In the NICU - Medical Care
Medical tests and examinations
Babies brought to the neonatal unit may be very unwell and need a high level of medical and nursing care. This means watching and measuring many of their bodily functions with tests and examinations. Every test or treatment is done for a reason. You will be informed about any major procedures your baby may need whenever possible. For some procedures, you can choose to be present, but sometimes this is not possible and you may be asked to wait in a separate area.
A barium study is a test that looks for abnormalities in the gastro-intestinal tract (GIT).
A special liquid is given and is watched as it moves through the GIT using X-rays.
- Barium swallow looks at the upper part of the GIT, e.g. the oesophagus (the tube that connects the mouth with the stomach) and stomach.
- Barium enema looks at the lower part of the GIT, e.g. the large intestine (colon/bowel).
Babies in the neonatal unit often need blood tests to check the level of various substances in their blood. The smallest amount of blood possible is taken using very small needles.
Common blood tests include:
- Blood gas sample
This is a small sample of blood that is used to determine the amount of specific gases, such as oxygen and carbon dioxide in the blood and also how acidic or alkaline it is. The neonatal team use this test to see how well the lungs are working and to see if the breathing support that is being used is working well.
- Full Blood Count (FBC)
An FBC measures the level of various parts of blood, e.g. red blood cells (RBC) and haemoglobin (Hb), which carry oxygen; white blood cells (WBC), which help fight infection; and platelets, which help blood to clot. An FBC is used to screen for anaemia (low red blood cell count) and infection (high or low white blood cell count).
- Urea and Electrolytes (U&E)
An U & E measures the level of urea and salts in the blood and provides an indication of the level of hydration.
This is a yellow part in the blood than can cause a yellow colouring of a baby’s skin. High levels of bilirubin cause jaundice.
This is a blood test taken to check for infection. It takes 36-48 hours for the result of this test to come back as it takes time for bacteria to grow in the culture if there is an infection. If there is an infection, the team can check with the microbiologist that baby is on the correct antibiotics.
A heel prick is a procedure where a tiny prick is made on the heel in order to get a sample of blood for analysis. Centile charts: Graphs showing the normal ranges of body measurements at different ages, like weight and the size of the baby’s head. These charts are used to make sure that your baby is growing the way that they are supposed to.
A CT scan views inside the body, using computer processed X-rays. CT scans are not commonly used for babies.
This is fluid that is made in the brain, which flows around the brain and spinal cord. Hydrocephalus occurs if the flow of this fluid gets blocked. This fluid is tested when we are checking for meningitis with a lumbar puncture.
ECHO uses ultrasound to evaluate the heart muscle, chambers and valves.
An EEG measures the electrical impulses of the brain.
CFM/aEEG: This is a machine that does a ‘mini-EEG’ that lets us see the electrical activity in a baby’s brain. There are three or five little probes attached to baby’s head. This is used often in babies who are at risk of having a seizure. This is also used in babies who are being cooled.
An ECG measures the electrical activity of the heart. The ECG needs ten stickers to go on baby’s chest.
Eye tests will be performed to check for Retinopathy of Prematurity (ROP) in babies at risk. Bigger babies may need eye tests for other reasons as identified by your baby’s doctor. There are varied reasons, and your doctor will explain if this test is required for your baby. See ‘Retinopathy of prematurity’ LINK.
All babies born in Ireland have their hearing screened by the HSE. This normally gets done before baby is discharged from the hospital. Babies who need to be moved to another hospital will have their hearing checked there or back in the maternity hospital after discharge home. This test is a test that your baby will pass or fail. Some babies, even if they pass, will be referred to an Audiology (Hearing) Clinic – this will happen if your baby has some medical conditions. If your baby fails this screening test, they will be checked again after discharge or referred to the Audiology (Hearing) Clinic.
A lumbar puncture is a test that is used to check the CSF, which goes around baby’s brain and spine. This test is mainly done to check if a baby has meningitis. Sometimes results come back very quickly, sometimes they take longer. This test uses a little needle put into the space between the bones in baby’s back. Baby is held very still for this test and it is a sterile procedure.
MRI is a special scan to get a clear picture of the inside of the body. MRIs are done most commonly to look at the inside of babies’ brains. MRIs don’t use any radiation because they use very strong magnets to do the scan.
The neonatal team will get your baby ready for their MRI. An MRI scan generally lasts at least an hour and sometimes longer. In small babies, the MRI scan is normally done after a feed so that they will sleep and stay still for the scan. This is called a ‘feed and wrap’ MRI because after their feed we keep baby cosy in the MRI scanner so that they sleep and stay still. Sometimes if your baby cannot stay still in the scanner or if babies are older, sometimes medication is used to help baby sleep during the scan. A specialised nurse will be in the MRI department with your baby at all times. The MRI nurse will tell you all about the scan if you are bringing your baby in from home for the MRI.
Ultrasound scans are like the scans done before your baby was born. There is no radiation with ultrasound scans. They are most commonly used to look at the inside of your baby’s brain in the neonatal unit. The ultrasound will be done by an ultrasonographer, a specialist radiographer who does ultrasounds, or by the consultant radiologist. If the ultrasonographer does the ultrasound, the results of it will be reported by the consultant radiologist.
Urinalysis is testing your baby’s urine. A little stick is used that is dipped into your baby’s urine. The colours that the stick turns can tell some things about your baby, like if there is sugar in their urine. Sometimes, the team looking after your baby check for infection in babies’ urine.
A video fluoroscopy is an X-ray, which is used to check if there is a problem in baby’s mouth or throat during swallowing.
Babies are weighed regularly in the neonatal unit, either inside their incubator or on a separate scale. Weight measurements are used to assess a how a baby is growing and if they are getting enough feed and fluids.
Length and head circumference measurements are also used to assess growth. All of these measurements go on a centile chart.
X-rays are pictures of the inside of the body, e.g. the heart, lungs, intestine (bowel) and bones.
The Newborn Bloodspot Screening Programme involves a blood test, which all newborn babies in Ireland have. This test looks for certain rare metabolic/genetic conditions. This screening test makes sure that any baby who has one of these conditions, is identified and treated as early as possible.
This test is also referred to as the ‘Heel Prick test’, ‘Guthrie test’ or ‘PKU test’ or Newborn Screening card.