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As I said in my previous blog entitled “The Joy of Working with Pediatric and Neonatal Nurses,” when I took care of critically ill newborn infants and children, young adults for about 30 years, I relied on the nurses I had the privilege of working with in the infant special care unit, the pediatric floor, the emergency department, and in the intensive care unit. These nurses are truly on the front lines and are first responders for these patients and their families, just as paramedics, EMTs, and battlefield paramedics are on the front lines!

Wherever I was, including when we were transporting these infants and children, I listened critically and thoughtfully to everything they told me about the patients we cared for. When they were worried and concerned, it was important that I also worried. I can literally give you hundreds of anecdotes of clinical situations, including instances in the delivery room with newly born critically ill infants when the nurse and I worked together to stabilize the baby with clinical issues ranging from being born at 24 weeks gestation with respiratory distress to a term newborn with undiagnosed probable Down syndrome.

In the ED, we had a well tanned 19-year-old male who presented in cardiac arrest one winter evening and a young girl with fever and purpuric lesions who presented in shock with meningococcemia.

On the pediatric floor, the nurse called me when her infant patient was having apneic episodes with oxygen desaturation with an RSV infection.

In the intensive care unit, there was a young girl with malignant cerebral edema after head trauma. Her nurse and I stayed by her bedside all day and night as we needed to manage her increased intracranial pressure. Thanks to our team, she survived and is now living a normal life.

In each of these clinical situations, I relied on the nurses I worked with who were almost literally on the front lines! I also worked with my wife, Sally, at Children’s Memorial Hospital, when I was a senior resident in 1979 when I covered our patients on our service. She worked on the front lines with a number of critically ill children and came up with some instrumental clinical observations and interventions that helped us in the care of these patients. She and her colleagues in the infusion area at what is now Ann and Robert H. Lurie Children’s Hospital of Chicago are on the front lines caring for children with cancer, inflammatory bowel disease, rheumatoid arthritis, systemic lupus erythematosus, and numerous other chronic illnesses. They do clinical assessments in addition to providing intravenous access for chemotherapy, infusion of biologics, and enzyme infusions for these sometimes critically ill patients. They work with nurse practitioners to care for these children.

I hope everyone has a sense for what these nurses do on the front lines and how instrumental they are in the care of these children and their families.

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