The following essay is a personal story about a NICU experience in 1991 describing a high-risk pregnancy following uterine rupture. After 18 weeks of home and then in-patient monitoring, the infant was delivered by emergency cesarean section at 30 weeks\' gestation. The story is written by a retired nurse, but is a first-hand parent narrative.

Neonatal clinicians utilize prefeeding interventions with premature infants to promote a natural process of oral-sensory development, hoping to prepare the infant for future oral feeding. Prefeeding interventions require a holistic approach, ensuring infants are actively involved in learning. Therapists can achieve this by prioritizing the development of intentionality, which is the conscious pursuit of action driven by motivation. The authors present a conceptual model of six neonatal behavioral states of learning called the \"Neonatal Intentional Capacities.\" This model illustrates how purposeful actions evolve into extended learning sequences and helps determine how well an infant can participate in learning experiences. The authors will elucidate the dynamic relationship between intentionality and the development of adaptive motor skills of prefeeding. Lastly, this article presents a consolidated and categorized grouping of current evidence-based prefeeding interventions. Utilizing the framework presented, the authors offer clinical guidance to support prefeeding treatment planning.

This is an interview with one of the founders of The Butterfly Project where a simple purple butterfly on an infant\'s incubator or cot can alert others in the NICU that this infant had a sibling who died, thereby guiding a respectful, more sensitive conversation with parents. The program has taken hold throughout the world.

Wolff-Parkinson-White (WPW) syndrome is a rare cardiac condition arising from abnormal embryologic development of the annulus fibrosus in combination with the cardiac conduction system. The abnormality results in the development of accessory pathways and preexcitation changes which can provoke episodes of tachyarrhythmias. The most common presentation of WPW syndrome is supraventricular tachycardia. Beyond customary abortive therapy, chronic management strategies vary based upon timing and clinical severity of the initial disease presentation. Prompt diagnosis and rate control have a dramatic impact on the outcomes of morbidity and mortality. The purpose of this article is to present a case study of a preterm infant who manifested with WPW syndrome. Additionally, the article will explore the pathophysiology of WPW syndrome and the timing and presentation of common clinical manifestations of the disease, along with current diagnostic and treatment strategies to achieve optimal patient outcomes in the neonatal population.

The controversial topic of oral feeding while on noninvasive ventilation remains at the forefront of preterm intensive care management. The intersection of pulmonary, neurologic, and gastrointestinal maturation coalesces at a postmenstrual age that requires changes in practices compared with those used in older infants. Various animal models in the past decades aimed to gain physiological knowledge of noninvasive ventilation effects on the suck-swallow-breathe coordination sequence. However, the preterm infant poses nuanced anatomic challenges. Although concerns for oral feeding while on noninvasive ventilation include aspiration risks and potential inpatient obstacles, there is evidence to support the feasibility, initiation, and progression of oral feedings while an infant is supported on high-flow nasal cannula and continuous positive airway pressure. There is evidence to support that this may accelerate attainment of oral feeding milestones and, thus, eventual hospital discharge. More recent multidisciplinary institutional protocols may provide cautious guidance on evaluation and algorithms to assess infants who may benefit from initiation and advancement of oral feeding versus awaiting further maturation.

Neonatal hypoglycemia (NH) is broadly defined as a low plasma glucose concentration that elicits hypoglycemia-induced impaired brain function. To date, no universally accepted threshold (reference range) for plasma glucose levels in newborns has been published, as data consistently indicate that neurologic responses to hypoglycemia differ at various plasma glucose concentrations. Infants at risk for NH include infants of diabetic mothers, small or large for gestational age, and premature infants. Common manifestations include jitteriness, poor feeding, irritability, and encephalopathy. Neurodevelopmental morbidities associated with NH include cognitive and motor delays, cerebral palsy, vision and hearing impairment, and poor school performance. This article offers a timely discussion of the state of the science of NH and recommendations for neonatal providers focused on early identification and disease prevention.

Tracheoesophageal fistula (TEF) with or without esophageal atresia (EA) results from maldevelopment of the trachea and esophagus during maturation of the primitive foregut. EA/TEF commonly presents shortly after birth because of increased oral secretions and the inability to advance a nasogastric or orogastric tube to the proper depth. Given that prenatal diagnosis is uncommon and early intervention is important to reduce morbidity and mortality risk, early recognition and diagnosis are imperative. We present a case series of two neonates diagnosed with EA/TEF, type \"C\" and type \"E,\" born at low-acuity centers, who required transport to a tertiary center for surgical support. The pathophysiology as well as types of TEFs, symptomology, stabilization goals, corrective treatment, and long-term implications will be examined. Finally, the educational needs of parents and caregivers will be discussed.

Preemies who survive the NICU grow up into adulthood. What is that like for them? Enter Christina Gagnon, a 25-week-old who was born in October 1986. Hear from her what life has been like up to now.

Critically appraising the literature is the third step in the evidence-based practice process. The lowest level of evidence includes expert opinion and related types of literature. This column describes the appraisal of this type of literature using a specific set of questions.

Nurses in NICUs report insufficient education as a persistent barrier to providing quality neonatal palliative care (NPC). Since existing literature on educational interventions in NPC is limited, this review aimed to identify and narratively synthesize literature both about nurses\' attitudes toward NPC and the NPC education received by nurses. We conducted a nonsystematic narrative literature review. Four themes were identified from the 28 articles included in this review. These were as follows: (a) nursing work in NPC, (b) NICU nurses\' experiences and perceptions of NPC, (c) facilitators and barriers to nursing work in NPC, and (d) educational interventions in NPC. This literature review identified studies about NICU nurses\' experiences and education in providing NPC. NICU nurses both desired and lacked education in NPC. This literature review identifies the importance of developing and evaluating NPC education for nurses.