Visiting the NICU Admission to the NICUHow we care for your baby Neonatal surgery Developmental care Parental involvement Coping and where to get help Family journeys Parental rights and responsibilities NICU jargon buster Frequently asked questions

The section aims to highlight some of the common problems and diagnosis found on the NICU. It does not aim to give treatment methods as each baby is individual and will have care tailored specifically according to their needs.  Speak to the nurse/doctor caring for your baby to find out how your individual baby will be treated if he/she has been diagnosed with any of the problems below.

 

 

 

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z

 

 

 

 

A

 

Anaemia

 

Anaemia is when the body does not have enough red blood cells. Red blood cells are responsible for carry oxygen around your baby's body. If your baby is Anaemic he/she may appear pale, be short of breath, and have increased oxygen requirements. A blood test can be taken to determine what the baby's red blood cell count is.

 

Your baby may become Anaemic because babies red blood cells have a shorter life span than adults. The life span is even shorter if mums blood group is different to baby's blood group. Babies also make fewer red blood cells in the first few weeks of life. The most common cause of Anaemia for premature babies is the taking of blood samples for investigations in the NICU. The number of blood transfusions your baby may need will depend on how small and how sick your baby is. Very tiny infants with respiratory problems may require transfusions as often as once a day.

 

 

Anaemia does not always need to be treated with a blood transfusion. Sometimes a baby will make more of his/her own red blood cells. A blood test called a reticulocyte count can be taken to show the percentage of newly made red blood cells. If your baby has had problems with Anaemia he/she will eventually require iron supplements in his/her milk. The dietician, nurses or doctors will be able to discuss this with you.

 

 

Apnoea

 

Apnoea is the term commonly used for stopping breathing for 20 seconds or longer and is directly related to prematurity. The more premature your baby is, the more likely apnoea will occur. This is because the receptors in the brain that control breathing are immature. Your baby will be continuously monitored for apnoea episodes and if apnoea does occur your baby will be gently stimulated to encourage regular breathing again. The use of a stimulant medication called caffeine is found to reduce the incidence of apnoea, and is commonly given to premature babies. If the episodes of apnoeas become more frequent or prolonged it may be a sign of stress, such as infection or secretions blocking the airway. Theses will be investigated appropriately.

 

 

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B

 

Bradycardia

 

Bradycardia is an abnormal slowing of the heart, often arising from other problems like low oxygen levels in the blood or from apnoea (breathing that stops longer than 10 seconds).

Bradycardia can be seen on your baby's monitor in the NICU and is treated by dealing with the underlying cause, such as apnoea and low oxygen levels. If your baby was born early they are likely to experience many episodes of bradycardia combined with apnoea and low oxygen levels until they develop further.

 

Often when your baby is bradycardic the NICU staff may not need to do anything, as your baby will usually start breathing again on their own and in response to this increased oxygen level your baby's heart rate will increase. If your baby's heart rate does not increase after approximately 20 seconds or so, a nurse may stimulate your baby by rubbing or stroking their side, back or feet.  If this does not work the staff will try giving extra oxygen. If your baby is already attached to breathing support the oxygen can be increased. If your baby is breathing on their own with no support the nurse may gently blow a stream of oxygen near your baby's face via a face mask attached to a neopuff connected to an oxygen and air supply from the wall.

 

 

 

Bronchopulmonary Dysplasia (BPD) - see chronic lung disease

 

 

C

 

Chronic lung disease (CLD)

 

Often the combination of the premature baby's immature lungs and the treatments to help him breathe (including machines and oxygen) can cause scarring of the delicate lung tissue. Babies who still need oxygen at 36 weeks gestation are considered to have CLD.

 

CLD is sometimes treated with steroids to decrease the amount of scarring, but steroids can cause side effects, so doctors usually wait as long as possible to begin steroid treatment. Other, more commonly used medicines include diuretics and bronchodilators. Occasionally, babies need home oxygen therapy for several months. A baby with CLD also needs a ventilator to help him breathe, and in severe cases, the surgical insertion of a breathing tube in the neck (a tracheostomy) may be required so the baby can go home on a ventilator, although this is uncommon.

 

Improvement for any baby with CLD is gradual. Lungs continue to grow for 5-7 years, and there can be subtle abnormal lung function even at school age, although many children function well.

 

D

 

Diaphragmatic hernia

 

Diaphragmatic hernia occurs early in development when the diaphragm which separates the lungs and the abdominal contents fails to form properly.

 

The problem is usually diagnosed before the baby is born. Babies who have a diaphragmatic hernia will have some contents of the abdomen in place of where the lungs should be, affecting the development of the lungs. As the lungs are not used while the baby is in the womb this does not cause any problems. However when the baby is born he will have difficulty breathing. The amount of lung which has been squashed will determine how unwell the baby is when he is born. In all cases the neonatal team will be present at the delivery and will intubate and ventilate the baby before transferring the baby to the neonatal unit. Although the final treatment is surgical repair of the hole in the diaphragm, this can only be done when the baby is stable enough. Sometimes the baby requires a lot of ventilatory support including high frequency oscillatory ventilation and nitric oxide (see jargon buster). After the surgery the long term outcome depends upon the amount of healthy developed lung remaining. Babies often need additional support for their breathing and help establishing feeds several weeks after the operation.

 

As with all babies with surgical conditions, they are followed up by the neonatal surgical team.

> Neonatal surgery - General surgery

 

 

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E

 

Exomphalos

 

Exomphalos occurs when the gut fails to return into the abdominal cavity during development. It is usually picked up on antenatal scans, and requires surgical treatment. The herniated gut is retained in a sac usually similar to the umbilical cord. Surgery will be planned for your baby as soon as possible after delivery, and feeding can be commenced following repair.

> Neonatal surgery - General surgery

 

F

 

Feeding problems

 

Feeding problems are very common in the newborn. If your baby has been born prematurely or has had surgery then oral feeds will be started very slowly. This is because the gut may be immature or sluggish following surgery. Tolerance of feeds will be assessed regularly to ensure that your baby is digesting the milk, avoiding problems such as vomiting. If your baby is not tolerating the small amounts of milk, vomiting or showing signs of being unwell the feeds will not be increased and they may even be stopped. The stopping and starting of feeds in this way is common on the NICU due to the delicate nature of the babies that we care for.

 

See also gastro-oesophagal reflux below.

 

 

 

G

 

Gastro-oesophageal reflux

 

Gastro-oesophageal reflux occurs when the stomach frequently regurgitates its contents upwards towards the mouth. If your baby has been born prematurely, has had abdominal surgery or has had problems establishing feeds then he/she is likely to be at an increased risk of developing reflux. Vomiting milk during or immediately after a feed is suggestive of reflux, and is usually treated by tilting your baby's bed to a more upright position and feeding more slowly. Occasionally medication is used to reduce gastric acid and help reduce reflux. These therapies control reflux in the majority of babies.

 

 

 

 

Gastroschisis

 

Gastroschisis is a condition where the abdominal contents are outside due to a defect in the abdominal wall. It is usually picked up on antenatal scans. It is different from exomphalos (above) in that the gut is not covered in a membrane. This means that surgical repair has to occur soon after the baby is born. Either all of the gut is put back into the abdomen in one go or the gut is put into a bag, known as a silo, and gradually pushed back in over a few days.

 

Feeding can be commenced slowly once the gut is back in the abdomen and the baby is stable.

> Neonatal surgery - General surgery

 

 

 

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Hirschsprung's Disease

 

Hirschsprung's Disease is a congenital condition which can cause extreme constipation, pain, and intestinal blockage. Anemia, bloody stools and diarrhea may also be noted with the condition. Hirschsprung's Disease manifests as a lack of appropriate nerve cells in the large intestine or colon. When the body cannot sense that the colon is full with waste products, the intestine can back up. In infants this may be seen as infrequency of bowel movements, which may be accompanied by painful spasms. Because of larger bowel movements, the sensitive skin around the anus can tear, causing blood in the stool. The definitive diagnosis of Hirschsprung’s Disease rests on histology of a rectal biopsy. The normal treatment for an infant with Hirschsprung's Disease is called a pull through surgery.

> Neonatal surgery - General surgery

 

 

 

Hydrocephalus

 

Hydrocephalus is where the fluid that normally flows around the brain fills the centre of the brain. This is caused by a blockage. The blockage may occur early on in development (congenital hydrocephalus) or following a bleed in the centre of the brain (intraventricular haemorrhage). The blockage may resolve by it self, but occasionally it will need to be drained. A small plastic tube is placed in the ventricle with the end just under the skin. This will allow doctors to take off fluid with minimal risk of infection. If the problem persist a special tube known as a 'VP shunt' has to be put in. This very thin tube is passed from the ventricle under the skin into the tummy and allows fluid to be drained continually.

> Neonatal surgery - Neuro surgery

 

 

 

 

Hypoglycemia

 

Hypoglycaemia occurs when your baby's bloodsugar level falls. If your baby has been born prematurely or small then he/she is at increased risk of developing hypoglycaemia due to decreased fat stores. Your baby is also at increased risk of hypoglycaemia if he/she has an infection, gets cold following delivery or if Mum is diabetic. Your baby's blood glucose level will be monitored regularly throughout his/her stay on the NICU. Hypoglycaemia can easily be treated depending on the cause.

 

 

 

 

Hyperglycaemia

 

Hyperglycaemia occurs when your baby's bllod sugar is persistently high. If your baby has been born prematurely then he/she is at an increased risk of developing hyperglycaemia due to the immaturity of the organs that routinely control blood glucose levels. Infants that become stressed, whether due to surgery or a routine medical procedure, are also at risk of developing hyperglycaemia due to the release of stress related hormones. Usually this form of hyperglycaemia is transient and in time your baby will become more proficient at regulating his/her own blood glucose levels. If your baby's blood glucose level continues to remain high over a prolonged period of time an insulin infusion may be commenced. Your baby's blood glucose level will be closely monitored, especially when on an insulin infusion, until he/she becomes proficient in regulation of his/her own blood glucose levels and the infusion can be stopped.

 

 

 

 

Hypotension

 

Hypotension is the term used when your baby's blood pressure is low and is measured in two ways: using a blood pressure cuff or inserting an arterial line,usually into the umbilical cord. A baby's blood pressure increases according to their gestational age, and is monitored carefully throughout a baby's stay on NICU. If your baby has been born extremely prematurely, then it is likely that they may need some blood pressure support in the first few days of life. The doctors and nurses assess the baby and can give medication to raise the blood pressure if necessary.

 

 

 

 

I

 

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Inguinal hernia

 

The inguinal canal is a tube that passes through a natural hole in the muscles of the groin. In babies, especially those born prematurely, occasionally part of the gut can get stuck in the tube. This can result in a swelling/bulge in the groin. The hernia may be on one or both sides.

 

If your baby has an inguinal hernia he/she will need to have an operation at some stage as there is a risk that a piece of bowel can become trapped in the inguinal canal (this is called a strangulated hernia). This will cause him/her to become unwell with pain and can cause damage to the bowel if not treated promptly.

> Neonatal surgery - General surgery

 

 

 

Intraventricular Haemorrhage (IVH)

 

If your baby has been born prematurely, especially more than 3 months early, they are particularly vulnerable. Shortly after birth there is a risk of bleeding into the fluid filled spaces in the centre of the brain (the ventricles); this is known as an intraventricular haemorrhage. If the bleeding is large there is a risk that it can damage part of the brain itself. The blood can also fill the ventricles and block the normal flow of fluid around the brain. This blockage can lead to a problem called hydrocephalus.

 

 

 

 

 

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Jaundice

 

Jaundice is very common in the newborn. Bilirubin is produced when blood is broken down by your baby, and is then removed by the liver. The majority of babies suffer from jaundice between 2-7 days of life because they are breaking down lots of red blood cells which were present when they were inside the womb.  Once born, these red blood cells are no longer required in such quantities and are therefore removed. If your baby has been born prematurely he is at an increased risk of jaundice because his liver has not had the time to mature fully and therefore cannot remove the bilirubin as effectively as a term baby. Your baby may appear slightly yellow in colour, and his bilirubin will be closely monitored for the first few days of life. Other causes of jaundice include:

• blood incompatibility - this occurs when your baby has a different blood group to his mother and results in excess red blood cell breakdown when he is first born, often resulting in jaundice
  
  
• breast milk jaundice - breast milk jaundice often appears if your baby has been given breast milk but the exact cause is unknown.  It occurs later in life, between 2-3 weeks and is considered harmless

Jaundice is commonly treated using phototherapy. There are three main types of phototherapy, which all work in the same way, assisting your baby to remove bilirubin from the blood.

• overhead phototherapy
• bilibed phototherapy
• biliblanket phototherapy

All forms of phototherapy give off a blue light and require your baby to be stripped of clothing to ensure maximum effectiveness.

 

 

 

 

 

K

 

 

 

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M

 

 

Malrotation

 

When the gut develops it has to fold up in the abdomen in a certain way. If it folds up the wrong way this is known as malrotation and can cause obstruction of the bowel (volvulus). Sometimes an obstruction can be seen antenatally. If this is suspected then when your baby is born he/she will be admitted to the neonatal unit and an x-ray of the abdomen taken. Your baby will be on a drip and will not be fed until this is done. If the diagnosis is correct your baby will require an operation to untwist the bowel and release the obstruction. If there is no sign of obstruction on the x-ray we will allow your baby to feed while closely observing him/her.

> Neonatal surgery - General surgery

 

 

 

Meconium Aspiration Syndrome (MAS):

 

Meconium aspiration occurs when a baby (usually born at term) inhales a mixture of meconium and amniotic fluid. The inhaled meconium can affect the baby's breathing in a number of ways, including chemical irritation to the lung tissue, airway obstruction by a meconium plug, infection, and the inactivation of surfactant by the meconium.

 

Newborns with meconium aspiration may require admission to NICU and support with their breathing, which can range from extra oxygen via a nasal cannula to full ventilatory support. Very rarely we have to transfer very sick babies for specialist support known as ECMO.

 

 

 

 

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Necrotizing enterocolitis (NEC)

 

Necrotising enterocolitis (NEC) is a disease of the intestine (bowel); which causes infection and inflammation of the bowel tissues. If the disease progresses it can lead to part or whole of the bowel dying.

 

Treatment for necrotising enterocolitis is usually by resting the gut and giving intravenous antibiotics.  However it may be necessary to operate to remove a portion of the bowel. The remaining ends of the bowel are either joined back together or brought up to the skin to form a stoma.

> Neonatal surgery - General surgery

 

 

 

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P

 

 

Patent Ductus Arteriosus (PDA)

 

A common problem for very premature babies is that a small connection between the vessels supplying the lungs and the vessels supplying the body with blood remains open.

 

When your baby was still developing in the womb, he or she had a short blood vessel called the ductus arteriosus (DA) linking two of the big blood vessels of the heart, the aorta (which provides blood to the rest of the body) and the pulmonary artery (which sends blood to the lungs). While your baby is in the womb the ductus arteriosus allows blood to bypass the lungs.

 

The ductus arteriosus usually closes shortly after birth, which allows for normal blood circulation. But in some babies, most often premature ones, the duct remains open, or closes, then opens back up again. When this happens it is called patent (open) ductus arteriosus (PDA).

 

If your baby has a PDA the lung vessels may be receiving too much blood to cope with causing breathing problems.

 

Breathing problems are one clue that your baby may have a PDA. A heart murmur and unusually powerful pulses which can be felt in the groin, wrist or top of the foot may also lead doctors to suspect the condition, which is then confirmed with an ultrasound of the heart.

 

In most occasions a PDA often sorts itself out, and may be so mild it causes your baby little or no problems. If the PDA does need further treatment the doctors will decide how much of a problem the duct is causing. If it is not to serious, the doctors may first try reducing the amount of fluids in your baby's body. If the duct is more serious the doctors may be able to close the ductus arteriosus by administering medicine. If that doesn't work, or if the baby is too sick to take the medicine, your baby may need an operation under general anaesthetic to close it.

 

The operation to close a PDA will take place in another hospital. Your baby will be transferred to that hospital with the ANTS transport team. Once your baby is stable following the operation they will be transferred back to the Rosie.

> Neonatal surgery - Cardiac surgery

 

 

 

 

Pneumothorax

 

 A pneumothorax is when a lung collapses because of a leak of air between the lung and the chest wall. It may occur spontaneously in term infants or may be seen in babies with breathing difficulties. If your baby has a large pneumothorax a tube called a chest drain will need to be inserted under local anaesthetic into your baby's chest, to remove the extra air.

 

 

 

Poor weight gain

 

Any infant born, whether prematurely or full term, will lose weight within the first 2-3 days of life and this is completely normal. Preterm infants and term infants requiring intensive care however, may lose weight for longer periods, or fail to gain weight at an adequate level, for a variety of reasons. Although we encourage your baby to receive breast milk at every opportunity, it may be necessary to give nutrition intravenously (TPN) if your baby is very premature or sick. Babies are weighed on a daily basis on NICU and dieticians are regularly involved in care to ensure that your baby is receiving the optimal nutrition to gain weight.

 

 

 

PPHN (Persistent Pulmonary Hypertension of the Newborn)

 

In the womb the lungs receive very little blood. At birth this has to change rapidly to ensure that the baby is able to receive the oxygen from the lungs. PPHN occurs when a baby fails to adapt and blood flow to the lungs remains reduced. Babies with PPHN are usually >34 weeks gestation and present with difficulty in breathing and are cyanosed (blue colour associated with a lack of oxygen in the blood) and may be breathing more rapidly than normal. Your baby will have blood tests, a chest x-ray and often an echocardiogram to diagnose and establish the severity of the PPHN. PPHN is often associated with other conditions such as hypoxic-ischaemic encephalopathy or meconium aspiration. Babies with severe PPHN will require specialist ventilation (high frequency oscillatory ventilation) and nitric oxide to open up the blood vessels of the lung.

 

 

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Respiratory Distress Syndrome (RDS)

 

Although there are many causes of breathing difficulties in premature babies, the most common is called respiratory distress syndrome (RDS). It occurs because the infant's immature lungs are not able to produce enough surfactant. This is a chemical produced in the lungs which prevent the lings from collapsing down when we breathe out. Steroids given to mothers before the baby is born help promote surfactant production. Premature babies are often given replacement surfactant directly into the lungs when they are born and they may need additional oxygen and help from a ventilator with breathing.

 

 

 

Retinopathy of prematurity

 

Retinopathy of prematurity (ROP) is the name of a disease that frequently affects the eyes of very small premature babies. The blood vessels at the back of the eye develops abnormally and if untreated can lead to retinal detachment and blindness (although with screening and treatment this is now rare). The risk of developing ROP is higher the smaller and more premature the baby is and is also increased if a lot of oxygen therapy has been needed. In spite of the best care that the neonatal unit can give, ROP still develops in some babies.

 

Most babies who are examined for ROP have very mild forms of the condition. These forms, called stage 1 and stage 2 usually get better by themselves, do not require treatment and do not cause any long term visual problems. A small proportion of babies, however, will develop a more severe form of ROP-stage 3.

Stage 3 ROP

 

These babies are at serious risk of loss of vision. Half of those babies who have severe stage 3 ROP will become blind due to retinal detachment and scarring if treatment is not undertaken.

 

Treatment with laser therapy occurs on the neonatal unit, and removes the abnormal vessels. Your baby will be monitored closely following treatment.

 

 

 

 

 

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Seizures

 

Seizures (also known as fits) are movements caused by abnormal electrical activity in the brain. They are not uncommon in the newborn. There are a lot of causes for seizures in the newborn, the most common being neonatal encephalopathy, also infection and metabolic problems can cause seizures. Seizures can also be difficult to diagnose compared to older children and adults, as babies make a lot of 'funny movements’, most of which are normal. If your baby is thought to be having a seizure various tests will be carried out including blood tests, lumbar puncture and cranial ultrasound scan. The electrical activity will be recorded using an EEG machine. In some cases an MRI of the brain will be done. It is important to both work out what is causing the seizure and to stop the seizure with various medicines. Seizures in the newborn is not epilepsy. The long term effect of seizures will depend on the underlying cause.

 

 

 

Sepsis

 

Sepsis is a term for infection that is present in the blood. Sepsis can develop following infection usually by bacteria, but also viruses and fungi. These organisms can get into the blood during labour and delivery or acquired while on the neonatal unit. Handwashing is the best way of preventing spread of infection across the neonatal unit.

 

Sepsis can be life threatening for newborns, especially if the baby has a weakened immune system because of prematurity or illness. When a baby's immature immune system cannot fight the microorganism, the infection can quickly spread and overtake the body, causing serious illnesses such as meningitis or pneumonia.

 

Identifying Sepsis

 

Sepsis in newborns is not always easy to identify since newborn babies often do not show symptoms in the same way older babies and children may show symptoms to infection. Babies with sepsis may be lethargic, have a low or high temperature, not tolerate feeds, and can have problems with apnoea or difficulty breathing and appear jaundiced (yellow skin).

 

A blood culture, along with a urine test and often a lumber puncture are used to diagnose an infection. An x-ray will sometimes be taken to assist with diagnosis.

 

Early diagnosis and treatment of the infection are important in helping prevent sepsis from overwhelming a baby's body. Therefore most premature or sick babies who are more at risk will have an infection screen soon after delivery and be commenced on antibiotics before the results of the tests are received.

 

 

 

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Tachycardia

 

Tachycardia occurs when your baby's heart rate is elevated, usually above 200 beats per minute. Tachycardia may occur if your baby is too hot, in pain or simply unsettled and usually treating the cause resolves the tachycardia quickly.

 

 

 

Tracheo-oesophageal fistula (TOF) and oesophageal atresia (OA)

 

TOF and OA are rare conditions which occur early in the baby’s development. They can occur individually or together and can sometimes be suspected on the antenatal ultrasound scan. TOF occurs when the trachea (windpipe) and the oesophagus (the food pipe) remain attached. Without surgical intervention this causes air to pass from the wind pipe to the food pipe and stomach. It can also allow stomach acid to pass into the lungs. Babies with OA are born with a small pouch at the top of the oesophagus which prevents food from reaching the stomach. Consequently, these babies cannot swallow their own saliva and require continual suction to remove secretions from the pouch.

> Neonatal surgery - General surgery

 

 

Transient Tachypnoea of the Newborn (TTN)

 

In the womb the baby’s lungs are filled with liquid. This liquid is normally removed before the baby is born and during birth. However, in some cases the lungs still have fluid in them, particularly those born by elective caesarean section.

 

The fluid in the lungs can cause breathing difficulties in the newborn, known as transient tachypnoea. It usually resolves within a couple of hours after birth but can take longer to clear. Unfortunately because it can be difficult to exclude TTN from other causes of breathing difficulties, if the breathing problems persist it is likely your baby will have a chest x-ray and may start antibiotics to treat infection.

 

TTN eventually will resolve and is not associated with any long term breathing problems.

 

 

 

 

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V

 

Volvulus

 

Volvulus is a surgical problem where the bowel loops on itself and causes obstruction. It is usually associated with other problems, particularly malrotation.

 

Any bowel obstruction will eventually result in bilious vomiting. If this is the case feeding will be stopped and your baby will be reviewed by the paediatric surgical team.

 

 

 

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