In the NICU - Medical Care
This is when the blood is more acidic than it should be. This can happen when the lungs are not working well, or because not enough oxygen is reaching parts of the body. It can be a combination of both. Sometimes, the body produces too much acid, or the kidneys do not remove the acids from the blood. This is called metabolic acidosis.
This happens when a baby does not have enough haemoglobin in their blood. This can be treated with a blood transfusion and sometimes, extra iron is given to babies to prevent anaemia.
Anaemia of prematurity can be a problem for preterm babies. Anaemia means that your baby has less red blood cells that carry oxygen than they normally should. It is due to an immature bone marrow.
- Anaemia can cause your baby to look pale and become more tired.
- If your baby is anaemic, they will need regular check-ups in the baby clinic until it gets better.
- Haemoglobin is what makes blood red and it carries oxygen in the blood. Some babies need to have a blood transfusion to treat this anaemia.
- Iron is important for red blood cells and haemoglobin. Most babies who were born preterm are recommended to take iron supplements during their first year after they are a month old, unless they get enough iron from their diet.
Apnoea is a pause in breathing of more than 20 seconds. Apnoea happens most commonly in babies who are preterm and babies grow out of it as the breathing centre in the brain matures and your baby gets closer to term. You may hear reference to apnoea of prematurity.
Premature babies may have an apnoea because the part of the brain that controls breathing is not developed yet. Often the baby starts breathing on their own, but might need to be gently helped by moving them slightly. Caffeine is often given to help with this. Apnoeas in premature babies might happen more than once. Most babies will grow out of apnoea of prematurity by the time they are around 36 weeks.
A condition where there is too little oxygen and too little blood flow in the body. This can cause injury to the brain and other organs in the body. The most common time for asphyxia to happen is during labour (whilst the baby is being born) or at birth.
There are a few ways that this word is used in the neonatal unit:
– Aspirate from the feeding tube: Aspiration is also used to describe when a sample is deliberately drawn up from the stomach – this may be referred to as a gastric aspirate and may be done to test if a feeding tube is in the correct position. Gastric aspirate will be checked with pH paper or a pH stick to check.
– Aspiration refers to breathing anything into the lungs that shouldn’t be there. In babies this is usually milk or meconium.
– Aspiration can also happen in feeding if baby inhales small amounts of milk when they are feeding. This can happen if baby is premature and hasn’t fully developed the skills needed for feeding, or if baby is unwell and breathing very fast when trying to breath.
The normal newborn baby’s heart rate is 120-180 beats per minute.
- Bradycardia is the term used when the heart is beating slower than normal.
- Tachycardia is when the heart is beating faster than normal.
Some babies have breathing problems. In babies who were born early, the lungs may not be fully developed. In babies who were not born early, they can be unwell and too weak to breathe well or they can have a problem with their lungs.
If a baby’s lungs are not fully developed, they can be very stiff. Doctors may use a tube to pass a substance called ‘surfactant’ directly into the lungs. Surfactant helps to make the lungs spongier and easier to fill with air, making breathing easier.
Babies with breathing difficulties may require extra support to help them to breathe, see ‘Forms of respiratory support’ LINK.
Babies who were born preterm and needed help with breathing may get chronic lung disease (CLD). Babies with CLD have stiffer lungs and have to work harder to get air into their lungs. They may also become more tired during feeds. Babies with CLD sometimes need additional oxygen support for a while after they go home. CLD may also be referred to as ‘broncho-pulmonary dysplasia’ (BPD).
Cyanosis refers to a bluish colour of the skin usually caused by a reduced oxygen level in the blood.
Encephalopathy means that baby’s brain is not working properly. Baby may have seizures or be irritable. Some babies with encephalopathy can be floppier than they should be; some babies do not react to us in the way that they are supposed to. Some severe forms of encephalopathy might cause babies to be unable to breathe without the support of a ventilator. Many things can cause encephalopathy. The medical team will decide how best to investigate and manage each individual case.
GOR refers to stomach contents (including milk) spilling back up into the oesophagus (tube that connects the mouth to the stomach) and mouth. GOR is common and is generally seen as milky spills or possets. It is quite harmless and most babies grow out of it as they get bigger and older. For tips suggestions for managing GOR, see LINK.
If your baby also brings back up some acid from the stomach, it can cause discomfort. If this is significant, it may be referred to as gastro-oesophageal reflux disease (GORD) and require treatment.
Reflux may also be referred to as regurgitation.
Haemorrhage means bleeding.
A hernia is a gap in a muscle – most commonly the tummy muscles – where something can pass through. Hernias are common in preterm babies and often go away without any treatment. They can affect up to 10% of preterm babies and are more common in boys than girls are.
Inguinal hernias appear in a baby’s groin. A surgical doctor in a children’s hospital fixes these as soon as the baby is big and strong enough to have surgery.
- Umbilical hernias appear behind a baby’s belly button. These normally go away without any treatment. They do not need surgery.
Hydrocephalus happens when the fluid that moves around the brain and spine gets blocked. When the fluid is blocked, the spaces inside the brain fill with this fluid and cause the brain to swell. Sometimes hydrocephalus gets better as baby grows up. Many babies who have hydrocephalus will need an operation in CHI at Temple Street to put in a device in your baby’s scalp, which enables the unit to drain the fluid when it is needed, or put in a little tube called a shunt that drains the extra fluid to the body.
High blood sugar (glucose) level. Babies with high blood sugars need close monitoring and sometimes can need some insulin, which is a medication that helps to reduce the level of sugar in the blood. Some parents can be concerned that high blood sugar in a small baby can be diabetes – neonatal diabetes is incredibly rare and is probably not the cause of your baby’s high blood sugar.
Low blood sugar (glucose) level: some babes are at higher risk of having low blood sugars than other babies, including babies who are very small or big for their age, or babies of mothers who have any type of diabetes. Some babies with low blood sugars get better with a sugar containing gel medicine, but some babies do need to have fluids given by their veins and close monitoring until their sugars stay normal.
Hypertonia is an increased muscle tone. Babies with hypertonia feel stiffer or much stronger than the average baby of their age.
Hypotonia is a low muscle tone. Babies with hypotonia feel softer or floppier than the average baby of their age.
Hypoxia is when baby’s organs are not getting enough oxygen. This is normally treated by giving baby more oxygen.
This is a type of neonatal encephalopathy that is caused by baby not getting enough blood flow and oxygen to their brain. This happens most often around the time of birth.
If your baby is at risk of infection, they may have blood tests to check for infection. Some babies also need to have a lumbar puncture to make sure that they do not have meningitis. When we test for infection in babies, we start antibiotics until the results are back. Sometimes the results can take up to two days to come back from the laboratory. We can contact the microbiologist for help about infections at any time. If your baby is diagnosed with an infection, they will need to continue antibiotics for an amount of time. The amount of time depends on what has caused the infection and what type of infection it is. Sometimes babies with particular types of infection are cared for in isolation to reduce the risk of passing the infection to other babies.
The ventricles in the brain are spaces where fluid passes through. In preterm babies, small bleeds can happen in this area. Very small bleeds do not usually cause problems, but the bigger bleeds (grade three and four) can sometimes cause problems with your baby’s development, as they get older. The neonatal unit checks for these bleeds in preterm babies with ultrasounds of their brain.
Jaundice is a yellow colour of baby’s skin and whites of their eyes. Jaundice is caused by a build-up of something called bilirubin in the blood. Jaundice can be normal, but the level of bilirubin that needs treatment depends on baby’s age. Bilirubin comes from when baby’s extra red blood cells from when they were a fetus are broken down. Most jaundice goes away on its own, but if the bilirubin level is high, your baby will be treated with phototherapy, which is a special blue light treatment that breaks down the bilirubin in baby’s skin.
see ‘Phototherapy’ LINK.
Some babies get more jaundice than other babies do if they have a different blood type to their mother, or their mother has antibodies to different blood types. Sometimes if levels of jaundice are very high in babies with this type of jaundice, a medication can be used to help to stop the antibodies breaking down baby’s blood cells.
If jaundice is very severe and at a dangerously high-level, baby could need a procedure called an exchange transfusion. This is uncommon now because the phototherapy lights for treatment are very efficient.
Sunlight does not work to treat jaundice and if you think that your baby has jaundice after going home from hospital contact your PHN or GP.
Meconium is poo/faeces made by the baby’s bowels before they are born. It is normally passed after baby is born.
Meconium aspiration syndrome develops when meconium is passed before baby is born and baby breathes it in before birth.
Meconium can irritate baby’s lungs and cause them to not work properly. It can take a while for the meconium to go away when it is in baby’s lungs. Some babies who breathe in meconium can need breathing support.
Meningitis is infection of the fluid around the brain and spinal cord (CSF). This can be diagnosed with a lumbar puncture. Meningitis can make some babies very unwell. Babies with meningitis can need a long time on antibiotics to get rid of the infection.
Metabolic bone disease can happen when babies do not have enough calcium and phosphorus in their bones. This can make their bones more fragile and at risk of breaking. Babies born preterm are at higher risk and require higher intakes of these minerals. Vitamin D plays a role too. Metabolic bone disease may also be called osteopenia of prematurity.
NEC is a condition where baby’s bowels can get very inflamed and stop working. Sometimes babies get better if their bowel is allowed to rest with no food and baby gets nutrition through their veins and antibiotics to stop bacteria that could get into the blood from the inflamed bowel. Sometimes, babies can get very, very sick with NEC and need to be transferred to a children’s hospital for surgery to remove the inflamed bowel. Sometimes the bowel gets so inflamed that it bursts and babies who have this condition also need surgery.
NAS happens in babies of mothers who were on specific prescribed or unprescribed medication during pregnancy. Babies with NAS can be irritable, unsettled, and cry a lot. Babies at risk of NAS are monitored closely to see if they need medication to make them more comfortable. NAS symptoms usually appear by about five days after a baby is born. This medication is normally only given in hospital, and so sometimes some babies need to stay in hospital for a few weeks.
A PDA is a little linking blood vessel that is supposed to be there before a baby is born when blood does not need to flow through baby’s lungs. It normally closes after baby is born and they start breathing. Sometimes it does not close in preterm babies and in some babies with a PDA, it can need treatment with medication. The medication does not work in some babies and sometimes babies need to be transferred to CHI at Crumlin to have the PDA closed with heart surgery or a device through a blood vessel.
PVL is a form of brain injury that can affect babies. This happens when the brain does not get enough oxygen when it is developing and some brain cells can die and be replaced with fluid cysts. PVL can be seen on an ultrasound of a baby’s brain – or on an MRI. PVL can cause problems with your baby’s development when they get older and babies who have PVL have their development more closely followed because of this.
A pneumothorax is when air gets out of the lung and collects inside the chest. This air can squash the baby’s lung and make breathing difficult. Normally we treat this air collection by using a needle to take out the extra air. In about half the babies with a pneumothorax the needle works and they don’t need any more treatment. Half of the babies who have a pneumothorax need a chest drain.
Before babies are born, they do not need to use their lungs and the blood pressure in their lungs stays high so that blood does not go through them. When a baby is born, the blood pressure in the lungs normally drops so that the blood pressure in the blood in the body is higher than the lungs. This means that blood can travel from the heart into the lungs to get oxygen, and then the oxygen can travel with the blood to the rest of the body. Sometimes when babies are sick, the blood pressure in their lungs stays higher than the blood pressure in their bodies, and so the blood can’t get oxygen from the lungs. This can be serious. There are some ways to treat this including a special gas (see inhaled Nitric Oxide) that brings the blood pressure in the lungs down and medication to bring up the blood pressure in the body.
A reservoir/VAD is a valve that is attached to the space in the brain where the extra fluid is in hydrocephalus so that the team in the neonatal unit can drain the fluid with a needle.
RSV is a virus that can cause chest infections in babies. Babies can get RSV from other adults or children with mild colds. This is one of the reasons why it is important that people who are unwell are not up close to your baby.
Some babies who are born very preterm or have heart problems are at higher risk of problems from RSV. Palivizumab (Synagis) is an approved prescription injection of antibodies that can help to protect high-risk babies from RSV disease. Palivizumab is given every month from October to March when baby is at home by a specialised nurse. You will be told about Palivizumab by the medical team before your baby goes home if they are considered high-risk.
ROP happens when the blood vessels at the back of the eye develop abnormally in very preterm or small babies. Babies who are at risk of ROP have their eyes checked by an Ophthalmologist (Eye Specialist).
Not all preterm or small babies get ROP. Sometimes if a baby has ROP it can go away without any treatment. If it progresses, the ophthalmologist will treat it with laser therapy or injections into the eye.
The outcome for ROP is usually very good. However, some cases result in minor vision problems. If babies with ROP are not followed up until the ROP goes away, they are at risk of blindness. This is why it is very important to go to baby’s eye appointments after they are discharged from the neonatal unit.
Seizures are caused by abnormal electrical activity in the brain. Sometimes we can see seizures because they cause abnormal movements. Sometimes seizures can cause baby to stop breathing.
Babies with seizures need to come to the neonatal unit for investigations and treatment and will require follow-up.
A shunt is a plastic tube that travels from the spaces in the brain where the extra fluid is when a baby has hydrocephalus, through a valve into the space around the organs in the body. Shunts are put in by brain surgeons in CHI at Temple Street.
Tachycardia is when the heart is beating more rapidly than normal.
Tachypnoea describes when a baby’s breathing is rapid, usually more than 60 breaths per minute.
TTN is a short period of fast breathing after birth. There can also be a noise called grunting. Amniotic fluid that is still in the lungs causes TTN. This fluid normally absorbs into the blood from the lungs. It generally lasts a short time and the baby usually makes a quick recovery but if it does not get better, then babies can need more tests.