Loma Linda University Health
University of Washington
Loma Linda, California
Seattle, Washington
Amy D’Agata, PhD, MS, RN
Mary Beth Bodin, DNP, CRNP, NNP-BC Assistant Professor, College of Nursing
Neonatal Consultant University of Rhode Island
Tuscaloosa, Alabama Kingston, Rhode Island
Adjunct Assistant Professor, Department of Pediatrics
Marina V. Boykova, PhD, RN Brown University
Assistant Professor Providence, Rhode Island
School of Nursing and Allied Health
Holy Family University, School of Nursing Deborah A. Discenza, MA
and Allied Health Founder, President
Philadelphia, Pennsylvania PreemieWorld, LLC
Springfield, Virginia
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