Modern perinatal and neonatal care practices have increased survival of infants that in previous care eras would have perished. The majority of infants admitted to a newborn intensive care unit following delivery currently do well and are discharged home. Unfortunately for others, the ultimate outcome may be death. The death of a newborn infant is clearly a devastating loss to parents. How parents are informed of their infant's actual or impending death can either add to a grief reaction, or help support parents through their loss. The literature supports that most healthcare professionals frequently feel inept while discussing the death of a newborn with the baby's family. This article will present parents' descriptions of what helped or did not help when they were informed of their infant's inevitable death. It will also demonstrate how simulation may be effective in improving communication of bad or sad news to families in a manner that sustains them in the immediate present, as well as adds to their future well-being.

Turmoil in the economy, looming health care reform, and the convergence of a shortage of nursing professionals accompanied by the demand for improving patient safety and decreasing medical errors with limited resources has created an environment likened to the perfect storm. As nurses make up the single largest component of the health care system, it is imperative that nurses achieve and maintain the highest level of competency. The Institute of Medicine's report on the future of nursing identified simulation as a key technological component in facilitating nurses in acquiring and maintaining competencies. This article will review the evidence supporting simulation, define the core elements of health care simulation, describe the bodies that regulate advanced practice nursing, identify the principle areas in which neonatal nurse practitioners (NNPs) must maintain proficiency and expertise, and illustrate how simulation is utilized in acquisition, maintenance and competency evaluation for NNPs in 1 of the largest NICUs in the country.

Bronchopulmonary dysplasia (BPD) is associated with significant short- and long-term morbidity in preterm infants, and it can be prevented in some infants with vitamin A prophylaxis. Vitamin A, once widely used in neonatal intensive care, was scarce for the last few years, but has become available again at a much higher price, leading to dilemmas about its routine use. In this review we discuss experimental, clinical and socioeconomic evidence related to BPD, and provide a framework for clinicians and policy-makers to evaluate the value of vitamin A treatment and make decisions about its use for prevention of BPD.