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LAURA A. STOKOWSKI, RN, MS • Section Editor

these infants experience adverse events such as Magnetic Resonance Imaging apnea, bradycardia, arterial desaturation, or other Accidents and Injuries symptoms following immunization.1 A recent study confirmed previous research find- agnetic resonance imaging (MRI) has ings that preterm infants who have apnea in the become indispensable in the care of patients 24 hours prior to immunization are highly likely to Mof all ages. Although the overwhelming num- have apnea in 48 hours postimmunization.2 This is ber of MRI examinations goes off without a hitch, the rationale for immunizing former preterm dangers do exist in the MRI suite, so we cannot relax infants several days before discharge from the our vigilance. In February of this year, the Joint NICU, so that they can be monitored for a period Commission issued a sentinel event alert, “Preventing of time following vaccinations. However, this accidents and injuries in the MRI suite,” to highlight study, conducted in Northern California, also these dangers and provide risk-reduction strategies.1 found that risk factors other than preimmunization Hazards associated with MRI examinations include apnea predicted apnea in the 48 hours after immu- projectile injuries when ferromagnetic objects such as nization. These risk factors were higher severity of ink pens, keys, or oxygen tanks are pulled into the MRI illness at birth, younger age at immunization, and scanner, dislodged ferromagnetic implants, burns, weight less than 2 kg. Two of the infants in the equipment malfunction during exposure to the power- cohort who had at least 1 of these risk factors had ful MRI magnet, inability to attend to patient support been discharged shortly after a vaccination, devel- equipment, acoustic injury, adverse reactions to MRI oped apnea at home, and were readmitted to the contrast agents, and adverse events related to the use hospital for apnea. of cryogenics (cooling). A list of ferromagnetic objects The most important risk factor for postimmu- is provided in the sentinel event alert.1 Hundreds of nization apnea is still the occurrence of apnea dur- injuries and a number of deaths have occurred in MRI- ing the 24 hours preceding the vaccination. For related events. The most frequent (70%) are burns infants in the NICU without apnea during the 24 related to heating of wires, leads, cables, and sensors in hours immediately before immunization, younger contact with the patient. Items such as safety pins, hair- age, smaller size, and more severe illness at birth are pins, or drug-delivery patches are easy to overlook important predictors of postimmunization apnea. when preparing a patient for MRI but can burn the This study supports cardiorespiratory monitoring of patient when currents are induced by the magnetic susceptible infants for at least 48 hours after they fields. Recommended actions to prevent patient burns receive immunizations.2 during MRI are included in the sentinel event alert.1 References Reference 1. Sen S, Cloete Y, Hassan K, Buss P. Adverse events following vaccination in 1. The Joint Commission. Preventing accidents and injuries in the MRI suite. premature infants. Acta Paediatr Scand. 2001;90:916–920. Sentinel Event Alert. Issue 38. http://www.jointcommission.org/ 2. Klein NP, Massolo ML, Greene J, Dekker CL, Black S, Escobar GJ, and the SentinelEvents/SentinelEventAlert/sea_38.htm. Published February 14, Vaccine Safety Datalink. Risk factors for developing apnea after immu- 2008. Accessed March 12, 2008. nization in the neonatal intensive care unit. Pediatrics. 2008;121: 463–469.

Apnea Following Immunization of Preterm Infants Drug to Treat Phenylketonuria Approved reterm infants of the right chronological age need to be immunized to protect them from or 55 years, the inborn error of metabolism vaccine-preventable diseases. Occasionally, known as phenylketonuria (PKU) has been P Fmanaged with a phenylalanine-free diet. In 1961, dietary management successfully prevented mental retardation in children with PKU when Address correspondence to Laura A. Stokowski, RN, MS; Dr Robert Guthrie developed a simple blood test that [email protected] permitted identification of affected newborns early Author Affiliation: Inova Fairfax Hospital for Children, Falls enough for dietary therapy to prevent brain damage Church, VA. from phenylalanine (Phe) accumulation. Copyright © 2008 by the National Association of Neonatal A new drug, sapropterin dihydrochloride (Kuvan, Nurses. BioMarin Pharmaceuticals, Novato, California), is

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the first drug of its kind approved by the Food and Drug Administration for treatment of PKU.1 Along Image of Nursing in the Media with a Phe-restricted diet, sapropterin dihy- drochloride reduces blood Phe levels in patients very year, the Center for Nursing Advocacy with hyperphenylalaninemia. Sapropterin dihy- (www.nursingadvocacy.org) announces its drochloride is a naturally occurring enzyme cofac- E“Golden Lamp” awards for the best and worst tor that works in conjunction with phenylalanine media portrayals of nurses during the past year. This hydroxylase to metabolize Phe. Phe is found in year’s list, the 5th annual, includes influential media foods that contain proteins (meats, dairy, egg from television shows and movies to news reports on products). It is estimated that 30% to 50% of PKU the nursing crisis in Africa. patients will respond to sapropterin dihydrochlo- Among the “worst,” award recipients were: ride. Patients who do not follow a Phe- • “Grey’s Anatomy,” “Private Practice,” “House,” restricted diet will not benefit from sapropterin and “Scrubs” for their grossly inaccurate physi- dihydrochloride. cian-centric vision of care; • Kelly Ripa of “LIVE with Regis and Kelly” for Reference promising to be her cohost’s “sponge bath nurse”; 1. US Food and Drug Administration. FDA approves Kuvan for treatment of • Will Shortz, puzzle master for the New York phenylketonuria (PKU). FDA News. http://www.fda.gov/bbs/topics/NEWS/ Times 2007/NEW01761.html. Published December 13, 2007. Accessed March 12, , for a crossword clue stating that ICU 2008. nurses were mere “helpers”; • New Jersey Governor Jon Corzine for suggest- ing that physicians alone saved his life following his near-fatal car crash; and National Institute of Child Health and • members of the UK Parliament for posing in and Human Development Renamed for promoting a naughty nurse calendar. Eunice Kennedy Shriver The best depictions of nursing continue to appear in the print media, according to Center for Nursing ongress has renamed the National Institute of Advocacy Executive Director Sandy Summers. Child Health and Human Development Specific pieces in The Wall Street Journal, The Star-Ledger C(NICHD) at the National Institutes of Health (Newark), and on WBUR, a Boston NPR affiliate, were in honor of Eunice Kennedy Shriver for her essential among the best. Movies were a mixed year for nursing. contribution to the Institute’s founding. Established The Center gave the film “Atonement” an “Honorable in 1963, the Institute is now called the Eunice Mention” for its limited but nurse-centered depiction of Kennedy Shriver National Institute of Child Health World War II healthcare. But the group said that soc- and Human Development. cer movie “Gracie” was one of the worst because of its In the early 1960s, Mrs Shriver urged her suggestion that the heroic lead character, unlike her brother, President John F. Kennedy, to establish an mother, could avoid being stuck in a dead-end loser job institute that would conduct research on children’s like nursing. health and human development. She later worked The Center noted that, as usual, many of the least with House and Senate leaders to help ensure pas- accurate and most damaging depictions were in the sage of the legislation that would make the institute influential television medium. Summers said that a reality. The NICHD sponsors research on devel- ABC’s new “Private Practice” included prime time’s opment before and after birth; maternal, child, and least knowledgeable major nurse character in mid- family health; reproductive biology and population wifery student Dell Parker. Overall, the Center found issues; and medical rehabilitation. An important that “Grey’s Anatomy” and “House” continued to be focus of the NICHD is expanding the evidence the worst offenders. Summers denounces their por- base in neonatology through programs such as the trayals of nurses as brainless servants, while all impor- NICHD Cochrane Neonatal Review Group and tant care, most of which nurses do in real life, is pro- the NICHD Neonatal Research Network. vided by heroic physicians. Depictions of nurses in For more information, visit the Institute’s Web site these globally popular shows contribute to the under- at http://www.nichd.nih.gov/. valuing of nurses.

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