Neonatology is a rapidly changing field of medicine, and there are bound to be variations from hospital to hospital in terminology, technology, and treatments. Your doctor may use slightly different terms to describe some of the medical conditions in babies born prematurely. However, this basic information may help you begin to build your understanding.
Need for Warmth
A premature baby, especially a baby with breathing problems, is marginally supplied with calories and oxygen - the fuels he needs to heat his body. A main objective of your NICU staff is to keep your baby warm - but not too warm. Your baby will mostly likely be placed in an incubator or warmer, so that his temperature may be carefully controlled.
A tiny device that acts as a thermometer may be taped over your baby's belly. It constantly senses your baby's temperature and regulates the temperature of the environment within the incubator. It will increase the warmth when your baby gets too cool and decrease it when he's too warm.
Your baby's axillary (under the arm) temperature will be checked frequently, as well.
For more added warmth, and also to keep him from grabbing or kicking tubes and wires, your baby may also be dressed in mittens, booties, and a hat.
The goal is to keep your baby's body temperature as close to normal as possible-98.6°F (37.0°C). This is also the temperature at which he conserves the most oxygen and calories, and gains the most weight.
It's very common for a premature baby to have breathing problems. The severity of the problem may depend on how prematurely your baby was born. A premature baby's lungs aren't as fully developed and ready to breathe as a full-term baby's. Let's look now at some common problems associated with breathing.
- Apnea and Bradycardia: Apnea is the term used to describe the times a baby interrupts breathing. Apnea is very common among premature babies in the early weeks of life. Apnea is often accompanied by bradycardia-a lower-than-normal heart rate. For a tiny baby this means the heart is beating fewer than 100 times a minute. This is considered slow for a baby, even though an adult heart rate is usually much slower.
- Respiratory Distress Syndrome (RDS): RDS is a breathing disorder that may be found in premature babies. It is caused by the baby's inability to produce surfactant - the fatty substance that coats the alveoli (the tiny air sacs in the lungs) and keeps them from collapsing. An unborn baby's lung tissue begins making small amounts of surfactant in the early weeks of pregnancy, but most babies aren't producing enough surfactant for proper breathing until the 35th week of gestation. However, since babies do vary greatly in their rates of lung development, some premature babies have enough surfactant to breathe without difficulty while others do not. In general, the more premature the baby, the greater the risk of developing RDS.
- Pulmonary Interstitial Emphysema (PIE) and Pneumothorax: If it is necessary for your baby to be on a respirator (breathing machine), the pressure may occasionally cause air to leak from his lungs. Tiny air bubbles may be forced out of the alveoli and in between layers of lung tissue. This condition, called pulmonary interstitial emphysema (PIE), usually subsides as your baby's respiratory problems improve and respirator pressure to the lungs can be reduced. Sometimes a tear can occur and leak into the surrounding chest spaces causing the lung to collapse. This is the condition called pneumothorax.
More than half of all full-term babies and more than three-fourths of all premature babies get jaundice during the first three to seven days of life. This isn't a reason for concern most of the time, although it does cause the baby's skin and whites of his eyes to turn somewhat yellow.
Babies are born with a large number of fetal red blood cells. Normally, as red blood cells break down, bilirubin, which is a yellowish pigment, forms. The bilirubin is detoxified (processed) in the liver. If the enzymes in the liver that process the bilirubin aren't working efficiently yet (which happens often in newborns and especially in premature babies) the bilirubin level rises in the blood and some of it enters body tissue, where it then temporarily causes a yellowing-the condition called jaundice.
While in the NICU, your baby's blood will be frequently checked for a rise in bilirubin. If the levels rise closer to those that are considered unsafe, he may be treated by phototherapy (most common) or exchange transfusion.
If your baby is in the NICU, chances are he will need to receive some type of medication, nutrients or perhaps blood. There are two common ways medicine is provided to your baby in the NICU.
- Umbilical Arterial Catheter: The umbilical arterial catheter is inserted through the end of a baby's umbilical cord (at the belly button) and is threaded through the umbilical artery into the aorta, the main artery supplying the body with oxygenated blood. While this sounds painful, it really isn't. There are no nerve endings in your baby's umbilical cord where the catheter (tiny tube) is inserted.
- IV Pump/Superficial IV: An IV pump is a machine attached to a pole placed near your baby's bed. IV stands for intravenous (in-trah-vee-nous), which means into the veins.