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Below is a list of common medical investigations and procedures that your baby may undergo during his/her stay on NICU. Not all babies require all investigations as this is determined by their condition. Speak to the nurse/doctor caring for your baby for specific information and rationale behind the procedures and investigations your baby may be encountering on the NICU.

 

Many tests such as daily blood tests, x-rays and head, heart and bladder ultrasound scans are considered routine and we will not specifically ask your permission to perform these. Other investigations and procedures are performed less but are still considered very low risk and are usually essential for your baby's care. These include lumber puncture, screening your baby's eyes, and more specialised scans - we will discuss these procedures with you beforehand unless in an emergency.

 

 

Antibiotic therapy

If an infection is suspected the appropriate tests are carried out and your baby will be treated with broad spectrum antibiotics (medication which tackles most general infections) even before any laboratory results are back. These antibiotics will normally be administrated for at least 48 hours. If any of the test results are positive for infection, your baby will receive a course of special antibiotics to target his/her particular infection more effectively. The length of the course of antibiotics will depend on the type of infection being treated and your baby’s response to it.

 

 

Blood and Blood Product Transfusions

During your baby's stay in the NICU it may be necessary for him/her to have transfusions of blood or blood products. To ensure your baby' blood is safe babies receive blood from as few donors as possible. All of the volunteers who give blood in the UK go through a strict screening process and every unit of blood is rigorously tested. The blood that is given to your baby will have been cross-matched against mum's blood. Your baby will be very closely monitored whilst the transfusion is in progress for signs of reaction. However, in general transfusion reactions are very unlikely to happen.

 

The kinds of transfusions your baby may receive while on the NICU include:

Red blood cells (RBCs)

 

These are the oxygen carriers of blood. If your baby's RBC count is low your baby's ability to carry oxygen is compromised and this may impact on the amount of oxygen/ventilation he/she requires and limit tissue growth and development. RBC may also be given if your baby has low blood pressure or is anaemic.

 

Platelets

 

Platelets are the factors in blood that allows clots to be formed around a wound to reduce bleeding. If your baby's platelet level is low, he/she is at an increased risk of bleeding therefore a transfusion of platelets may help your baby to form clots and prevent bleeding.

 

Human Albumin Solution (HAS)

 

This is plasma, the liquid portion of blood, which may be used for volume expansion if your baby's blood pressure is low or he/she has poor circulation.

 

Fresh Frozen Plasma (FFP)

 

Fresh Frozen Plasma (FFP) contains valuable clotting factors. FFP may be given if your baby has clotting problems.

 

Cryoprecipitate (Cryo)

 

Cryo is a component of FFP and contains a concentration of clotting factors. Cryo is given to correct deficiencies in the clotting process.

 

Immunoglobulin (antibiotics)

 

When babies are born early or are sick, they sometimes do not have sufficient antibiotics to help them fight infection. Therefore, it may be necessary to give an infusion of immunoglobulin to boost your baby's immunity.

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Blood tests

While your baby is in the NICU blood tests will be performed regularly to monitor the body’s organ function and test for signs of infection. The regularity of the blood tests will depend on how sick your baby is. Yours baby's blood can be tested on the unit, but some samples will be sent to the laboratory to gain more in depth information. We always use the smallest amount of blood possible and usually take a sample from the heel, an arterial line if your baby already has one or from a fine needle inserted into the vein. The doctors and nurses will be happy to discuss the reasons for the various tests we do and the results as these become available.

 

Blood may also be required for non routine specialist tests. In these circumstances the parents will be spoken to and consent obtained.

 

 

Cannulation

Cannulation is the term used for the insertion of a cannula into one of your baby's veins. This cannula is a small plastic tube which allows for the delivery of fluids, medicines and blood transfusions to ensure the well-being of your baby.

 

 

 

 

Cerebral Function Monitor (CFM)

The CFM is a specialised brain monitor which measures the brain’s electrical activity. Four very tiny needles are placed under the baby’s skin and secured with tape. The monitor can be left on for hours or days. The overall activity of your baby’s brain can be measured as well as abnormal electrical activity which is associated with seizures.

 

 

Chest Drain

Chest drains are tubes that can be insertedinto your baby's chest, to either remove the extra air from a pneumothorax (a pneumothorax is when a lung collapses because of a leak of air between the lung and the chest wall), or to drain blood from a wound following surgery.

 

Chest drains are inserted under general anaesthetic and secured to the skin. The drain will remain in for several days until no more air is leaking from the lung, or in the case of a drain being inserted to drain blood following surgery the drain will remain until the surgeon is happy for it to be removed.

 

 

Contrast study

If your baby is having problems with feeding he/she may need a Contrast Study to look for bowel complications. An X-ray of your baby's bowel is taken while fluid which can be seen on x-ray (contrast fluid) is placed into your baby's stomach. A Contrast Study is performed in the radiological department in the main hospital. To transfer your baby to the radiological department your baby will be placed in a warmed transport incubator. A doctor or the nurse looking after your baby will explain both the procedure and transfer to you in more detail. You are welcome to walk with the medical staff and your baby down to the scanner.

 

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Echocardiogram (ECHO)

An echocardiogram is an ultrasound scan of your baby's heart to check the chambers and valves of the heart.

 

 

Electroencephalogram (EEG)

An EEG looks at the electrical activity of the brain and is especially used if your baby is thought to be experiencing seizure activity. The instrument is the same one used for Cerebral Function Monitoring(CFM), but uses a large number of sensors placed all over the head. Unlike the CFM, the EEG sensors are placed on the head using special electrode gel. The EEG can be done on the NICU and is pain free. A number of sensors are placed over your baby's head and the activity recorded for about 20-30 minutes. The electrical activity is then analysed by a consultant before you receive the results.

 

 

 

Exchange Transfusion

 

An exchange transfusion involves removing your baby’s blood in stages and replacing it with fresh donor blood. Your baby may require an exchange transfusion for a number of reasons:

• Rhesus incompatibility
• ABO incompatibility
• Severe jaundice which is not responding to phototherapy
• Severe infection
• Severe disturbances in body chemistry
• Toxic effect of drugs

Rhesus incompatibility occurs in a baby when mum has a Rhesus negative blood group and baby has a Rhesus positive blood group.

This may not be a problem with the first pregnancy. However, if blood was passed from baby to mum during her first pregnancy or during labour and her second baby is also Rhesus positive then mums antibodies that would have formed will pass into the baby’s bloodstream via the placenta. These antibodies will act by destroying the baby’s red blood cells which may cause severe anaemia and jaundice.

The blood that is used for an exchange transfusion is adult donor blood that has been screened for infections and is cross matched against both mums blood and baby’s blood to ensure that it is compatible with both.

 

 

Exchange Transfusion Procedure.

To perform this procedure the doctors will insert fine tubes into an artery and into a vein usually through the umbilicus. A small amount of blood is removed from your baby and replaced with donor blood slowly over a few minutes. This procedure is repeated every few minutes for up to two hours, depending on how much blood needs to be exchanged. This procedure is performed slowly to ensure he/she remains stable throughout while being closely monitored. This is a sterile procedure therefore your baby may be covered with sterile towels.

A doctor will discuss all of this with you prior to the procedure.

 

 

 

Genetic Testing

 

Genetic tests are used to see if your baby’s condition might be associated with his/her genetic makeup - the genes and chromosomes that are passed on from both parents.

To perform the test a small sample of blood will be taken from you baby for testing. If any other type of tissue is needed this will be discussed with you first. A doctor will discuss which type of test or tests are being performed.

 

There are two types of tests used:

• Chromosome analysis – Chromosomes are the structures within our cells that contain many genes. Chromosome analysis will look for abnormalities of the chromosomes. If an abnormality is found this may help to explain some or all aspects of your baby’s condition. In some circumstances abnormalities unrelated to your baby’s condition may be found. All test results will be discussed with you as soon as the results become available.
  
  
• Single gene analysis – This test is highly specific and generally only gives information about a single genetic condition.
  

 

Test results:

 

The length of time it takes to receive test results vary from a few days to many weeks. The doctors on the unit will keep you informed and discuss the results with you as soon as they are available. 

 

If a diagnosis is discovered it may sometimes be appropriate to test both parents and any siblings, to determine if the problem has been inherited. A doctor will discuss this with you.

 

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Infection screen

If your baby is showing signs of being unwell or has been born prematurely one of the doctors will perform an infection screen. To perform a full infection screen the doctor will need to obtain samples of your baby's blood, urine and possibly spinal fluid. These samples will be given to the hospital laboratory to see if they can grow any bacteria, virus or fungi from the samples. Samples may also be taken from your baby's sputum or a swab taken from a wound site. Blood tests including a full blood count (FBC) and C-reactive protein level (CRP) are also taken. These will indicate if the baby is suffering from an infection. In some instances of suspected infection an x-ray of your baby's tummy or chest may be taken.

 

The doctors or nurse looking after your baby will aim try to inform you of the plan to perform an infection screen. However, in some cases this is not always possible, but you will be informed that samples have been sent to the laboratory and spoken to about the results of the screen and any possible plan for treatment. Your baby will automatically be started on a course of antibiotics. These antibiotics will be reviewed once the results are obtained by the laboratory.

 

 

Intravenous (IV) and Arterial lines

Instead of giving your baby injections every few hours, IVs allow certain medications to be given continuously, several drops at a time through the vein. A cannula is inserted in the vein and connected to the medication or fluid. These are also known as drips. Although we usually try to insert a cannula into a vein in the leg or arm, occasionally we have to insert one into a vein in the head, known as a scalp vein.

 

Arterial lines are cannulae which are inserted into one of the arteries of the hand or foot. They are used to continually measure blood pressure, which is important if your baby is very ill, and for taking repeated blood tests.

Long Line

 

In order to give your baby essential nutrients (TPN) and also certain drugs, a specialised line needs to be put in which goes into one of the large blood vessels of the body; these lines are known as Long Lines. To put a long line in a cannula is inserted into one of the veins in the arm, leg or scalp and a tiny tube fed through it which goes all the way to the large blood vessels. Once inserted an x-ray is taken to check the position of the line. The nursing staff will carefully observe these lines for leakage and swelling and will remove them immediately if there are any concerns.

 

 

Umbilical catheters

 

The umbilical cord provides a way for the doctors to insert arterial or venous lines into your baby without having to use a needle through the skin. These vessels are mostly used in the first few days after birth.

• Umbilical Vein (UVC)
  The line in the vein is used for giving fluids, extra nutrients and medication. After several days the UVC will be removed and is often replaced by a Long Line.
  
  
• Umbilical Artery (UAC)
  The line inserted into your baby's artery is mostly used to measure your baby's blood pressure which will be displayed on the monitor and to take blood samples to measure oxygen levels in the blood. If the doctors find it difficult to insert a line into the umbilical artery an artery in your baby's leg or arm may need to be used.

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Intubation

If your baby is having problems with his/her breathing and the doctors decide he/she requires some mechanical breathing support via a ventilator (breathing machine) a endotracheal tube (ETT) will be inserted into his/her mouth or nose and connected to the ventilator. The part of the tube you can see will be secured to your baby's face to prevent it from moving around while the other end rests in your baby's trachea (windpipe) just above the opening to his/her lungs. The ventilator is then able to deliver the required support continuously. To ensure your baby is as comfortable as possible during the procedure an anaesthetic and muscle relaxant will be given.

 

 

Laser therapy

Laser therapy is used to treat severe retinopathy of prematurity (ROP). During laser treatment the ophthalmologist directs a bright beam of laser light through the pupil of the eye. The laser light is used to treat the front part of the retina and results in the shrinking away of the abnormal blood vessels. If laser treatment is recommended for your baby the procedure is usually performed in an enclosed room in the neonatal unit. Your baby will be sedated and given pain relief to keep him/her comfortable. Treatment takes about 50minutes for each eye. One laser treatment is usually enough but occasionally further laser treatment is necessary.

 

 

Lumbar Puncture

As part of an infection screen a Lumbar Puncture may be performed to test for meningitis. A Lumbar Puncture is performed by inserting a small hollow needle into the lower part of your baby's spinal canal in between to bones in the lower back to draw out a sample of fluid that surrounds your baby's spinal cord. This fluid is called cerebrospinal fluid (CSF) and it surrounds and protects your baby's brain and spinal cord. Your baby's CSF will then be sent to the laboratory for testing. Analysing the CSF will show if there is a meningitis infection present in this vital part of your baby's nervous system.

 

During the procedure a nurse will be supporting your baby in a curled up position to aid the insertion of the needle. This nurse or another nurse will also be protecting your baby's eyes from the bright light and comforting your baby throughout. Pain relief will be given prior to the procedure.

 

 

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MRI (Magnetic resonance imaging)

An MRI scan produces computer generated pictures of the organs inside your baby's body. The images the scans produce are usually two-dimensional but, in some cases, several different scans can be taken to build up a three-dimensional image that can be displayed on a computer screen.

 

The MRI scanner is some distance from the Rosie in the main Addenbrooke's hospital. To transfer your baby to the scanner your baby will be placed in a warmed transport incubator. Because the scanner works by using very strong magnets, care is taken to ensure nothing magnetic is on your baby and special monitors and pumps designed for use in an MRI scanner are used.

 

Because the MRI scanner is not near the Rosie your baby will need to be in a stable condition before this investigation can be performed. The medical staff will talk to you in more detail about the scan and why your baby needs an MRI Scan and involve you in the plans as much as possible. You are welcome to walk with the medical staff and your baby down to the scanner. The most common reason to perform and MRI scan is to image your baby’s brain. These scans are seen by both neuroradiologists at Addenbrooke’s as well as being sent to the Hammersmith Hospital in London, which specialises in imaging babies brains.

 

Phototherapy

Phototherapy is the most common treatment for jaundice, and works by producing more soluble bilirubin products so that your baby can absorb them more easily.

 

 

On the NICU there are blue overhead phototherapy lamps, white spot phototherapy lamps on the side of the incubators and small blue phototherapy blankets that your baby may lie on. They all work in the same way. Your baby will be placed under the light with only a nappy on so that the majority of his skin is exposed. He will also have eye shields on to protect his eyes from the bright glare. Phototherapy has few complications and is used on NICU's worldwide. However, your baby's bilirubin levels will be monitored closely with a small blood test, and the NICU nurses and doctors will also ensure that he does not get too hot, too cold or dehydrated. Often babies can develop a small rash on their body when they are receiving phototherapy. This is nothing to be concerned about and will quickly fade when the lights are removed. Parents are encouraged to continue caring for their baby when he is receiving phototherapy by comforting him, doing nappy changes and having him out for cuddles.

 

 

Rectal Cell Biopsy

Tissue is obtained by performing a suction anal biopsy. The specimen is examined for the presence or absence of nerve cells. This procedure can be performed on the unit and pain relief will be given prior to the procedure.

 

 

Ultrasound

The doctor may perform an ultrasound scan to view your baby's heart, kidneys, liver or brain. During an ultrasound test, a doctor will move a device called a transducer over the part of your baby's body that needs to be scanned. The transducer sends out sound waves, which bounce off the tissues inside your baby's body. The transducer also captures the waves that bounce back. Images are created from these sound waves. The most common scan to be performed while your baby is on the neonatal unit is a head ultrasound scan. This is performed to allow the doctors to have a look at the structure of your baby's brain. It can show whether there has been any bleeding or other problems. The doctor will always discuss the results of any scans they perform.

 

 

Urine sample

A urine sample may be taken from your baby as part of an infection screen or to test for electrolytes. There are a number of ways we can collect your baby's urine depending on the kind of test needed. A cotton wool ball may be placed in your baby's nappy or a small bag attached. If a sterile sample is needed the doctor may have to insert a small needle straight into your baby's bladder, guided by an ultrasound scan. and aspirate the urine out to insure it is not falsely contaminated.

 

 

X-rays

Scans and x-rays are often needed on babies that are too ill to be taken to the x-ray department. For this reason the ultrasound and x-ray machine stay permanently on the unit; they can be used for routine investigations or quickly in the event of an emergency.

 

The doctor may order a chest or abdomen x-ray for your baby. X-ray technology uses electromagnetic radiation to make images. A Radiographer will come up to the unit to take an x-ray of your baby; although the amount of radiation from an x-ray is small, you will be asked to stand away from the incubator while the x-ray is being done.

 

 

 

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