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The intensive care nursery at West Penn Hospital contains different types of specialized equipment designed for sick newborn babies. It may seem like there are so many monitors, alarms, and pieces of equipment in the nursery that there is little room left for the baby. However, each piece of equipment is necessary for the full recovery of your infant.
Most babies will be placed in heated beds that help them to keep warm, provide them with oxygen, if necessary, and permit the nurses and doctors to watch them closely. Any equipment needed to meet your baby’s individual needs will be show and explained to you.
As your baby makes progress in the nursery, the special equipment may no longer be needed, and we may be able to then arrange for transfer from the intensive care nursery back to the referring hospital, other facilities, or to our Pediatric Unit. On the Pediatric floor, you will be able to have a single, individual room where you can stay with your baby.
The neonatologists at West Penn Hospital also care for infants at Transitional Infant Care (TIC) located at the Children’s Home of Pittsburgh close to West Penn Hospital. This unit is designed for babies who are recovering from their medical problems but are not ready to go home. Both the TIC and the stepdown unit at West Penn provide a more “home like” environment and allow you to have even greater contact with your child. We will further discuss this with you if we feel your child may benefit from this type of transfer.
The pieces of equipment we use most often are described below.
- Cardiorespiratory monitor – a machine that measures and records a baby’s heart and respiratory rate. An infant’s blood pressure and oxygen level can also be measured on the same machine in our nursery.
- Endotracheal (ET) tube – a soft, plastic tube placed into the windpipe which helps a baby breathe.
- Infusion control pumps – various types of electronic pumps, used to deliver fluids and medications to the baby at the correct rate.
- Intravenous (IV) catheter – a soft, thin plastic tube in an arm, leg or scalp vein through which medicines and fluids are given. Because babies’ veins are so fragile, IV sites are frequently changed.
- IV solutions – the medicines and fluids being given to the baby through IV tubing.
- Open warmer – an open bed with a heating lamp providing warmth for larger babies or for babies following surgery.
- Pulse oximeter – this device measures the amount of oxygen in the baby’s blood by shining a special red light against the skin.
- Sensor for temperature control – a mechanism that measures a baby’s skin temperature and alerts the baby’s bed to increase or decrease the temperature. This sensor helps to keep an infant at an appropriate temperature.
- Umbilical catheter – a soft, thin plastic tube placed in the blood vessels of the umbilical cord. The catheter can be used to give fluids and medicines, as well as measure blood pressure and draw blood. Umbilical catheters do not cause any discomfort to infants.
- Ventilator – a machine that helps a baby breathe.
Understanding Your Baby’s Weight
It is important for you to learn the weight of your baby while in the NICU. The nurses and doctors of the NICU will often discuss the progress of your baby in relation to his or her weight.
This chart will help you determine the weight of your baby throughout his or her stay in the NICU. For example, to obtain pounds and ounces equivalent to 1500 grams, look for the gram number closest to 1500 (which is 1503), then read left for pounds and up for ounces. A baby weighing 1500 grams weighs 3 pounds, 5 ounces.
After a baby is born, he or she will have a blood test that will screen for over 30 rare but potentially serious illnesses. Testing for these conditions in newborns allows us to treat them before a baby may get sick. This early identification and treatment are obviously very important.
We routinely perform other screening studies for certain babies, usually those born weighing less than 3 pounds or those who have been very ill. Within a few days after small or sick babies are admitted, we will complete a head sonogram to determine if there has been bleeding or injury within the brain. Head sonograms painlessly take pictures of the brain through the soft spot at the top of an infant’s head using sound waves. Sonograms may be repeated periodically on tiny, premature babies until they are mature enough to go home.
Another screening test done routinely on small babies is an eye examination. Beginning at six weeks of age, we regularly check babies’ eyes for any signs of Retinopathy of Prematurity (ROP). This condition is associated with damage to the retina and abnormal development of the retinal blood vessels. ROP can occur in any premature baby, but we usually find it only in very tiny babies who have been quite sick. Once the retinas have become mature, ROP cannot occur, and we do not need to examine the eyes for ROP anymore. Usually this happens about the same time a baby is ready to be discharged from the nursery.
We are now able to test the hearing of a newborn and detect hearing loss very early in life. This allows treatment to begin as soon as possible after birth. This test will be performed prior to hospital discharge.
You may be asked to sign forms for blood transfusions or special procedures. If your baby needs a blood transfusion during his or her hospital stay, you or someone you designate may be given information about the Directed Donation Transfusion Program.
Glossary of Terms
You will hear the doctors and nurses of the NICU use a number of medical terms when discussing the care of your baby. Refer to this guide to help you understand the definitions of these terms.
Acidosis – a disturbance in the acid-base balance (pH) of the blood or body tissues which occurs when there is an accumulation of acids or an excessive loss of biocarbonate (base). Breathing problems and severe illness may cause this condition.
Alveoli – tiny sacs that fill the lungs. The sacs fill with air when breathing and allow oxygen to enter the circulatory system.
Anemia – a common blood condition characterized by fewer-than-normal red blood cells. Red blood cells carry oxygen to all the tissues of the body.
Antibiotics – medications used to treat infections.
APGAR Score – a score given immediately following birth indicating a baby’s general
condition. Heart rate, breathing, muscle tone, color, and reflexes are evaluated. This score is used to determine whether a baby needs medical attention following delivery.
Apnea (also known as an “A”) – a condition common to premature infants where breathing pauses longer than 15 or 20 seconds and then resumes. Apnea can be accompanied by bradycardia (see Bradycardia). This condition usually resolves as the infant matures. Until babies breathe regularly, monitors are used to alert nurses
whenever apnea occurs.
Aspirate – the amount of formula remaining in a baby’s stomach after a reasonable amount of time is allotted for digestion.
Bagging – pumping oxygen into a baby’s lungs by squeezing a bag connected to either a mask placed over a baby’s mouth and nose or to a breathing tube in a baby’s windpipe.
Bililights – a set of special fluorescent lights used to decrease yellow jaundice, or bilirubin, in newborns.
Bilirubin – see “Jaundice.”
Blood Gases – small amounts of blood drawn periodically from a baby’s heels or from an in-dwelling artery catheter to measure the amount of oxygen, carbon dioxide and pH (acidity) of the blood. These results help doctors determine whether a baby needs more or less oxygen, or requires assistance with breathing.
Blood Pressure – the force of the blood in the arteries which causes the blood to flow through the body.
Bradycardia (also known as a “B”) – a condition common to premature infants where the heart rate slows momentarily below normal levels (usually less than 80). Monitors are used to detect this condition.
BPD – or bronchopulmonary dysplasia – is also known as chronic lung disease. This condition occurs often in tiny, premature babies, especially those who have had respiratory distress requiring a ventilator. Babies’ lungs often inflame or scar before they are able to heal and grow. Until they recover, infants with BPD require extra oxygen, medication and sometimes ventilator support to help them breathe. Although this condition may last for many weeks, infants no longer need extra oxygen or medication once recovered.
Central Line – an intravenous (IV) line surgically placed into a large vein.
Chemstrip or Accucheck – a special strip of plastic used to determine how much glucose (sugar) is present in a blood sample.
Chest Physiotherapy (chest P.T.) – the procedure of tapping on the baby’s chest to help the drainage of mucus from the lungs. Sometimes a baby’s chest is also vibrated with a special device to help loosen mucus from the lungs.
Chest Tube – a plastic tube used to remove accumulated air from under an infant’s chest wall, resulting from a pneumothorax (see Pneumothorax).
Circumcision – the procedure of removing the foreskin of the penis.
Cold Stress – the act of moving a baby from an isolette to an open crib to see if body temperature can be maintained.
CPAP (Continuous Positive Airway Pressure) – small prongs placed in the baby’s nose that are attached to a ventilator. The ventilator delivers oxygen and pressure to the baby’s lungs to help open the tiny air sacs (alveoli). The baby will still breathe on his/her own. CPAP may also help if your baby is prone to apneas and bradycardias.
Culture – a lab test used to determine if a baby has an infection. Body fluids commonly tested are spinal fluid, blood, urine, and windpipe secretions. The test determines whether bacteria, virus, or fungus are present.
Cyanosis – bluish or “dusky” discoloration of the skin, caused by a lack of sufficient oxygen.
Edema – an excessive amount of fluid in the body, causing swelling, especially of the hands, feet, legs, and eyelids.
EEG (electroencephalogram) – a painless test that measures brain waves. The test is administered by taping a number of tiny wires to the baby’s head for the procedure.
EKG (electrocardiogram) – a test which records the electric current produced by the heart muscle through which information can be gained about the heart’s structure and function.
Endotracheal Tube (ET tube) – a tube inserted through a baby’s mouth into the windpipe. This tube is then connected to a respirator (also known as a ventilator) which helps the baby breathe.
Eye Exam – an examination of the baby’s eyes done by an ophthalmologist (eye doctor). This test may be done once or several times prior to discharge.
Fontanel – the “soft spot” on the top of a baby’s head.
Gastroesophageal Reflux – sometimes called “reflux” or “GER” for short. The muscle at the top of the stomach is weak in some babies, and formula mixed with acids from the stomach may flow backwards into the esophagus (the tube between the throat and stomach), causing frequent spitting and heartburn. This is especially common among premature babies and may cause episodes of apnea and bradycardia. Thickening formula
with cereal is often helpful. Sometimes medications are used to treat this condition.
Gestational Age – the length of time from conception to delivery; full-term babies are born at a gestational age of 40 weeks.
Glucose – the type of sugar found in the blood which is used by the body for energy.
Gram – a basic unit of weight in the metric system. There are 454 grams to a pound and 28 grams to an ounce (see weight chart).
Grunting – the sound babies make during exhaling when they are having difficulty breathing.
Hearing Test – an examination of the infant’s hearing ability done by specially-trained personnel.
Heart Murmur – an extra sound sometimes heard when listening to the heartbeat. A heart murmur may be a normal finding or indicate a heart condition.
Heel Stick – a method of obtaining blood samples by pricking the heel.
Hematocrit – a test which measures the concentration of red blood cells.
Hyperalimentation (Hyperal) – a special solution given intravenously that gives a baby nutrients necessary for growth – proteins, sugars, vitamins, and minerals.
Hypoglycemia – a blood sugar level below normal.
Hypotension – abnormally low blood pressure.
Intravenous (IV) – the administration of fluids, nutrients, vitamins, minerals, and medication into a vein through a hollow needle or catheter. This can be done by placing a needle in a vein in the baby’s hand, foot, or scalp or by inserting an umbilical catheter. Complete nutrition can be provided by IVs when babies are unable to eat.
Intubation – procedure used to give oxygen to a baby’s lungs by the insertion of an endotracheal tube through the mouth and into the windpipe.
Isolette – the name of the incubators in the NICU used to keep babies warm. “Portholes” on the sides allow NICU staff and parents to touch and take care of the infant.
IVH (intraventricular hemorrhage) – bleeding near or within the fluid-filled spaces (ventricles) located in the middle of the brain. This condition is generally detected through a head sonogram.
Jaundice – yellow color of the skin resulting from an excess of bilirubin in the body. This condition is treated with phototherapy. During phototherapy, special patches are placed over the baby’s eyes to protect them.
Kilo (kilogram) – a unit of weight in the metric system (one kilo equals 1000 grams or 2.2 pounds).
Lactation – having to do with breastfeeding.
Lumbar Puncture (LP) or Spinal Tap – insertion of a needle into the spine between the vertebrae in the lower back to obtain a sample of the spinal fluid.
Meconium – a dark green material in the intestine at birth that is the first stool a baby passes.
Monitor – a general name used to refer to all electronic equipment that measures, among other things, a baby’s heart and respiratory rates, as well as blood pressure.
Nasal Cannula – tubing with two little prongs that rest under the baby’s nose. Oxygen flows through the nasal cannula to help the baby breathe.
NEC (necrotizing enterocolitis) – a serious infection or inflammation in the intestines.
Babies with NEC are given nutrition through intravenous fluids in a vein until their intestines have healed.
Neonatology – the medical specialty dealing with the treatment and care of sick newborn infants.
NG Tube – a small tube used to feed babies who are too small or sick to eat by mouth.
NPO – a physician order that a baby may not be fed anything by mouth.
Oxygen Bubble – a clear, plastic hood placed over a baby’s head through which warm, moist oxygen is delivered.
Patent Ductus Arteriosus (PDA) – a type of heart murmur in premature infants that usually resolves itself spontaneously.
Phototherapy – See “Bililights.”
Pneumothorax – a collection of air in the chest, outside the lung, resulting from a small hole in part of the lung. This occurs when a tiny tear within the lung allows air to leak between the lung and the chest wall. A plastic chest tube is placed into the chest between the ribs to remove this air and relieve the pressure on the lungs, which allows the lung to re-expand and heal.
PO2 – a measure of oxygen in the blood.
PCO2 – a measure of carbon dioxide in the blood.
Premature – an infant who is born earlier than 37 weeks gestation (see Gestational Age).
Pulse Oximeter – device used to monitor oxygen saturation in the blood.
PVL (periventricular leukomalacia) – a type of brain injury caused by lack of oxygen or blood flow to the brain. Head sonograms detect this condition, usually several weeks or months after a baby is born.
Red Blood Cells – the cells in the blood that contain hemoglobin and carry oxygen.
Replogle – a small plastic tube passed through the nose or mouth and into the stomach that is used to keep the stomach empty.
Respirator (also known as a ventilator) – a machine used to substitute for, or assist with, breathing.
Respiratory Distress – a disorder most often seen in premature infants in which there is a tendency for the tiny air sacs of the lungs to collapse as the baby exhales. Three of the most common causes seen in the NICU are:
- Hyaline Membrane Disease, or lung disease of prematurity – premature babies develop this condition because their lungs are not yet ready to make surfactant, a substance that helps keep the lungs expanded. This disease is also called Respiratory Distress Syndrome.
- Transient tachypnea of the newborn or wet lung – this condition occurs when excess fluids remain in the lung after delivery. The baby steadily improves as the fluids are absorbed by the body.
- Pneumonia – an infection in the lungs caused by bacteria, a virus or any irritating substance.
Retraction – the sucking in of the baby’s chest when inhaling. It is a common symptom of respiratory distress.
Room Air (RA) – normal room air with an oxygen concentration of approximately 21 percent.
Seizure – a brief period of too much nerve activity which causes a baby’s body to tense and make unusual movements for a few minutes. If your baby has a seizure, tests will be conducted to determine the cause of the problem. Seizures are easily treated with medication.
Sepsis – an infection in the blood that is treated with antibiotics.
Sepsis Workup – a series of tests that check for the presence of infection.
Stool – bowel movement.
Suction – removing mucus from the nose, throat, or endo-tracheal tube using a plastic tube attached to a vacuum.
Surfactant – a protein substance normally found in the lungs that enables the alveoli to expand. Surfactant deficiencies cause Hyaline Membrane Disease (see Respiratory Distress).
Tachycardia – rapid heart rate, usually greater than 160 beats per minute.
Tachypnea – rapid breathing, usually greater than 60 breaths per minute.
Term Infant (Full Term) – an infant whose gestational age is between 38 and 42 weeks (see Gestational Age).
Transfusion – blood or plasma, or blood products, given into the vein.
Tube Feeding (PE Feedings) – feedings given through a small tube inserted through the mouth or nose and into the stomach. Premature babies or babies who are too ill to suck and swallow in a safe, coordinated manner are fed this way.
Umbilical Artery Catheter (UA Line) – a plastic tube that is placed within the blood vessels of the umbilicus (naval or “belly button”) to allow for direct measurement of blood pressure and delivery of fluids. It also allows blood to be removed for various tests that assist in the care of an infant.
Umbilical Venous Catheter (UV Line) – a plastic tube that is placed within the blood vessels in the umbilicus (naval or “belly button”) to allow delivery of fluids. The tube also allows blood to be removed for various tests that assist in the care of an infant.
Vital Signs – the “measurement” of temperature, pulse, respiration and blood pressure.