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Equipment

MONITORS

  • Apnoea monitor: used in a crib when your baby no longer needs intensive monitoring. It has an audible alarm that will sound should your baby stop breathing. Different kinds are available in South Africa. Some monitors operate with a mattress that is placed under your baby in the crib with an attached monitor to sound in the event of apnoea. Some has an electrode that is padded to your baby's skin on her tummy with an attached monitor. Some monitors are wireless and attach to your baby's nappy to stimulate breathing by means of vibration.
  • Blood pressure monitor: machine that measures your baby's blood pressure. The blood pressure may be measured periodically with a small cuff placed around your baby's arm or leg, or may be measured continuously if your baby has a catheter (tiny tube) going into one of the arteries.
  • Cardiac-respiratory monitor: displays the heart rate of your baby. An alarm will sound if your baby's heart rate drops below or is above the limits set for your baby. The limits are commonly set to sound if the heart beats less than 100 beats per minute or is more than 200 beats per minute. Three adhesive patches with wires (called electrodes) connected to them are placed on your baby's chest, abdomen, arms or legs. The wires are connected to a machine that displays your baby's heart rate, heart beat pattern, breathing rate and breathing pattern. It is quite common for premature babies to stop breathing for more than 20 seconds (apnoeic spells), in which case the alarm will sound.
  • Pulse oximeter/oxygen saturation monitor: continuously measures your baby's blood oxygen. There is a tiny light, which is attached to your baby's palm, foot, finger, toe or wrist by a piece of adhesive elastic. A cord goes from the light to a machine that displays the amount of oxygen being carried by red blood cells in your baby's body. This may be part of the cardio-respiratory monitor or a separate monitor. Normal blood saturation for a premature baby is about 88-92% when the baby receives oxygen; and above 96% when she is breathing on her own. These levels might change slightly according to sea level.

 

INCUBATORS

  • Open incubator/overhead crib: open flat bed with a heater that keeps your baby warm, which is regulated by her own temperature. A temperature probe continuously measures you baby's temperature. The overhead crib has enough space for all the tubes and wires and provides easy access to your baby. Some new incubators can change from open to closed by moving the overhead part of the incubator.
  • Closed incubator: bed for a premature baby that is covered with see-through Perspex sides to enable you to see your baby. The incubator provides a warm and humidified environment. It will automatically warm up or cool down according to your baby's temperature (if your baby has a skin temperature probe). If she starts maintaining her temperature, the incubator temperature may be adjusted to provide the exact extra bit of heat your baby may need.
  • Temperature probe: coated wire that is placed on your baby's skin and covered with a soft, adhesive patch. It measures your baby's temperature and provides information that is used to help regulate the amount of heat from the overhead heater or incubator. Clothing and linen covering her might interfere with the temperature regulation and that is why babies are sometimes not dressed when in an incubator.
  • Thermometers: used in the NICU to measure your baby's temperature - it can be mercury or electronic thermometers. The thermometer is placed in contact with the skin under your baby's arm for up to three minutes. The normal temperature for a premature baby will be acceptable between 36.5°C and 37.5°C. Temperature is never taken in a baby's mouth for safety reasons.

 

BREATHING EQUIPMENT

  • A chest tube/intercostal drain: tube inserted into the chest between two ribs. It is used when a baby had chest surgery, has a pneumothorax (air or gas between the membranes of the lungs) or has fluid accumulation between membranes of the lungs. Its purpose is to drain excess air or fluid out of the chest to allow your baby's lungs to expand, which will help her breathe easier.
  • Continuous positive airway pressure (CPAP): oxygen or normal air provided to your baby via nasal prongs that fits snug her nostrils. It provides pressure that prevents the baby's lungs (alveoli) from total collapse each time she exhales. With this machine, your baby breathes on her own, but a little assistance is provided to keep the lungs expanded.
  • Bubble CPAP: oxygen or normal air provided to your baby via continuous positive airway pressure created by a water chamber. Pressure is created by water pressure instead of mechanical pressure and prevents her lungs (alveoli) from total collapse each time she exhales.
  • Endotracheal tube (ET): inserted through your baby's nose or mouth, directly into her windpipe (trachea) to deliver air to her with an ambubag, ventilator or oscillator when she cannot breathe on her own. The tube is secured by tape and passes through the vocal chords. You will not be able to hear your baby cry until it is removed.
  • Nasal prongs (or cannula): flexible hollow tube with little prongs that fit into the nostrils to deliver oxygen (or air) under a small amount of pressure. Delivering oxygen under pressure helps to keep the air sacs (alveoli) in the lungs open. If the oxygen is delivered under pressure, it is known as CPAP.
  • Oxyhood (headbox): small plastic hood that covers your baby's head and helps to provide a stable humidified oxygen environment. It is not used very often due to better and more advanced technology that is available these days.
  • Oxygen mask: placed over your baby's nose and mouth, allowing oxygen to flow through a tube into the mask at a constant rate. The oxygen mask is mostly used together with an ambubag to deliver manual pressure to your baby when she collapses or is transported to theatre or another area in the NICU. An oxygen mask and ambubag can be used as a temporary replacement for a ventilator.
  • Saturation probe: little red light that is attached to your baby's palm, foot, finger, or wrist by a piece of adhesive elastic and runs to the saturation monitor with a wire. This probe measures the oxygen levels in the blood.
  • SiPAP: new way of providing ventilation without the use of an ET tube. It is, however, not suitable for babies who need to work very hard to breathe and those who are very ill.
  • Suction catheter: small tube to remove mucus from your baby's nose, throat or windpipe and helps to keep the breathing tubes clear.
  • Ventilator (or respirator), high frequency ventilator (oscillator): machine that helps your baby breathe, since many premature babies have trouble breathing. The ventilator is attached to your baby via the ET tube and can do all of her breathing for her, or just part of it. Others, called high frequency ventilators or oscillators, keep the lungs open with a constant pressure and then give hundreds of tiny puffs of air or oxygen each minute. These tiny puffs do not appear as normal breathing, but rather as if the chest is vibrating, called chest wiggle.

 

IV THERAPY

  • Intravenous therapy: Your baby receives fluid through a tube into her blood stream. Intravenous means ‘within a vein'. A vein is a small tube in the baby's body that transfers blood, which is poor in oxygen, from wherever it is in your body towards the heart and lungs to get fresh oxygen. IV therapy involves putting a small, flexible tube (called a catheter) into your baby's vein to deliver fluids, nutrients, medicines or blood directly to her system.
  • An arterial line is similar to an intravenous (IV) line, except that it goes into an artery instead of a vein. An artery is a bigger tube that carries blood, which is rich in oxygen from the lungs and heart to all the areas in the body where it is needed, such as muscles or organs. This line can be used to measure blood pressure or draw blood from.
  • Intravenous (IV) or infusion pumps and tubes are machines used to provide exact, measured amounts of IV fluids, medications or nutrients to your baby and you will find it on the counter or attached to a rail at your baby's bedside. A needle or small tube is placed into one of your baby's veins and then attached by tubing to a container of fluid to deliver fluids to her. Common sites for IVs are hands, feet, arms, legs and the head.
  • A peripheral line is a very thin IV tube that is placed into the arm, hand, leg, foot or scalp and used to administer fluids. To place a peripheral line, a small needle is inserted into a vein that is close to the skin surface. Once in place, the needle is removed and a catheter (small hollow tube) remains in place and is connected to the intravenous tubing. The catheter is secured with plaster so that your baby can't pull it out. The IV site may become swollen and red after time, due to irritation caused to the veins and then needs to be administered in another area. This happens due to the fragility of your baby's veins. If the IV is placed in the arm or leg, it may be secured with a splint. Splints may be used to keep your baby's arm or leg straight when she is receiving a drip to prevent the tube from being occluded or kicked out.
  • Broviac catheter: central line placed in the blood vessel that leads directly to the heart and needs to be inserted by a doctor through a surgical procedure. This type of catheter is considered when your baby will receive IV fluids over a long period of time or receives medication or nutrition that is irritating to thin peripheral veins.
  • Peripherally inserted central catheter (PICC-line): another kind of central line, which is usually inserted through a vein in the neck or in the bend of the arm and then guided into a large vein that takes it directly into the heart. An X-ray is taken to ensure that the catheter is in the correct position. Complications that may occur with insertion of a PICC-line include infection, an irregular heartbeat, bleeding and breaking or plugging of the catheter. The line may need to be removed if any of these occur. The advantages of a PICC-line over a peripheral line includes that it allows higher concentrations of nutrients and medications to be given, with less irritation to the veins. When IV therapy is needed for a long time the PICC-line eliminates the need for multiple needle sticks to take blood samples or deliver IV nutrition, fluids or medications.
  • Umbilical catheters: inserted through the end of the umbilical cord into either an artery (an umbilical artery catheter or UAC) or a vein (an umbilical vein catheter or UVC) or both. Umbilical catheters are usually inserted directly after birth when the umbilicus is still soft and moist and is only recommended for babies whom the staff knows will need long-term IV therapy. The umbilical catheter is secured to your baby's tummy with a small amount of tape and a small stitch may also be used to secure the catheter. The stitch does not hurt your baby, since the umbilical cord does not have any nerves. The umbilical catheter has some advantages: blood samples can be painlessly drawn directly from the umbilical catheter for blood tests; the need for your baby to be pricked with a needle to take blood samples are reduced; blood pressure can be monitored continuously; and fluids, medications and nutrients can be given to your baby via the veins.

 

PHOTOTHERAPY EQUIPMENT

  • Phototherapy is used to treat a condition called jaundice, which is when too much bilirubin in the blood turns your baby's skin and the whites of her eyes yellow. This happens because her liver is not yet mature enough to break down the old red blood cells in her body. The bilirubin levels are determined according to a sliding scale, which takes your baby's gestational age, weight and age from birth into account. If these bilirubin levels rise too high, your baby will be placed under phototherapy lights or on a biliblanket. Specially designed ultraviolet lights help to break down the bilirubin, which makes it is easier for your baby's body to get rid of it through the urine.
  • Bililights: special overhead lights are used for single phototherapy and in the case of double phototherapy; the overhead lights are used together with lights around your baby. The lights will not burn or harm her skin; however, it is common for babies receiving phototherapy to develop a skin rash that will disappear when the lights are taken away. Her eyes will be covered to protect it from the lights and she will be undressed to allow as much of the skin as possible to absorb the light rays. If your baby receives phototherapy you should limit the time you hold her to allow for maximum exposure to the lights.
  • Biliblanket: performs the same function as phototherapy lights, but your baby will wear only a nappy and put in a baby grow-like blanket on a bilibed that will provide the UV lights to break down the bilirubin. Your baby doesn't need to wear protective eye covers when lying on this blanket.

 

NUTRITION AND FEEDING

  • Breast milk: refers to the milk produced by a baby's own mother and is the best nutrition a baby can get. Your baby is not able to suckle on your breast immediately, but she still needs your milk, which you can express to be given to her via a tube. It is then referred to as expressed breast milk or EBM.
  • Breast pumps: used to express milk from the breast when the premature baby is still too small to suckle from Mom's breast to get the milk. Electrical breast pumps have a rhythmic sucking action and can only be used from the second day after birth. Hand pumps are also very effective and more portable, since they do not work with electricity, but here Mom regulates the pumping action. Each mother should use her own sterilised tubing for breast milk expressing. Breast pumps can also be used to pull the nipple out when your baby struggle to latch on a flat nipple or full breast.
  • Naso-gastric tube (NG tube) or oro-gastric tube (OG tube): small tube inserted through your baby's nose (naso-gastric) or mouth (oro-gastric) directly into her stomach. The tube will be secured to your baby's face with a piece of soft tape and feeding then flows through this tube.
  • Nipple shield: used when your premature baby really struggles to latch onto the breast because she has not yet accomplished the skills to get a proper grip on the nipple to feed. Your nipple may also be a bit flat or the breast can be very full. Nipple shields are only used for a short time and are not recommended for sore or cracked nipples, but when your baby cannot latch without a bit of extra help.
  • Breast milk bank: service that provides pasteurised human milk for babies when the mother is unable to provide breast milk for her baby and gives consent that her baby receives a donor's breast milk. There are currently breast milk banks in most of the bigger cities in South Africa.

 

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