364 JOGNN © 2007, AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses

Although the mortality of premature infants re-quiring care in neonatal intensive care units (NICU) has decreased substantially over the past 20 years, morbidity remains a signifi cant problem. Not only do about 50% of these premature infants experience some degree of developmental handicap during the preschool years but they also have much higher rates of health problems, including cerebral palsy, poor growth, visual and hearing problems, asthma, bron-chitis, croup, and otitis media, than healthy full-term infants ( Bucher, Killer, Ochsner, Vaihinger, & Fauchiere, 2002; Doyle & Casalaz, 2002 ). Unlike mortality, the incidence of these problems has not improved. However, recent research and clinical evi-dence are beginning to identify some promising new approaches to these problems.

The articles in this second CLINICAL ISSUES series on neonatal care focus on the outcomes of pre-maturity and NICU care. The authors present recent evidence on the causes and nursing interventions to ameliorate three of the long-term complications of prematurity. Dr. Suzanne Thoyre ’ s article examines medically signifi cant feeding problems in children born with extreme prematurity. Although many neo-natal nurses are aware of the early diffi culties fami-lies experience feeding their premature infants, nurses seldom realize that these early diffi culties can lead to long-term feeding problems, with symptoms such as eating only a few types of food or very small por-tions, diffi culty transitioning to textured foods, and refusing food. Thoyre describes how the medical his-tories and feeding experiences of prematurely born children are associated with the later development of feeding problems. She also suggests nursing interven-tions at the time of NICU discharge that can help reduce the incidence of these problems and their impact on the infants ’ families.

Brigit Carter addresses necrotizing enterocolitis (NEC), a serious complication of prematurity that shows decreasing mortality but high morbidity. Long-term complications of NEC include feeding

intolerance, short gut syndrome, impaired growth, and developmental and cognitive delays. As Ms. Carter discusses, even though no current treatment is known to prevent these complications, neonatal nurses can play a major role in reducing their occur-rence through the early detection of NEC in order to initiate treatment at early stages of the disease when it can most easily be treated.

The fi nal article by Drs. Susan Brunssen and G. Jean Harry discusses the critical issue of diffuse white matter injury and its contribution to the de-velopmental problems of premature infants. Recent research provides evidence that hypoxic-ischemic and infl ammatory insults, particularly to the pre-oligodendrocytes in the premature infant ’ s brain, play major roles in the pathogenesis of develop-mental problems. Brunssen and Harry review the recent literature on the development of oligoden-drocytes and the brain, how they are affected by neurological insults, and their relationship to the developmental outcomes of extremely premature infants. They also describe nursing interventions to reduce the risk of these problems.

Although the long-term outcomes of premature infants requiring neonatal intensive care are currently guarded, the articles in this series show hope that signifi cant reductions in the occurrence of these long-term complications can occur in the next decade. Re-cent research is providing insights into the causes of these problems. In addition, nursing interventions, particularly early detection and discharge planning, can ameliorate their impact. Together, more effective medical treatments and nursing support should fi nally be able to reduce the long-term impact of prematurity on these vulnerable infants and their families.

Diane Holditch-Davis , PHD, RN, FAAN Professor

Address for correspondence: Diane Holditch-Davis, PHD, RN, FAAN, School of Nursing, Duke University, Trent Drive, DUMC 3322, Durham, NC 27710. E-mail: diane.hd@duke.edu.

CLINICAL ISSUES EDITORIAL

Outcomes of Prematurity and Neonatal Intensive Care Unit Care

July/August 2007 JOGNN 365

REFERENCES

Bucher , H. U. , Killer , C. , Ochsner , Y. , Vaihinger , S. , & Fauchiere , J.-C. ( 2002 ). Growth, developmental milestones and health problems in the fi rst 2 years in very preterm infants compared with term infants: A population based study . European Journal of Pediatrics , 161 , 151 - 156 .

Doyle , L. W. , & Casalaz , D . ( 2002 ). Outcomes at 14 year of extremely low birthweight infants: A regional study . Archives of Disease in Childhood: Fetal and Neonatal Edition , 85 , F159 - F164 .