Failure TO Thrive

Many of you may or may not be aware of a condition diagnosed as failure to thrive.  I myself just became aware of this, and thought it would be an informative topic to write on, however there isn't much information out there on it and it does seem to be somewhat of a medical anomaly.

Failure to thrive has been recognized as a medical condition since the early 1900s. It describes a condition rather than a specific disease. Children/infants that are considered as failing to thrive have a rate of growth that does not meet the expected growth rate for a child their age. It's hard to know what rate of growth is expected for any individual child/infant, since many factors, can and do influence growth. Failure to thrive is believed to affect up to 5 percent of the population but is most common in the first six months of a child's life. It is commonly seen in babies born prematurely.

It is important from medical standpoint to determine whether failure to thrive is resulting from medical problems or factors in the environment, such as abuse or neglect.

There are many medical issues that may cause failure to thrive:

~Chromosome abnormalities such as Down syndrome and Turner syndrome

~Thyroid hormone deficiency, growth hormone deficiency, or other hormone deficiencies

~Damage to the brain or central nervous system

~Heart or lung problems

~Anemia or other blood disorders

~Gastrointestinal problems that result in a lack of digestive enzymes

~Long-term gastroenteritis and reflux

~Cerebral palsy

~Long-term infections

~Metabolic disorders

~Complications of pregnancy and low birth weight

Other factors that may lead to failure to thrive:

~Emotional deprivation

~Economic problems that affect nutrition, living conditions, and parental attitudes

~Exposure to infections, parasites, or toxins

~Poor eating habits, such

~Many times the cause cannot be determined.

Treatment

The treatment depends on the cause of the delayed growth and development. Delayed growth due to nutritional factors can be resolved by educating the parents to provide a well-balanced diet.

If psychosocial factors are involved, treatment should include improving the family dynamics and living conditions. Parental attitudes and behavior may contribute to a child's problems and need to be examined. In many cases, a child may need to be hospitalized initially to focus on implementation of a comprehensive medical, behavioral, and psychosocial treatment plan.

What are high blood pressure and preeclampsia?

Blood pressure is a measure of how hard your blood pushes against the walls of your arteries. If the force is too hard, you have high blood pressure (also called hypertension). When high blood pressure starts after 20 weeks of pregnancy, it may be a sign of a very serious problem called preeclampsia.

Blood pressure is shown as two numbers. The top number ( systolic ) is the pressure when the heart pumps blood. The bottom number ( diastolic ) is the pressure when the heart relaxes and fills with blood. Blood pressure is high if the top number is more than 140 millimeters of mercury (mm Hg), or if the bottom number is more than 90 mm Hg. For example, blood pressure of 150/85 (say "150 over 85") or 140/95 is high. Or both numbers can be high, such as 150/95.

A woman may have high blood pressure before she gets pregnant. Or her blood pressure may start to go up during pregnancy.

If you have high blood pressure during pregnancy, you need to have checkups more often than women who do not have this problem. There is no way to know if you will get preeclampsia. This is one of the reasons that you are watched closely during your pregnancy.

High blood pressure and preeclampsia are related, but they have some differences.

High blood pressure

Normally, a woman's blood pressure drops during her second trimester. Then it returns to normal by the end of the pregnancy. But in some women, blood pressure goes up very high in the second or third trimester. This is sometimes called gestational hypertension and can lead to preeclampsia. You will need to have your blood pressure checked often and you may need treatment. Usually, the problem goes away after the baby is born.

High blood pressure that started before pregnancy usually doesn't go away after the baby is born.

A small rise in blood pressure may not be a problem. But your doctor will watch your pressure to make sure it does not get too high. The doctor also will check you for preeclampsia.

Very high blood pressure keeps your baby from getting enough blood and oxygen. This could limit your baby's growth or cause the placenta to pull away too soon from the uterus. High blood pressure also could lead to stillbirth.

Preeclampsia

Preeclampsia is a pregnancy-related problem. The symptoms of preeclampsia include new high blood pressure after 20 weeks of pregnancy along with other problems, such as protein in your urine. Preeclampsia usually goes away after you give birth. In rare cases, blood pressure can stay high for up to 6 weeks after the birth.

Preeclampsia can be deadly for the mother and baby. It can keep the baby from getting enough blood and oxygen. It also can harm the mother's liver , kidneys , and brain. Women with very bad preeclampsia can have dangerous seizures. This is called eclampsia.

What causes preeclampsia and high blood pressure during pregnancy?

Experts don't know the exact cause of preeclampsia and high blood pressure during pregnancy. But they have some ideas about preeclampsia:

·         Preeclampsia seems to start because the placenta doesn't grow the usual network of blood vessels deep in the wall of the uterus. This leads to poor blood flow in the placenta.

·         Preeclampsia may run in families. If your mother had preeclampsia while she was pregnant with you, you have a higher chance of getting it during pregnancy. You also have a higher chance of getting it if the mother of your baby's father had preeclampsia.

·         The mother's immune system may react to the father's sperm, the placenta, or the baby.

·         Already having high blood pressure when you get pregnant raises your chance of getting preeclampsia.

·         Problems that can lead to high blood pressure, such as obesity , polycystic ovary syndrome , and diabetes , could raise your risk of preeclampsia.

What are the symptoms?

High blood pressure usually doesn't cause symptoms. But very high blood pressure sometimes causes headaches and shortness of breath or changes in vision.

Mild preeclampsia usually doesn't cause symptoms, either. But preeclampsia can cause rapid weight gain and sudden swelling of the hands and face. Severe preeclampsia causes symptoms of organ trouble, such as a very bad headache and trouble seeing and breathing. It also can cause belly pain and decreased urination.

How are high blood pressure and preeclampsia diagnosed?

High blood pressure and preeclampsia are usually found during a prenatal visit. This is one reason why it's so important to go to all of your prenatal visits. You need to have your blood pressure checked often.   Sudden increase in blood pressure often is the first sign of a problem.

You also will have a urine test to look for protein, another sign of preeclampsia.

If you have high blood pressure, tell your doctor right away if you have a headache or belly pain. These signs of preeclampsia can occur before protein shows up in your urine.

How are they treated?

Your doctor may have you take medicine if he or she thinks your blood pressure is too high.

The only cure for preeclampsia is having the baby. You may get medicines to lower your blood pressure and to prevent seizures. You also may get medicine to help your baby's lungs get ready for birth. Your doctor will try to deliver your baby when the baby has grown enough to be ready for birth. But sometimes a baby has to be delivered early to protect the health of the mother or the baby. If this happens, your baby will get special care for premature babies.

Do preeclampsia and high blood pressure lead to long-term high blood pressure?

If you have high blood pressure during pregnancy but had normal blood pressure before pregnancy, your pressure is likely to go back to normal after you have the baby. But if you had high blood pressure before pregnancy, you probably will still have it after you give birth.

Experts don't think preeclampsia causes high blood pressure later in life. But women who get preeclampsia may have a higher-than-normal chance of getting high blood pressure after pregnancy or later in life.

General Preemie Information

Every day, thousands of families experience the joy that comes with the birth of their new baby. However, sadly, every year, thousands more families experience the pain of losing their baby or seeing their tiny child fight for their life. Premature birth, is the birth of a baby, before 37 completed weeks of gestation. Babies are considered to be full term from 37 weeks of pregnancy and will have the best chance of healthy development if they are born after this point. Premature labor affects 12.5% of all births in the US, and despite vast improvements in neonatal care, the number of premature babies born each year has not decreased since the 1960s. It remains very difficult to identify the women at risk of premature delivery because the causes are still very miss-understood. Research has concluded that babies born very early (before 25 weeks) are more likely to survive than in the past, but survival of these babies has led to an increase in disability.

Lifestyle influences that may cause pre-term labor:

Smoking

Recreational drug use

High caffeine intake

Poor diet (or being underweight)

Over strenuous physical activity

Medical conditions

Conditions experienced prior to pregnancy (such as systemic lupus or renal disease).

Pregnancy related conditions (such as pre-eclampsia, pregnancy-induced diabetes, or obstetric

Cholestasis).

Previous pregnancy problems

Previous pre-mature children

Gynecological history

Cervical surgery

Cervical or uterine abnormalities

Cervical weakness 

Infection

Vaginal infections (such as gonorrhea, Chlamydia, bacterial vaginosis or

group B streptococcus)

Current pregnancy

Multiple pregnancies

What are the risk factors associated with premature birth?

Many women with no identified risk factors will go on to experience premature delivery, however

there are some factors that are known to increase your risk of having a premature baby.

It is important to note that while many of these conditions are risk factors for premature birth and may

cause early labor, there are also circumstances where premature delivery is initiated by medical staff. For example, if a woman suffers from pre-eclampsia, the baby is not thriving in the womb, or if there is an ante-partum bleed and either the health of the mother or baby is at risk, then premature delivery of the baby may be the only option. The exact cause of many premature births remains unknown, but there are some conditions and factors that may increase your chances of having a premature baby.

Stop smoking

Ideally you should stop smoking. This is probably the single most important thing

you can do to reduce your risk of having your baby early. Smoking cigarettes, or

breathing in somebody else’s smoke reduces the amount of oxygen in your

blood stream which in turn deprives your baby of oxygen. There is a huge

amount of evidence showing that smoking is definitely related to premature

delivery. Ideally both you and your partner should stop smoking before trying

for a baby, but it’s never too late to stop. 

Don’t take recreational drugs

Using recreational drugs, particularly cocaine, during pregnancy is a risk factor for

premature delivery. It is important to stop either prior to pregnancy or as soon as you discover you are

pregnant. However, if you use recreational drugs on a regular basis please seek professional help to overcome it, as without it you may risk endangering both your health and that of your baby.

Avoid caffeine

High levels of caffeine have been shown to increase the risk of miscarriage and premature birth.

Government guidelines therefore recommend reducing your caffeine intake to less than 300 mg per

day, which is roughly three average, sized caffeinated drinks. These include coffee, tea,

chocolate drinks and bars and some soft drinks and energy drinks.

Avoid stress and over-strenuous activity

Research suggests that stress leads to high blood pressure, which can be a cause of premature birth

and miscarriage. It’s important to manage the amount you take on during your pregnancy and to give

yourself plenty of time to rest and relax. Standing for long periods or shift work may become difficult for

pregnant women, and it is sensible to avoid strenuous or tiring situations. Exercise is great for reducing stress and maintaining fitness as you get ready for labor. It is very important, however not to over-exert yourself. Check any planned exercise routine for safety (swimming, walking and yoga are excellent, low-impact, forms of exercise), and make sure your instructor knows you are pregnant.

All pregnant women should attend regular appointments. This is particularly important as regular contact can help to identify women at risk of premature delivery and also allows the progress of the pregnancy to be closely monitored. Women who are at greater risk of having a premature baby will most likely be referred to maternal fetal specialist early in their pregnancy. This appointment will enable you to discuss any tests that are available at your hospital regarding prematurity, and plan the care for your pregnancy.   Some tests include the following.

Detecting and treating infection

Research has shown that some urinary and vaginal infections are commonly related to preterm labor. These can sometimes be present with no symptoms so it is very important to attend your appointments where you will be tested for infection, and given appropriate treatment if infection is detected.

Urinary testing

You may be asked for a urine sample for testing at each visit. If an infection is suspected following a test, a further sample may be sent to a laboratory to confirm infection, and so appropriate antibiotics can be prescribed. Common symptoms of a urine infection are burning or stinging when passing urine, increased frequency of passing urine, unpleasant smell, backache and sometimes feeling just ill. Your urine will also be tested for the presence of protein which can be an indication of a complication in Pregnancy, called pre-eclampsia.

Vaginal swabs

Vaginal swabs are sometimes taken if a vaginal infection is suspected, and antibiotic treatment may be prescribed. However, at present there is limited evidence regarding their effectiveness. It is therefore important for you to seek medical advice if you are concerned about your discharge in pregnancy. If you notice creamy, yellow, green or brown discharge, itchiness, or an unpleasant smell, you should talk to your doctor. Remember that vaginal discharge in pregnancy may be heavier than normal, but if it is clear or white and causes no discomfort, it is probably normal.

Cervical assessment

One of the early signs of labor is the shortening of the cervix. In some women, this cervical change

occurs prematurely, leading to preterm labor. For women at risk of pre-term birth, changes in the

cervix can be monitored, so that appropriate care can be offered.

Transvaginal ultrasound

Traditionally, cervical changes have been detected by either vaginal or speculum examination.

However, a new and more reliable test is being developed to examine and measure the cervix using

transvaginal ultrasound (internal scan). 

Cervical cerclage (Stitch)

A cervical cerclage operation is performed under anesthetic in an attempt to keep your cervix closed

by putting a stitch around the neck of your womb. This is usually carried out vaginally, during the early

weeks of your pregnancy

Premature labor care

If you’re at all worried that you might be in premature labor, or your ‘waters’ break (ruptured

membranes), even if you have no labor pains, contact your nurse/dr immediately for advice. Ruptured membranes can be the first sign of preterm labor, and it is very important to ensure you receive appropriate care immediately to prevent possible infection and to ensure any onset of labor is monitored carefully. Tocolytic drugs are administered to women whose labor spontaneously starts prematurely. These drugs delay labor allowing time for the woman to be transferred to a specialist neonatal unit if

necessary, or for steroids to be administered. Steroids have been given to women at risk of preterm

delivery since the 1970s. They are given to improve the baby’s lung function, helping them to

establish breathing at birth.

A Memory Book For Preemies

There may not be many but there are a few and after researching we are in love with this baby book for preemies. The care and love that went into making this book is apparent in every page. Each page helps parents to create a story they will cherish forever. If you have a preemie and have not been able to find a baby book to fit your needs you should check this one out. God bless & enjoy browsing Jessica's beautiful Miracle Bebe website.

Common NICU Disorders

Prematurity

Normally, pregnancy lasts from 37 to 42 Weeks (approximately nine months). Infants born before 37 weeks are considered to be premature. Although a premature baby may not be fully prepared for life outside the womb, he has been completely formed (even fingers, toes, and nails) since he was 12 weeks old! Most of a premature baby's problems result from a lack of time: to acquire the more mature characteristics such as fat, some enzymes, and internal body regulators. The size and frailty of your premature baby may frighten you at first. This will lessen as you visit more often and get to know him. Most parents search for the reason for their child's premature birth and feel some responsibility for it. Was there something they did or didn't do that could have caused it? Often a premature birth cannot be explained or related to anything. Your obstetrician will be able to answer some of your questions and help you sort through this problem. It is important to begin resolving some of' these feelings in your mind early, so you can focus your attention and energy on your baby.

Premature babies look different than full term babies. The most apparent difference is size. They may weigh anywhere from just over one pound to five or six pounds or more, depending on the length of the pregnancy They have less fat than a term baby and smaller muscles. Because of this, they may seem skinny or bony (especially around the ribs). With time they will fill out. Their skin is softer and thinner and may be covered with light hair (lanugo). It will disappear in a few weeks just as it would have inside the uterus. The muscular reflexes are usually acquired late in pregnancy. Because of this, your baby's movements may seem shaky or jerky. He will become increasingly coordinated as he grows older. His sucking and swallowing reflexes usually do not occur in a coordinated fashion until 32 to 34 weeks' gestation. When your baby is ready to digest milk, tube feedings can be given until this sucking and swallowing coordination has been acquired. Meanwhile, you can help him practice with a pacifier.

Prematurity carries with it a wide range of potential problems, from mild to severe. Fortunately, in the last decade there have been great advances made in the understanding of premature babies. Now, the chances are much greater for premature babies to grow up to live happy, healthy lives.

Respiratory Distress Syndrome

The most common difficulty premature babies have is Respiratory Distress syndrome (RDS), also known as Hyaline Membrane Disease (HMD). In this disease, there is a relative lack of surfactant. Surfactant coats the lining of the lungs and allows them to inflate easily and retain air. Surfactant frequently is not present in sufficient amounts until the last month of pregnancy. Insufficient amounts will cause the baby to work harder to take deep breaths. This can be very tiring. Some of the medical help required may be oxygen, CPAP, a ventilator, or adding surfactant into the baby's windpipe (trachea). These treatments will be discussed later in this section. RDS frequently improves between the third and fifth day of life, although these babies may be ill for some time with related problems. Our staff is very familiar with RDS and has much experience helping babies through it. Even when a baby is not ready to be held, he can be comforted by the warm touch of his parent's finger.

Patent Ductus Arteriosus

Before birth, a lot of blood does not need to go to the baby's lungs to pick up oxygen because oxygen is supplied by the mother's bloodstream through the placenta. The blood is directed away from his lungs and to the rest of his body by a vessel called the ductus arteriosus. The ductus arteriosus is located just outside the heart and normally closes shortly after birth because it is no longer necessary. Often, in premature babies it fails to close. This open vessel is called a patent ductus arteriosus (PDA). If the ductus remains open, mild to severe problems can occur. The therapy given will depend on the severity of the problem. Two possible treatments to close a PDA are medication and surgical closure. Usually medication is the preferred treatment and most often is successful. Either will be explained to you before it is begun.

Apnea

It is normal for premature babies to have an irregular pattern of breathing. At times, they may even stop breathing. If this occurs, the breathing monitor and sometimes the heart monitor alarm and the nurse will help the baby to begin breathing again. She may tickle him or rub his body to remind him to breathe. She may also have to give him breaths of air with the resuscitation bag at his bedside. These "apnea spells" (episodes of stopped breathing) may be caused by many things. Most frequently, they are due to an immaturity of the breathing control center in the brain and will go away in time.

Infection

Babies are generally more prone to infection than adults. If the medical team suspects your baby has an infection, tests may be needed. Samples of blood and/or other body fluids may be sent to the laboratory. Tests to detect infection may take many days. Antibiotics may be started right away.

Necrotizing Enter colitis (NEC)

NEC is an infection of the wall of the intestines (gut). It may spread to the blood. Premature babies are prone to this disease. They cannot be fed by usual means, and will need nourishment by vein. Although often mild, some cases are very serious. Surgery is sometimes necessary to repair or remove damaged intestine.

Retinopathy of Prematurity (ROP)

ROP is a problem of the retina (back part of the eye that "sees"). It occurs mostly in very premature infants. Most cases are not severe and get better on their own. However, on occasion, it can threaten vision in one or both eyes, and surgery may be necessary to improve the chance for sight. Cedars-Sinai's NICU is recognized for its low incidence of ROP.

Pneumothorax

Occasionally, air will "leak" from the baby's lungs into a space between the lung and the chest wall. This trapped air prevents the lung from fully expanding. If large enough, this will cause difficulty breathing and the air may need removal by placing either a needle (for one time removal) or a plastic tube (for continuous removal) in the chest. The tube may need gentle suction to draw out the trapped air. This tube is left in place until the air is removed and the lung is no longer leaking air. This may take a few or many days.

Meconium Aspiration

Occasionally, while still in the mom, babies may pass stool (meconium). If the baby breathes it into his lungs (aspirates), it can cause difficulty breathing. Treatment for this problem may include placing a tube into the baby's lungs and cleaning them out with suction. The baby may need oxygen, chest therapy and even the help of a ventilator. The body clears the last traces naturally.

Jaundice

Jaundice (yellowing of the skin) is a common problem in babies. It occurs when a pigment called bilirubin enters the blood. Bilirubin is formed by the normal breakdown of red blood cells. Bilirubin is cleared by the liver and removed from the body. A baby's liver may not be able to perform this job efficiently. A blood test can be done to check the amount of bilirubin in the blood. If it is more than the normal amount, treatment will be started. Light of a specific wave-length and intensity (phototherapy or bililights) will help lower the bilirubin. We will keep your baby's eyes covered with small eye patches and allow his body to be completely exposed to light. Usually a few days of this treatment will resolve the jaundice. Rarely, the jaundice may be severe enough to require an exchange transfusion. (The baby's blood, which is high in bilirubin, would be slowly replaced by donated blood low in bilirubin.

Intraventricular Hemorrhage (IVH)

IVH is bleeding in the area of the normal hollow spaces (ventricles) of the brain. Sometimes the bleeding is so minor that it does not get into the ventricles at all, but only causes minor blood clots at their edges. At other times, bleeding can get into the hollow spaces themselves or even extend into the brain. The most common hemorrhages are minor and do little if any harm. The bleeding is graded from 1-4. Grades 1 and 2 are usually minor. Grades 3 and 4 also can result in little or no harm, but with these grades of hemorrhages the baby's development must be observed more closely, as there is an increased possibility of brain damage. Babies are tested for this by ultrasound of the head. Sometimes more than one test is needed. At times other studies such as Computed Tomography (CT scan) or Magnetic Resonance Imaging (MRI scan) are needed.

Multiple Births

It is common for twins, triplets, or quadruplets to need some time in the NICU before going home. Often, this is because they are born prematurely. Sometimes, they have special medical problems related to their growth in the womb together. Also, birth defects are more common in multiple births. Parenting multiples is challenging. You will have to plan for extra clothing, supplies, space, and help you may need when they come home. You will also have two (or three or four) times the emotional ups and downs of the NICU. It may be difficult to keep track of information on more than one baby at the same time. If one baby is having a problem, it may be difficult to be happy for the one/others doing well. Also, it is not unusual for one baby to go home before the other. Visiting may become more difficult when you have one new baby at home and one in the hospital. Many parents find it helpful to keep a journal or notes about each baby, so that things do not get confused. Getting the support of other parents of multiples, who can understand this complex time, often helps parents. These other parents can share things that helped them when they were dealing with more than one baby at once. Your social worker or the parent liaison can help you contact a parent-to-parent volunteer or an organization for parents of multiples in the community.

Infants with Congenital Defects (Defect Present at Birth)

There are 4 million live births in the United States each year. Of these, 1 in every 33 babies is born with a defect. These defects may vary from simple to life threatening. Sometimes the defect needs quick correction while at other times surgery is best delayed. These decisions are made on an individual basis, by a team. The team includes parents, social worker, geneticist, pediatrician, surgeon, physical therapist, etc. Genetics is involved to educate the family and the health care team about several aspects of care. Often, more than one birth defect may be present. Thus, several tests may be needed to make sure that no occult (hidden) defect is overlooked. The most common organ to be affected by a defect at birth is the heart. Infants born with congenital heart disease (Heart defect present at birth)

Infants Born with Congenital Heart Disease (Heart Defect Present at Birth)

Some babies are born with problems in the form or function of their heart. The heart is responsible for pumping blood to all parts of the body. The healthy heart has four chambers which each serve a specific function. The heart receives "used blood" from the body, pumping it to the lungs for oxygen. It then receives "fresh blood" from the lungs, and sends it out to the body again. When any part of the heart or its major vessels is abnormal or does not function well, medical or surgical treatment may be necessary. A variety of tests will help to determine the specific problem in the heart. Some problems can be treated easily, while others may be very complex and life threatening. When a heart problem is suspected or diagnosed, a cardiologist and a cardiac surgeon, if needed, will be added to the team. They will be able to give you more details about your baby's heart and what treatments may be needed.

(Pictures from L-R; Cole Doyle one day old born at 31 wks; Wyatt Doyle two days old born at 31 wks under phototherapy lights for jaundice)

NICU Terminology

NICU Terms

A's and B's

Abbreviation’s which refer to episodes of apnea and bradycardia; see APNEA and BRADYCARDIA.

ANEMIA

A less than the normal number of red blood cells in the blood.

APNEA

The cessation of breathing.

ASPHYXIA

A condition where there has been a lack of sufficient oxygen to the tissues of the body. The brain and the kidneys are the most sensitive organs to a lack of oxygen.

ASPIRATION

Breathing a foreign material (such as formula, stomach fluids, meconium, etc.) into the lungs.

BAGGING

Filling the lungs with air, or oxygen by squeezing a bag which is connected to an endotracheal tube. (Also can be attached to a mask and fitted over the face.) This allows a dr or nurse to breathe for your baby when he/she’s own breaths are not enough.

BILILIGHTS (Phototherapy)

Special lights used in the treatment of jaundice; see JAUNDICE.

BILIRUBIN

A breakdown product of red blood cells. See JAUNDICE.

BLOOD GASES

The amounts of oxygen, carbon dioxide and degree of acidity in the blood. A small amount of blood is taken from the heel (by heel stick), umbilical catheter or from the artery near the wrist where your pulse is felt to test for these levels.

BLOOD PRESSURE (BP)

The pressure of the blood in the arteries with each pulsation of the heart.

BRADYCARDIA

An abnormally slow heart rate.

BROVIAC

See CENTRAL CATHETER

CARDIOLOGIST

A medical doctor who specializes in the heart and circulation.

CBC (Complete Blood Count)

A count of the various types of cells present in the blood, chiefly: red cells (for carrying oxygen), white cells (for fighting infection), and platelets (for prevention of bleeding).

CENTRAL CATHETER or CENTRAL LINE

A thin, flexible tube (catheter) placed in a larger vein or artery to deliver medications or necessary fluids and nutrients to the body. Broviac catheters are usually placed in the upper chest and tunnel under the skin to enter the vena cava, the large blood vessel in the center of the body carrying blood to the heart. PICC lines (percutaneously inserted central catheters) are usually threaded through a vein in the arm to the vena cava. Central catheters also include umbilical venous and umbilical artery catheters which may be inserted into the vein or artery of the belly button shortly after birth.

CHEMSTRIP

A test in which a drop of the baby's blood is placed on a strip of special paper to determine the amount of sugar in the blood.

CHEST TUBE

A small plastic tube placed through the chest wall into the space between the lung and chest wall to remove air or fluid from this space. See PNEUMOTHORAX.

CIRCUMCISION

A surgical procedure done to remove the foreskin of the penis. Usually done just before the baby goes home and only on request.

CONGENITAL

Existing at the time of birth.

CPAP

Continuous Positive Airway Pressure - a form of ventilator assistance which helps to keep the baby's lungs properly expanded. CPAP does not breathe for the baby, but allows the baby to breathe into a "wind."

CT SCAN (of the head)

Computerized x-rays which show the size and position of many parts of the brain. A CT scan also can be done on other parts of the body. 

CULTURE

A laboratory test of blood, spinal fluid, urine, or other specimens which shows if germs are present and which ones they are.

CYANOSIS

Blue color of the skin occurring when there is not enough oxygen in the blood.

DIFFERENTIAL

A test which divides the white blood cell count (from the CBC) into several categories, chiefly: "polys" (short for polymorph nuclear leukocytes), "bands" (immature "polys"), "lymph’s" (lymphocytes), "monos" (monocytes), "cos" (eosinophils), "basos" (basophiles). The percentages of each cell type may vary in different kinds of infections; for example, polys and bands usually will predominate in bacterial infections, while the number of lymph’s usually will increase in viral infections.

ECHOCARDIOGRAM

A test done to look at the heart using sound waves through the chest wall. This is much like an ultrasound done during pregnancy and is neither harmful nor painful.

EDEMA

"Puffy" skin from a build-up of fluid in body tissues.

ENDOTRACHEAL TUBE (ET Tube)

A plastic tube which goes from the baby's nose or mouth past the vocal cords and into the upper trachea (windpipe).

EXCHANGE TRANSFUSION

A treatment which removes the baby's blood in small quantities and replaces it with donor blood. This procedure is used most frequently to lower the level of bilirubin in the baby's blood. (See also Jaundice.) It also may be used to raise or lower the number of red blood cells, and improve the ability of the blood to clot.

EXTUBATION

Removal of a tube which has been placed through the nose or mouth into the trachea; see ENDOTRACHEAL TUBE.

GASTROENTEROLOGIST

A medical doctor who specializes in the digestive system.

GASTROSTOMY

A surgically created opening in the abdominal wall to provide nutrition directly into the stomach.

GAVAGE FEEDINGS

Feedings delivered by a small plastic tube placed through the nose or mouth and down into the stomach when the baby is too weak or too premature to suck and swallow.

GENETICS

The branch of medicine that deals with heredity, the variation of individuals, prognosis for development and function, and risks of recurrence of genetic conditions.

HEART MURMUR

A rushing sound made by the blood within the heart, usually heard with a stethoscope. This may or may not be a sign of a problem for a baby.

HEELSTICK

A quick prick of the heel with a sterile instrument (much like a finger prick) to obtain small blood samples for tests.

HEMATOCRIT (crit)

A test done to determine if the amount of red blood cells in the blood is adequate.

HYDROCEPHALUS

An abnormal accumulation of cerebrospinal fluid (the normal fluid which bathes the brain and spinal cord) in the ventricles of the brain.

HYPERALIMENTATION

See PARENTERAL NUTRITION

HYPERBILIRUBINEMIA

An elevated level of bilirubin in the blood. See JAUNDICE.

HYPOGLYCEMIA

A low amount of sugar (glucose) in the blood.

I: E RATIO

The ratio of the length of the forced breath provided by a ventilator to the length of the time between two breaths.

INFILTRATE (IV Infiltrate)

The slipping of an IV needle out of a vein, allowing IV fluid to accumulate in the surrounding tissues.

INTRAVENOUS (IV)

A small plastic tube or hollow metal needle placed into one of the baby's veins, through which fluids, sugar, and minerals can be given when the baby cannot take all of his nourishment by feedings.

INSPIRATORY TIME (IT)

The length of a forced breath provided to the baby by a ventilator.

INTRAVENTRICULAR HEMORRHAGE (IVH)

A collection of blood in and around the ventricles (hollow portions) of the brain.

INTUBATION

Placing an endotracheal tube in the baby's trachea (windpipe). See Endotracheal Tube.

JAUNDICE

A yellow coloration of the skin and eyes caused by increased amounts of bilirubin in the blood. Bilirubin is a break-down product of red blood cells; it is processed and excreted by the liver. Treatments for jaundice include phototherapy ("bili-lights") and (rarely) exchange transfusion.

LUMBAR PUNCTURE ("Spinal Tap")

A procedure in which a small needle is placed in the small of the back, between the vertebrae (back bones), to obtain spinal fluid for bacterial cultures and other tests.

MAS (Meconium Aspiration Syndrome)

See MECONIUM ASPIRATION.

MECONIUM

The first bowel movements that a baby has which are thick, sticky, and dark green to black in color.

MECONIUM ASPIRATION 

The inhalation of meconium into the lungs. If a baby passes meconium before delivery, the meconium may be inhaled into the lungs, causing problems with breathing after the baby is born. This condition is called meconium aspiration syndrome (MAS).

MENINGITIS

Infection of the fluid that cushions and surrounds the brain and spinal cord.

MRI (Magnetic Resonance Imaging)

A computerized method of viewing any portion of the body. It uses magnetism rather than x-rays.

NASAL CANNULA

A clear plastic tube which passes under the nose to provide supplemental oxygen.

NECROTIZING ENTEROCOLITIS (NEC)

An infection of the wall of the intestines, which may spread to the blood. Premature babies are particularly vulnerable to this disease. Surgery is sometimes necessary to remove damaged intestine, and the baby may need prolonged feeding by vein until he recovers. See also PARENTERAL NUTRITION, SEPSIS.

NEONATOLOGY

The medical specialty concerned with diseases of newborn infants (neonates). Neonatologists are pediatricians who have received several years of additional training.

NEUHROLOGIST

A medical doctor who specializes in disorders of the kidneys.

NEUROLOGIST

A medical doctor who specializes in the brain and nervous system.

NPO

Nothing to be given by mouth.

OPHTHALMOLOGIST

A medical doctor who specializes in disorders of the eye.

OTOLARYNGOLOGIST

A medical doctor who specializes in the ear, nose, and throat.

OXYHOOD (02 hood)

A clear plastic hood placed over the baby's head through which oxygen is given.

PARENTERAL NUTRITION 

Protein and sometimes fats (lipids) given along with sugars and salts by vein when the baby cannot tolerate complete feedings by nipple or gavage.

PATENT DUCTUS ARTERIOSUS (PDA)

A small vessel which allows blood to bypass the lungs. This vessel is open while the baby is in the womb, but normally closes shortly after delivery. If the vessel fails to close on its own, special medication or surgery may be needed. 

PEAK INSPIRATORY PRESSURE (PIP)

The highest pressure that is delivered to the baby by the ventilator during a forced breath.

PEEP

See POSITIVE END-EXPIRATORY PRESSURE.

PHOTOTHERAPY

A treatment in which the baby is placed under bright lights (frequently blue in color) or on a special light blanket which helps bilirubin to be excreted into the intestine. See also BILIRUBIN, JAUNDICE.

PICC LINE

See CENTRAL CATHETER

PIP

See PEAK INSPIRATORY PRESSURE.

PKU

A rare disorder in which one of the amino acids (a building block of protein) cannot be handled normally by the baby, leading to elevated levels in the blood. Babies with PKU require a special diet. All babies are routinely tested for PKU, as well as several other disorders, before going home from the nursery. This test is required by law.

PNEUMOMEDIASTINUM

Leakage of air from the normal passageways of the lung into the space surrounding the heart inside the chest. A pneumomediastinum is usually harmless in itself, but is often associated with a pneumothorax (which can be life-threatening if large). See PNEUMOTHORAX.

PNEUMOTHORAX

Leakage of air from the normal passageways of the lung into the space surrounding the lung inside the chest wall, causing a partial or complete collapse of the lung.

POSITIVE END-EXPIRATORY PRESSURE (PEEP)

The lowest pressure that is delivered by the ventilator to the baby between forced breaths. See also PEAK INSPIRATORY PRESSURE (PIP).

RED BLOOD CELLS

The cells in the blood which carry oxygen.

REFLUX

A return or backward flow; gastroesophageal (GE) reflux occurs when portions of feedings or other stomach contents flow back up into the esophagus.

REGIONAL CENTER

One of a network of state-funded agencies which helps to coordinate community services and resources to infants at risk of having a developmental delay; also provides services and coordination of resources to children and adults with specific developmental disabilities.

RESPIRATORY DISTRESS SYNDROME (RDS)

A common breathing problem of premature infants caused by insufficient surfactant in the baby's lung. This results in an excessive stiffness of the baby's lungs. See also SURFACTANT

SEIZURE

A "short circuiting" of the electrical activity in the brain, sometimes causing involuntary muscle activity or stiffening. There are many causes of seizures. If your child has a seizure, speak with your baby's doctor about this condition and its implications.

SEPSIS

Infection of the blood. See also MENINGITIS, NECROTIZING ENTEROCOLITIS.

SEPTIC WORKUP

An assortment of tests performed on an infant who is suspected of having an infection. This may include chest x-ray and/or abdominal x-ray, as well as blood, urine, and spinal fluid cultures. Because infections in babies can progress very rapidly, the baby is frequently started on antibiotics until the results of the cultures are known.

SUPRA-PUBIC TAP

Obtaining an uncontaminated sample of urine by first cleaning off the lower abdomen, then inserting a needle directly into the urinary bladder.

SURFACTANT

A material secreted by special cells within the alveoli (air sacs) of the lung, which makes the lung flexible and helps to keep the lung from collapsing. Deficiency of surfactant is the main problem in Respiratory Distress Syndrome (RDS). Commercial products are available which can be put into the lungs through the tube in the windpipe. These products frequently are very helpful to the premature baby with RDS.

TRACHEOSTOMY

A surgical opening in the trachea, below the larynx (voice box) to allow air to enter the lungs; usually done to by-pass a narrowing in the area immediately below the larynx.

TRANSFUSION

Giving donated blood to the baby by vein or artery.

ULTRASOUND OF THE HEAD

A test done using sound waves which shows an image of the brain. The test is not harmful or painful to the baby and may be done at the bedside.

UMBILICAL CATHETER

A small plastic tube in one of the umbilical (belly button) blood vessels (either an artery or a vein).