Investigations and procedures

Caring for your baby

Below is a list of common medical investigations and procedures that your baby may undergo during his/her stay on SCBU. 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 SCBU.

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 SCBU 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 SCBU include:

Red blood cells (RBC's)

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.

Blood tests

While your baby is in the SCBU 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.

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.

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.

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.

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.

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 SCBU 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.

Phototherapy cot

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.

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.

Ultrasound scan

Doctor performing ultrasound scan 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.

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