Common problems and diagnosis

Information about some of the common diagnosis and problems your baby may encounter

The section aims to highlight some of the common problems and diagnosis found on the SCBU. 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.

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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.

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 SCBU due to the delicate nature of the babies that we care for.

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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

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 is the infant of a diabetic mother. Your baby's blood glucose level will be monitored regularly throughout his/her stay on the SCBU. Hypoglycaemia can easily be treated depending on the cause.

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

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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.

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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.

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 SCBU.

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.

Temperature Instability

If your baby has been delivered prematurely, is unwell or is small then he/she may need to be admitted to the SCBU to help control his/her temperature. The optimal temperature for your baby is 37’C, this is the temperature at which your baby’s bodily organs and systems can function at their best and he/she can grow. Your baby may be placed on a ‘hot cot’ which is a water filled mattress that can be warmed or cooled according to your baby’s requirements. Your baby’s temperature will be monitored regularly throughout the day to ensure that he/she does not become too hot or too cold. As your baby begins to grow you will find that he/she needs less support in maintaining his/her temperature and the ‘hot cot’ temperature can gradually be reduced until your baby is ready to be nursed in a standard cot.

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