acade mNyews
Contributing Editors: Debbie Fraser, MN, RNC-NIC; Heather Goodall, MSN, RNC-NIC, IBCLC;
Elizabeth Light, MSN, RN; Arlene Lovejoy, MS, RNP, CNS, RNC-NIC, NPT-C, RRT; Jody Ridky, RN,
MA; Kathryn Rudd, RNC-NIC, C-NPT, MSN; Lori Williams, DNP, RNC-NIC, CCRN, NNP-BC (Initials
in parentheses after a section identify the contributing editor)
HAMLET: Shakespeare or the
Mysteries of Human Milk?
Joanne Ridky, RN, MA
Imagine the impact of a single substance able to reverse
antibiotic resistance and to kill tumor cells without harming
healthy cells. Dr. Anders Hakansson, working as a graduate
student in the laboratory of Dr. Catharina Svanborg, Lund
University, Sweden, was studying human milk effects on the
binding of bacterial cells to epithelial cells when he noted that
a specific casein fraction of human milk blocked the bind-
ing of the bacterial cells and also affected the viability of the
lung cancer cells used in the experiment.1 Further research
determined that the casein protein, alpha-lactalbumin, must
be partially unfolded and then bound with a specific fatty
acid found in human breast milk to become a substance
now known as HAMLET: Human Alpha-lactalbumin Made
LEthal to Tumor cells. Two major lines of research have
evolved from these observations: use of HAMLET in antimi-
crobial activity and as a tumoricidal agent.
According to the Centers for Disease Control and
Prevention, antibiotic resistance has quadrupled since
2003, outpacing the discovery of new antibiotics.2 Since
the discovery of penicillin, 17 classes of antibiotic have
been established. Bacteria have developed a minimum of
one and often several mechanisms of resistance to antibi-
otics. Every class of antibiotics has at least one strain of
bacteria resistant to it.3 Drug companies are somewhat
reluctant to invest heavily in new antibiotics as their use
will be limited, and resistance will eventually develop.
This increase in resistance to antibiotics has increased
research looking for other modes of antimicrobial activity.
Substances produced by organisms and which are bacterio-
cidal under natural conditions are one research focus.
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Alpha-lactalbumin is a whey protein found in the milk
of many species. Initially, only a-lactalbumin found in
human milk was believed to have antimicrobial and anti-
tumor properties. Further research by Malin Svensson
and Sara Linse at the Department of Biochemistr y,
Lund University, Sweden, showed that the activity was
present only after the a-lactalbumin bound with a spe-
cific fatty acid found naturally only in human milk. Alpha-
lactalbumin from other species can become tumoricidal
if associated with the correct fatty acid (C18:1).1,4 Low
stomach pH causes partial unfolding of a-lactalbumin
and the release of oleic acid through the hydrolysis of
human breast milk lipids by acid lipases. Alpha-lactalbumin
(2 mg/mL) and oleic acid (.50 percent of the fatty acid
chains of triglycerides) are present in human milk. The
unsaturated C18:1 component of oleic acid binds with the
a-lactalbumin in the stomach to form HAMLET.
The Anders Hakansson Laboratory at the University
at Buffalo has demonstrated the ability to use HAMLET
as an adjuvant to antibiotics and to successfully destroy
drug-resistant Staphylococcus aureus and Streptococcus
pneumoniae.5 HAMLET alone has been shown to have
a specific bacteriocidal effect against S. pneumoniae with
some bacteriocidal activity against Haemophilus influenzae
and some strains of Moraxella catarrhalis.3 In studies using
sensitive and resistant strains of S. pneumoniae, the anti-
biotics gentamicin, erythromycin, and penicillin, each in
Disclosure
The views and opinions expressed in the News of the Academy of Neonatal
Nursing are those of the contributing editors and do not necessarily reflect those
of the Academy of Neonatal Nursing. The Academy of Neonatal Nursing is
not responsible for products, programs, or links mentioned in these pages. They
are provided as a convenience and should not be viewed, in any way, as an
endorsement of any particular website, company, product, or service.
NEWS
© 2014 Academy of Neonatal Nursing 173
http://dx.doi.org/10.1891/0730-0832.33.3.173
combination with HAMLET, showed significantly increased
activity. Antibiotic-resistant strains grown in biofilms or col-
onizing the murine nasopharynx of mice were effectively
eradicated at concentrations effective against sensitive strains.
HAMLET’s antibiotic-sensitizing activity extends to those
bacterial species which HAMLET alone cannot eradicate.
HAMLET was further investigated to determine if
using it as an adjuvant would lower the needed concen-
tration of common antibiotics against both sensitive and
resistant bacterial strains. Using a subinhibitory concen-
tration of HAMLET with penicillin (PCN) G reduced the
concentration of PCN G needed to eradicate the sensi-
tive pneumococcal bacterial strain by 20 percent. Testing
a PCN G–resistant pneumococcal strain in an identical
manner, again with a sub-inhibitory concentration of
HAMLET with PCN G, the amount of PCN G required
was reduced by 95 percent. This demonstrated that, with
this particular strain of pneumococci, using HAMLET as
an adjuvant would once again put this strain in the PCN
G–sensitive range and that the amounts of PCN G needed
to be effective could be greatly reduced. The procedures
were repeated using erythromycin and gentamicin, each
one in combination with HAMLET. Again, the results
were impressive. With the HAMLET/erythromycin com-
bination, the required concentration of erythromycin for
the sensitive strain decreased threefold, while the concen-
tration needed for the resistant strain decreased 300 fold.
Use of HAMLET with gentamicin reduced the amount of
gentamicin needed to be effective fourfold; increasing the
amount of HAMLET reduced the amount of erythromy-
cin required eightfold.3 Final results showed conclusively
that HAMLET potentiates the antipneumococcal activity of
these classes of antibiotics, reducing the amount of antibi-
otic needed with sensitive strains and significantly increasing
potentiation with antibiotic-resistant strains. Short time-kill-
ing studies were also conducted, documenting reduced kill-
ing time in the presence of HAMLET. Antibiotics to which
these bacteria were previously resistant could now be used
in combination with HAMLET, rendering the bacteria no
longer resistant and reducing the concentration of antibiotic
needed for eradication of pneumococci.
In vitro studies were conducted to evaluate the effects
of HAMLET with antibiotics in killing biofilms. The results
showed the combination of HAMLET and PCN to be sig-
nificantly more effective than the additive effect of treating the
biofilms by either agent alone.
The studies were conducted in vivo utilizing mice
inoculated intranasally with S. pneumoniae for 48 hours.
They were then treated with either gentamicin alone or
HAMLET alone. The mice treated with gentamicin alone
exhibited a slow decrease in bacterial burden with an initial
dose of 3 g/mouse in the nasal lavage and 10 g/mouse
in the nasopharyngeal tissue, while the mice treated with
HAMLET showed no decrease in bacterial burden in either
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174
the nasal wash or the nasopharyngeal tissue. Mice were then
treated with gentamicin in combination with HAMLET.
There was a significant decrease in colony-forming units
(CFUs) at a dose of 3 mcg gentamicin with HAMLET
where a 1,500 mcg dose of gentamicin alone was needed
to eradicate nasal lavage-associated bacteria. A 5,000-mcg
dose of gentamicin alone did not eradicate tissue-associated
bacteria, while 3 mcg gentamicin with HAMLET achieved
a comparable decrease.3 Penicillin experiments were then
conducted using the same procedures and yielding simi-
lar results, leading to the conclusion that HAMLET does
potentiate antibiotics in vivo against bacterial strains known
to be resistant, rendering the drug once again useful.3
MRSA infection treated with methicillin in combination
with HAMLET rendered the MRSA bacteria in the mouse
nose ten times more susceptible to methicillin than it was
without HAMLET, demonstrating that methicillin could be
used in the treatment of the resistant strain of S. aureus.6,7
A biofilm is an assemblage of microbial cells that is irre-
versibly associated (not removed by gentle rinsing) with a
surface and enclosed in a matrix of primarily polysaccharide
material.8 A bacterial colony is a cluster of bacteria grow-
ing on but not irreversibly associated with the surface; the
colony is not enclosed in a matrix. Pneumococci produce
biofilms in the nasopharynx during asymptomatic coloni-
zation. Biofilms have been proven to be highly resistant
to antibiotics.3 Pneumococci colonized in biofilms are 10
to 1,000 times more resistant to antibiotics than when
they are in colonies. Estimates are that 65 percent of all
human bacterial infections are the result of microbial
growth as biofilms. Nasopharyngeal eradication of coloni-
zation in mice was not achieved with PCN alone nor with
HAMLET alone; however, in combination, total eradica-
tion of the biofilm colonization was achieved.3
Additional studies have been conducted across multiple
generations of bacteria exposed to HAMLET. The bacteria
have not been able to develop resistance to HAMLET, and
the researchers have not been able to make the bacteria
resistant. Hakansson states, “Because of the long coevo-
lution of human milk and bacteria that are a part of the
normal flora, we do not foresee that bacteria will easily
become resistant to HAMLET.”2
At this time, the Hakansson Laboratory, founded by
Anders Hakansson and his wife, Dr. Hazeline Hakansson, plans
to test additional strains of both S. pneumoniae and S. aureus
and to expand the in vivo testing of models to provide further
evidence that HAMLET is a safe and effective adjuvant.9
The other focus of research involving HAMLET is its use
in the treatment of tumors. In 1998, Davis and colleagues
reported that breastfed children were less likely to develop
cancer than were formula-fed children.10 At the time, no one
could identify why this was so. The discovery of HAMLET
and its antitumor properties has led researchers to believe that
it is this protein, found in the stomach of infants after ingesting
NEWS
M AY / J U N E 2 0 1 4 , VO L . 3 3 , N O . 3
breast milk, which may be a contributing factor. The infant
stomach is a low pH environment, which induces protein
unfolding. Human breast milk contains triglycerides, which
are hydrolyzed in the stomach, releasing oleic acid. Thus, all
the necessary ingredients for HAMLET production exist in
the infant’s gastrointestinal tract. The studies that have shown
breastfed infants have a lesser incidence of childhood cancer
specifically identified the incidence of lymphoma and cancers
of the rapidly dividing GI tissue as being diminished.
In the early studies of human milk where the ability
of the casein faction to bind to epithelial cells was being
examined, it was also noted to cause apoptosis of the lung
cancer cells.1 This activity was limited to the human milk
casein, and it was later determined that the activity was due
to a conformational change in a-lactalbumin after it bound
to specific fatty acids found in human milk. Bovine and
other species a-lactalbumin can be made tumoricidal when
associated with the specific fatty acid found in human milk.
While it is noted that HAMLET can bind with both
healthy and tumor cells, it can only enter tumor cells.
Research, coordinated between the Hakansson Laboratory
and Camilla Kohler in Dr. Sten Orrenius’ lab in Stockholm,
Sweden, revealed that once inside a tumor cell, HAMLET
interacted with the mitochondria, resulting in the activa-
tion of the apoptosis-specific proteases.1 This activity of
HAMLET was also observed in mitochondria purified from
healthy cells, leading to the belief that healthy cells are not
sensitive because HAMLET cannot enter them. Thus,
HAMLET, unlike traditional chemotherapy, kills tumor
cells while having no effect on healthy cells. Sixty tumor
cell lines, primary tumor cultures from different tissues,
and ten primary cell cultures from healthy tissues have been
tested for their sensitivity to HAMLET. All tumor cells
were found to be sensitive, while all healthy cells showed
resistance to the apoptosis-inducing activity of HAMLET.
In vivo studies have supported the finding that
HAMLET is active against tumor cells while not affecting
healthy cells. In one study, tumor tissue from glioblas-
toma patients was transplanted under rat skulls, and then
one dose of HAMLET was infused into the brain. The
HAMLET treatment delayed the death of the rats when
compared with nontreated rats. Of even greater impor-
tance, examined tissue showed that apoptosis was induced
in the tumor cells but that no healthy cells were affected.
This confirmed the in vitro finding that the HAMLET
protein only affects tumor cells and that the side effects
from treatment with HAMLET should be few.1
Another in vivo study involved the use of HAMLET
in benign papilloma virus warts. Skin cells were infected
with the virus and transformed into warts. Treated topi-
cally with HAMLET, it was found that the condition was
eliminated, and this treatment effect was long lasting.7
Nine patients with urinary bladder carcinomas had
HAMLET instilled into the bladder one week prior to
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VO L . 3 3 , N O . 3 , M AY / J U N E 2 0 1 4
surgery. Endoscopic photography provided evidence of
tumor size reduction in eight of the nine patients, while
apoptosis induction was found in tumor tissue but not
healthy tissue.9
In vitro studies in the Hakansson Laboratory have dem-
onstrated success when using HAMLET to treat carcinoma
of the lung, throat, kidney, colon, bladder, prostate, and
ovaries. Melanomas, glioblastomas, and leukemias have
also responded to treatment with HAMLET.1
HAMLET properties are well documented. It kills a
wide range of tumor cells while sparing healthy cells; kills
more than 40 types of tumor cells by a natural non-tox-
ic mechanism; occurs naturally in human milk, and may
account for the lowered cancer incidence in breastfed chil-
dren. It is a proven effective adjuvant to antibiotics in the
treatment of drug-resistant bacteria, has antiviral properties,
and can be produced in large quantities at drug quality.11
Further research and in vivo trials must be conducted
before the full safety and efficacy of HAMLET can be
determined. It appears promising and provides one more
reason to stress to new mothers the value of breastfeeding
for at least the first six months.
1. Hakansson A. Breast-feeding, HAMLET, and cancer. Anders
Hakansson Laboratory. University at Buffalo. http://www.acsu.buffalo.
edu/~andersh/research/milkcancer.asp. Accessed February 24, 2014.
2. Rice SC for Healthline Networks, Inc.. Breast milk protein called
HAMLET helps kill dangerous hospital ‘superbugs’. http://www.
healthline.com/health-news/children-breast-milk-protein-kills-super-
bugs-050213. Accessed February 24, 2014.
3. Marks LR, Clementi EA, Hakansson AP. The human milk protein-
lipid complex HAMLET sensitizes bacterial pathogens to traditional
antimicrobial agents. PLoS ONE. 2012;7(8):e43514. doi: 10.1371/
journal.pone.0043514
4. Svensson M, Mossberg AK, Pettersson J, Linse S, Svanborg C. Lipids
as cofactors in protein folding: stereo-specific lipid-protein interac-
tions are required to form HAMLET (human alpha-lactalbumin made
lethal to tumor cells). Protein Sci. 2003;12(12):2805-2814.
5. University at Buffalo. Protein complex found in breast milk forces
drug-resistant ‘superbugs” including MRSA to respond to anti-
biotics again. Medical News Today. http://www.medicalnews
today.com/releases/259958.php. Accessed February 24, 2014.
6. Schultz C. Breast milk protein could help fight superbug. http://
www.smithsonianmag.com/smart-news/breast-milk-protein-could-
help-fight-superbug-48877252/. Published May 2, 2013. Accessed
February 24, 2014.
7. HAMLET (protein complex). http://en.wikipedia.org/wiki/
HAMLET_%28protein_complex%29. Updated February 6, 2014.
Accessed February 24, 2014.
8. Donlan RM, Centers for Disease Control and Prevention. Biofilms:
microbial life on surfaces. Emerg Infect Dis. [serial online] 2002 Sep
[date cited]. http://dx.doi.org/10.3201/eid0809.020063
9. Hsu C. Researchers reverse antibiotic resistance in superbugs.
University at Buffalo News Center. http://www.buffalo.edu/news/
releases/2013/05/001.html. Accessed February 24, 2014.
10. Davis MK, Savitz DA, Graubard BI. Infant feeding and childhood
cancer. Lancet. 1988;13(2):365-368.
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175
11. MIG. Faculty of Medicine, Lund University. HAMLET, a new concept memos or minutes from committees, or thank-you notes
for cancer therapy. http://www.med.lu.se/english/labmedlund/mig/ from families or colleagues. Now imagine translating these
research_groups/the_svanborg_group/the_hamlet_project. Accessed
materials into a portable, easily accessible collection that
February 24, 2014.
can be used to demonstrate your achievements and profes-
About the Author sional growth to current/future employers or colleagues.
Joanne Ridky, RN, MA, has more than 33 years of nurs- Gone are the days of housing your collection in a shoebox!
ing experience in neonatal and pediatric intensive care Portfolios are a professional way to provide evidence of
units. For the past 15 years, she has been a travel nurse in your accomplishments.
NICUs across the United States. Additionally, she works Portfolios are collections of professional evidence
as a legal nurse consultant. She has served on the Executive that demonstrate knowledge, skills, accomplishments,
Committee of ANN and is currently an editorial consultant and movement toward achieving professional goals. They
for Neonatal Network and a contributing editor for the have been endorsed across professions as a means for
News of the Academy. showcasing achievements and professional growth, as well
as encouraging reflection-in-practice and reflection-on-
News from ANN’s Executive Committee practice. The portfolio goes beyond the resume or the cur-
Annette Carley, RN, MS, NNP-BC, PPCNP-BC riculum vitae by providing an additional layer of evidence
An evolving tool in nursing education and nursing prac- that is valid, authentic, reliable, and current. It is also more
tice is the professional portfolio.1 This tool is ideal for nurses than a historical and longitudinal collection of evidence
who wish to demonstrate ongoing professional development and is a powerful tool for developing a personal profes-
as well as progress toward personal and professional goals. sional action plan. Collecting and organizing portfolio
The leadership of the Academy of Neonatal Nursing is com- evidence (artifacts) is integral to the process of portfolio
mitted to supporting the professional development of our development and is best paired with reflective assessments
members and recently made profile pages available to begin that justify the inclusion of the artifact in the portfolio col-
your journey toward portfolio development. lection. This enhances the potential for ongoing personal-
Imagine a nursing briefcase that contains documents ized professional development.1,2
and materials to showcase your evolving professional self. Portfolios have been described in the literature in
These materials might include photos, flyers from profes- a number of ways according to their intended use.
sional meetings, continuing education transcripts, evalu- Formative, learning, or growth and development portfo-
ation documents, journal or personal diary narratives, lios typically include personal reflections and user-selected
evidence that show personal self-assessment and progress
toward goals. Summative, best work, or credentialing port-
Transition to Home folios showcase best effort and often include evaluations or
(from News of the Academy – March/April 2014 Issue)
presentations that are carefully selected by the portfolio
Word Search Answer Key
user to demonstrate competency and achievement of goals
Q W E H R T Y U I O P A F S D I as part of a personal development plan.1,3,4 Both have their
F G H O J K L Z X C V B O N M M place in professional nursing practice and development.
N V C M X Z M O N I T O R L K M
The degree of sophistication can vary, and portfolios
A P N E A O P A S D F G M H J U
may exist in paper-based or electronic formats. Paper-based
portfolios may include documents and imagery that dem-
I U Y T R E W Q M N B V U C X N
onstrate competency and skill in education, leadership,
M Q A Z W S X E D C R F L V T I
creative care planning, management, and clinical practice.
E G P E D I A T R I C I A N B Z
Electronic portfolios (ePortfolios) are created and main-
D Y H N E U J M I K O L P Q W A tained online and can include mixed media such as audio
I E A S V D Z X C R T Y D F G T or video files, web-based narrations, or other evidence to
C C B R E A S T M I L K V B D I compellingly demonstrate work toward goals or accumu-
A Y U I L H J K N M O P L L I O lated achievements. A distinct advantage of the ePortfolio
T K J H O G F D S A P O I U A N
is the potential for linking to a variety of additional online
evidence, compatibility with a variety of robust media, and
I Y T R P E W Q N B V C X Z P Q
ability to be used for dissemination widely to others.3
O A Z W M S X E P A C I F I E R
As suggested by Twaddell and Johnson, it is time for
N D C R E F V T G B R Y H N R U
nurses to support their professional development as well
S J M I N K O L P Q I W R E T Y as begin to showcase achievement and movement toward
I U O P T A S D F G B H J K L Z goals.4 The professional portfolio represents a means to
achieve this.

ACADEMY NEWS
176 M AY / J U N E 2 0 1 4 , VO L . 3 3 , N O . 3
1. Green J, Wyllie A, Jackson, D. Electronic portfolios in nursing educa-
tion: a review of the literature. Nurse Educ Pract. 2014;14(1): 4-8.
doi: 10.1016/j.nepr.2013.08.011
2. Casey DC, Egan D. The use of professional portfolios and profiles for
career advancement. Br J Community Nurs. 2010;15(11):547-548,
550-552.
3. Andre K. E-portfolios for the aspiring professional. Collegian .
2010;17:119-124. doi:10.1016/j.colegn.2009.10.005
4. Twaddell JW, Johnson JL. A TIME for nursing portfolios: a tool for
career development. Adv Neonatal Care. 2007;7(3):146-150.
Call for Abstracts
We invite you to share your knowledge and expertise at
the 14th National Neonatal Nurses Conference. Have you
developed an innovative program, completed a research
study, or provided exceptional care for a select group of
neonates? Please consider developing a poster or podium
presentation to share with your colleagues from across the
United States, Canada, and abroad. Go to academyonline.
org for guidelines and submission forms. Deadline for
abstract submission is July 1, 2014.
Practice Questions for Certification
In keeping with ANN’s mission to advance the knowl-
edge and education of neonatal nurses, we would like to
challenge and prepare you for your certification exam with
Practice Questions for Certification. If you have study topics
or questions you would like to contribute, please contact
Ute Berman at uberman@academyofneonatalnursing.org.
The answers to these questions are on page 178 (KR)
1. A 31-week-old neonate has the following arterial
blood gas:
pH, 7.37; PC02, 55; HCO3, 30; and PaO2, 84.
This blood gas indicates:
a. compensated respiratory alkalosis
b. respiratory acidosis
c. compensated respiratory acidosis
d. compensated metabolic alkalosis
2. The leading risk factor for the development of
necrotizing enterocolitis (NEC) is:
a. prematurity
b. early feedings
c. frequent blood transfusions
d. apneas and bradycardias
3. The major source of heat energy production in neo-
nates comes from:
a. shivering
b. burning of fatty acids
c. flexion and contraction of extremities
d. increasing heart rate
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VO L . 3 3 , N O . 3 , M AY / J U N E 2 0 1 4
4. At 1 week of age, the most common cause of
early-onset neonatal sepsis is:
a. Escherichia coli
b. Enterobacter
c. Group B beta-hemolytic Streptococcus (GBS)
d. Haemophilus influenzae
Member in the Spotlight
Mi Jefelito! CHD repair in the Hello from Hospital Bernard
Dominican Republic. Mevs, Haiti!
Have you participated in the Radiologic Rodeo? Have
you analyzed cardiac rhythms using Smith’s Ps? Have you
determined what is wrong with Baby ANN? If you have
answered “yes” to any of these questions, you have visited
the Baby ANN website.
February 16, 2014, marked the second anniversary
of Baby ANN. Since October 1, 2013, ANN member
Sean Smith, BSN, RN, Paramedic, NREMT-P, FP-C,
C-NPT, CCRN-CMC, CFRN, CEN, CPEN, has been
overseeing the case study submissions for Baby ANN.
He has been a frequent contributor since the site’s incep-
tion. Sean was also the first winner of the Baby ANN
contest in September 2012. Sean’s involvement with
Baby ANN grew from his own experiences preparing
certification review items for the Neonatal/Pediatric
Transport (C-NPT) and Certified Pediatric Emergency
Nursing (CPEN) exams and training to perform neonatal
ECMO for patients with congenital diaphragmatic her-
nia under the mentorship of Joy Perkins, RRT/RN, and
Dr. Kayes at Shands at the University of Florida. Case
study topics are selected from the published blueprints of
various neonatal certification exams. Studies come from
Sean’s library of cases written for C-NPT and CPEN
reviews, new patient profiles, and reader submissions,
when available.
Sean spends at least 12 hours per month working on
the Baby ANN website. When asked who works with him,
Sean replied, “Our readers are the MOST important part
of the team.” Jobeth Pilcher is a valuable mentor. Another
partner is Elizabeth John, who works in marketing and
research for ANN. She posts some of the nonclinical mate-
rial seen from time to time.
If you haven’t checked out Baby ANN, you are missing
a great resource for self- and staff education or certification
preparation. You can practice cardiac rhythm analysis, x-ray
interpretation, or work through a case study. In February
NEWS
177
 Z A Q X W E W C D E V F R B T G Hypoxic Ischemic Encephalopathy
N H Y M J E Y K I L O P O I Y T Word Search
H K L Q W G A G R E F L E X E R
HIE
H I E G F D S A M N B V C X A Z
EEG
H J K L C O P I U Y T R E W P Q coolcap
G H Y P O T O N I A F D S A G M seizure
N B V C O X Z A S D G H J K A L hypoxia
D G A J L D Q X S I X H O U R S hypotonia
P Q O W C I E U R Y T Y L A S K
apgars
gag reflex
Q V C B A X N Z M G F P H D J S
reperfusion
O S K M P I J N U H B O Y G V H temperature
N E G S K F Y X Z A Q X E R T I shiver
W I E T D U D J S J C I N S U V six hours
O Z R S G T E M P E R A T U R E Directions: Here are 12 words that relate to the topic
K U A I D J B S V K W U X S V R of Hypoxic Ischemic Encephalopathy. See if you can
find them all. Words may appear in any direction;
T R E P E R F U S I O N S J D L
horizontally, vertically, diagonally, or even backwards.
G E R S U L H I J W I T C Z N E The solution to this word search puzzle will be published
in the July/August 2014 News of the Academy.

2014, the format for case studies was changed, with a new
study posted on odd weeks and a consolidated answer/
solution set following on even weeks. Readers can submit case
studies to s.smith@academyofneonatalnursing.org. Studies
should be 2–5 sentences in length, with at least one question.
Patient identifiers should be excluded. Answers and refer-
ences/resources should be included. Sean’s goal is to have a
complete reference resource for readers for all of the patholo-
gies commonly addressed on neonatal certification exams,
Answers to Practice Questions for Certification
1. Answer is C. The pH is normalized so the blood gas is
compensated. The value that is out of range is the PCO2,
and it is acidotic; so it is compensated respiratory acidosis.
2. Answer is A. Prematurity is the leading risk factor
for the development of NEC.
3. Answer is B. The burning of fatty acids in brown fat
is the major source of heat production in the neonate.
4. Answer is C. GBS is the leading cause of early-onset
sepsis in the neonate.
arranged by review of systems, and in the format of Smith’s
Ps: Problem, Presentation, Pathology, Palliation, Pearls,
and Pitfalls. ANN members can look forward to Bowel
Badness, Cardiac Conundrums, Pulmonary Puzzlers, Skeletal
Strangeness, and more. Sean states, “It is my pleasure and
privilege to serve our hardworking and enthusiastic readers!”
Besides the Baby ANN website, Sean’s other passion is the
NICU/PICU at Hospital Bernard Mevs in Port au Prince,
Haiti. Sean is a regular clinical educator and staff nurse/
paramedic for both adult and neopedie ER/ICU. In the past,
Sean has volunteered for Operation Smile, teaching Neonatal
Resuscitation/Helping Babies Breathe in Morocco, as well as
International Children’s Heart Foundation in the Dominican
Republic and Honduras. He also has many coauthor credits,
most notably the Shock chapter in the latest edition of the
Emergency Nursing Association’s Trauma Nursing Core
Course. Sean is currently a per-diem clinical educator/staff
nurse for the Emergency Department at Granville Medical
Center in Oxford, North Carolina, and owns his own busi-
ness, lecturing several times per month on a state, national,
and international level on a variety of topics (notably lab val-
ues, airway management, emergency nursing, and neonatal/
pediatric emergencies). If you have a Sean sighting, please say,
“thank you” for keeping Baby ANN alive and well. (LW)

ACADEMY NEWS
178 M AY / J U N E 2 0 1 4 , VO L . 3 3 , N O . 3
 Academy of Neonatal Nursing
Membership Application
Join or renew online at www.academyonline.org
Membership applications for institutions or to institutional addresses are not
accepted.

_______ New _______ Renewal Academy ID # ________________________

First Last Credentials

Home Address City State Zip/Postal Code

Daytime Telephone E-mail

Nursing License Number and State Highest Level of Nursing Education RN/LVN/LPN

Employer Title/Present Position

Level of Neonatal Unit in Which You Practice Recruited by (Name and Membership Number) If Applicable

_____ Please check here if you are currently a subscriber to Neonatal Network:® The Journal of Neonatal Nursing so that your subscription can be correctly credited.

MEMBERSHIP BENEFITS MEMBERSHIP DUES

A one-year subscription to 1 Year U.S. $95 Canadian $95
Scholarship opportunities
Neonatal Network: ® The 2 Year U.S. $180 Canadian $180
Journal of Neonatal Nursing
15 free contact hours of 1 Year International $120
including online journal access
continuing education credit,
Access to members-only for online courses only, for 2 Year International $240
website each year of membership 1 Year U.S. Nursing Student $75
(must enclose current copy of transcript)
Academy Connection Conference Loyalty Program
eNewsletter 1 Year Retired (65 or older) $75
Online continuing Additional Items:
Recruitment Rewards
education courses ANN membership pin—$5
Discount at Academy-sponsored Star Benefits—Retail Radiology CD 2nd Edition—$40
conferences (a minimum of $25) discounts available online Full Zip Hooded Carolina Blue
Sweatshirt with Academy Logo—$36
Discounts on most books
EBP Premier Resource (For Additional Items ONLY: U.S. Shipping Included.
sold through the Academy Canada and International add $5)
& NICU INK Bookstore
S M L XL 2XL

PAYMENT — Please Print Clearly

CA residents please add 8.25% tax on sweatshirts and radiology CDs only $ _______________

Dues $ ______________ Sweatshirts $ ______________ Radiology CDs $ ______________ ANN’s Nursing Scholarship Donation $ ______________

International Shipping $ ______________ (International customers add $5 for each item of merchandise ordered)

Total Enclosed $ ____________

Make checks payable and mail to: Academy of Neonatal Nursing (ANN), 1425 N. McDowell Blvd., Suite 105, Petaluma, CA 94954-6513
Visa MasterCard Discover

Billing Address (if different from above) _______________________________________________________________________________

Card # _____________ - _____________ - _____________ - _____________ Security Code _________ Exp. Date _______ / _______
(Include the 3-digit security code located on the signature space of your card)

Signature ___________________________________________________________________________________________ Date _____________

To keep costs low, your membership fee must accompany your application. We do not bill. Please allow 4 weeks to receive your Academy membership card.
All payments must be in U.S. funds. Checks from non-U.S. banks are not accepted. For convenience, all international members are encouraged to join online at
www.academyonline.org. Please call us at 707-795-2168 if you have any questions.