in the nicu

arriving in the nicu

The NICU is a completely new world, but will be your baby’s home for the next few weeks or possibly even months. Preterm infants are admitted to the NICU since it is the best place outside the womb where they can receive all the support they need. The staff in the NICU are exactly the people you want to care for your premmie right now, since they each have a specialised job to do, and they work together as a team to provide complete care for your baby. The NICU is a whole new world with strange sounds and lots of equipment. The following is a few of the things you will most often see in the NICU and soon it will be as part of your life as an early morning cup of coffee.

Washbasin

PREVENT INFECTION
For the safety of your own baby and all the others in the NICU, you should always wash your hands on entering the NICU, and spray with the disinfectant hand spray. This should be done whether you are planning on touching your baby or not, since many infections can be spread unknowingly in various ways. It is in the best interest of your baby’s health that you keep to these “rules” and thereby minimise the risk for unnecessary infections.

Disinfectant hand spray

Open incubator / Overhead
Crib

INCUBATORS

During the first few days, your baby will probably be on an open overhead crib, a warmed bed that has enough space for all the pipes and wires and provides easy access to the baby.  Once your baby is stable enough she will be transferred into a closed incubator until she is able to maintain her own temperature at 36,5 – 37,5 OC.  Some babies are in closed incubators from birth, depending on the NICU policy.

Closed Incubator

Nesting

POSITIONING

Your preterm baby should be positioned in a way, which is similar to the womb environment.  She is provided with boundaries to support flexion and allow her to put her hands to her mouth/face, which help her to self-regulate.   This method of positioning is known as “nesting”.

Nesting

Basic Care Equipment

Baby with Socks

BASIC CARE EQUIPMENT

You will require a few basic care items for any new baby after birth. It may include nappies, cotton wool swabs, alcohol (to clean the umbilical cord) and nappy cream.  

Body heat is easily lost through your baby’s head and a woollen or cotton hat or beanie should be worn to help her maintain her temperature.  Some babies may wear socks, however after birth, all babies have cold hands and feet, since they send blood (which carry oxygen and glucose) to the important organs such as the heart, brain and lungs resulting in cold hands and feet.

Baby with Woollen Cap

Cardiac Monitor

Temperature Probe & Cardiac Stickers

MONITORS

A cardiac monitor is used to monitor the baby’s heart rate, breathing, saturation and blood pressure.

A saturation probe is attached to one of the limbs to monitor the oxygen levels in the blood.  This is usually maintained at 88% to 92% when the baby is receiving supplemental oxygen and more than 96% in room air.  It may also vary according to height above sea level.

A temperature probe is attached to the baby’s tummy or back to regulate the temperature provided by the incubator.

An apnoea mattress / monitor is used to notify you if the baby stops breathing once she is in a closed incubator or open crib.

Saturation Probe

Apnoea Mattres

DRIPS

Drips can be put on any limb or on the head.  Some doctors prefer Broviac catheters. This is a drip placed into a central vein.  Splints are used to keep the drip from occluding and infusion pumps are used to regulate the flow of medicine and drips.

Drip (intravenous infusion)

Splint

Infusion Pump

“Sunglasses” for phototherapy

PHOTOTHERAPY

Babies with jaundice receive phototherapy and their eyes are covered to protect them from the possible damaging light.

Phototherapy inclosed incubator

Oxygen – Nasal Cannula

Ventilator

OXYGEN EQUIPMENT

Premature babies usually need some help with breathing and depending on their condition they will receive oxygen via nasal cannula or a headbox or they can be placed on CPAP – a machine that helps to keep the lungs open.  A ventilator or oscillator is a machine that breaths for the baby.

Baby on CPAP

Baby on CPAP

NICU Language

With your baby being admitted to the NICU you will learn a whole new language. Use this glossary to help you understand and even speak this foreign language with as little effort as possible. Terminology and people included are according to the South African context. This page is brought to you with the courtesy of Prematurity – Adjusting your Dream.

GLOSSARY OF NICU TERMS

The people and terminology for them:

  • ICU: Intensive Care Unit
  • NICU (Neonatal Intensive Care Unit): This specialized unit is where premature babies or very sick babies are monitored and cared for. It can also be referred to as Special Care Nursery (SCN) or Intensive Care Nursery (ICN).
  • Neonate: This is how an infant is described for the first thirty days of their life.
  • Premature infants: This is a baby born before 37 weeks gestation. These babies are often referred to as ‘premmies’.
Prematurity can be further defined according to the baby’s birth weight:
Low birth weight baby < 2500 grams at birth
Very low birth weight baby < 1500 grams at birth
Extremely low birth weight baby < 1000 grams (micro premmie)

PEOPLE

Many professionals work together to care for premmie babies. You may meet some or all of the following:

  • Audiologist: person who specialises in hearing problems, tests for hearing loss and the treatment thereof.
  • Cardiologist: doctor who specialises in heart problems.
  • Case manager: person involved with medical aids. She will reassess your baby’s medical status daily and keep the medical aid informed. She will also contact you if there are any problems from the medical aid’s side. If you have queries on whether you have sufficient funds from your medical aid to cover the care of your baby while in NICU, this will be the person to speak to.
  • Endocrinologist: doctor that specialises in gland and hormonal problems.
  • Lactation consultant: health care provider who has advanced training and certification in breastfeeding management. In some NICUs the lactation consultant is available to help the nursing mother establish and maintain a breast milk supply until her baby is ready to breastfeed. The consultant then helps mothers with the actual skill of breastfeeding. If your NICU does not have a lactation consultant appointed to the unit, the neonatal nurses might help you in this regard, but you might find it useful to contact a lactation consultant once you go home and need additional support.
  • Neonatal nurse: registered nurse who is specially trained (referred to as a trained neonatal sister) or experienced (referred to as an experienced neonatal sister) to provide nursing care to high-risk, premature and ill newborns. She performs and coordinates the many tasks necessary to care of your baby. She will also look after the family and show you how to take care of your baby.
  • Neonatologist: specialised paediatrician in high-risk, premature babies. She will supervise the medical care of your baby.
  • Nephrologist: specialised doctor in kidney (urine) problems.
  • Neurologist: specialised doctor in brain and nervous system problems.
  • Occupational therapist: specially qualified person in the promotion of development and treating of developmental problems. You may encounter this person either in the NICU or in a follow-up clinic visit.
  • Opthamologist: specialised doctor who will check your baby’s eyes and provide appropriate treatment.
  • Paediatrician: specialised doctor in child health care. You will probably take your baby to your own paediatrician after discharge from the NICU.
  • Pathologist: specialised doctor in blood problems. This doctor will analyse your baby’s blood results and send a report with the results to the NICU.
  • Physiotherapist: specially qualified person in assessing movement and muscle problems in babies. They are sometimes also involved in the treatment of respiratory problems. You may meet one in the nursery or later in a follow-up clinic.
  • Radiographer: person who will take X-rays of your baby’s lungs and abdomen. These X-rays may be repeated a few times a day when your baby is still very ill or when necessary when your baby is getting stronger.
  • Radiologist: specialised doctor who evaluates and writes a report on the X-rays.
  • Shift leader: neonatal nurse who is second in charge when the unit manager is on duty. She is responsible for the management of the NICU when the unit manager is unavailable.
  • Social worker: qualified person who can help you with non-medical issues. She can assist you by providing counselling, emotional support, information on community resources and where the need arises, financial information.
  • Speech and language specialist: qualified person trained in speech and language development and problems. If this person is also a qualified feeding therapist, she will play an important role in assisting your baby with feeding problems, such as sucking and swallowing difficulties.
  • Unit manager: neonatal nursing sister who is in charge of the NICU. She supervises all nurses and clerks in the NICU. You are welcome to contact her with any queries or problems you might experience that cannot be solved by speaking with other nursing staff.
  • Ward secretary: receptionist in the NICU. She will often be the one answering the phone in the unit and can help you with all kinds of administrative information and activities.

 

SPECIAL TESTS

  • Ultrasound: a standard test that takes an ultrasound image of any of your baby’s organs by means of sound waves producing images. Ultrasound scans are simple, painless procedures and contain no radiation. Head sonar scans can be used to check for areas of bleeding from weakened or broken blood vessels in the brain. An ultrasound of the heart can be used to examine the heart to detect any abnormalities or expected conditions for premature babies, such as a patent ductus arteriosus (PDA), which is a little hole in the heart that did not close soon enough after birth. Ultrasounds can also be performed on your baby’s kidneys and stomach.
  • X-ray: the most common type of imaging scan. It can show the condition of the lungs and other organs and check the position of any tubes or catheters inserted in your baby’s body. For some conditions, your baby may have several X-rays a day. This may be worrying, but there is no need to be concerned, since an X-ray is a painless procedure and experts agree that the amount of radiation used is too low to cause harm to your baby, now or in the future.
  • Echocardiogram: an ultrasound of the heart that shows the blood flow and heart chambers and vessels to determine any heart problems.

 

LABORATORY TESTS

  • Blood gases: to check levels of oxygen, carbon dioxide, and acids in the blood.
  • Blood cultures: to tell if your baby has an infection.
  • Chemical (electrolyte) balance: to determine levels such as salt and bicarbonates.
  • Blood glucose levels: to determine blood sugar levels.
  • Bilirubin level: to check for jaundice.
  • Full blood count (FBC): to measure the level of different cells in your baby’s blood.
  • Hematocrit: to check for anaemia, which is an abnormal low number of oxygen-carrying red blood cells in the blood.

 

MEDICAL TERMS

  • Alveoli: These are tiny sacs in the lungs that exchange oxygen and carbon dioxide with the bloodstream.
  • Antibodies: These are proteins that help to fight harmful viruses or bacteria.
  • Aorta: This is the main artery leading from the heart. Oxygen-rich blood is supplied to the rest of the body this way.
  • B.I.D.: An abbreviation derived from a Latin term, meaning twice daily.
  • Bilirubin (Bili): This yellow substance occurs when red blood cells break down. Your baby’s skin may take on a yellowish tint because of excess bilirubin. In large quantities, bilirubin may cause a certain form of brain damage.
  • Blood pressure (BP): The top number of your baby’s blood pressure is called the systolic pressure. This indicates the pressure that is exerted when your baby’s heart contracts and sends blood to your baby’s body. The lower number, the diastolic pressure indicates the pressure that is exerted between heartbeats. see Low Blood Pressure
  • Breast Milk (B/M): Self Explanatory
  • Breastfed or Breastfeeding (BF): Self Explanatory
  • Bronchial tubes: These are the larger tubes that go from your baby’s trachea to their lungs.
  • Bronchioles: These smaller tubes branch off from your baby’s bronchial tubes.
  • Capillaries: These very small blood vessels remove waste and provide oxygen and nutrients to the body.
  • CNS: Central Nervous System (brain and spinal cord) or Clinical Nurse Specialist
  • Cerebrospinal fluid (CSF): This liquid is produced by the ventricles of the brain and circulates around the spinal column and brain of your baby.
  • Corrected age: The actual age your premature baby would be, if he was born on his due date. If he is five months old, but was two months premature, his corrected age would be 3 months.
  • Ductus arteriosus: This blood vessel joins the aorta with the pulmonary artery. In many premature babies, this vessel is not closed and must be closed by either drugs or surgery. The closing of this vessel enables proper blood and oxygen flow to the lungs.
  • Edema: Fluid retained by the body that causes swelling and puffiness.
  • Fontanel: The soft spot on your baby’s head, indicating the unjoined sections of the skull.
  • Gestational Age (GA): Gestation is the period of time between conception and birth during which the fetus grows and develops inside the mother’s womb. Gestational age is the time measured from the first day of the woman’s last menstrual cycle to the current date.
  • Hemoglobin: This material in red blood cells actually carries the oxygen. It also contains iron.
  • Lecithin: This is one of the ingredients used in the making of surfactant.
  • Metric measures of liquid (cc or ml): 30cc (or ml) is 1 ounce; 5 cc is ~1 teaspoon
  • Metric weight (Gms or Grams): 450 grams = 1 pound; 1 kilogram (Kg) = 1000 grams
  • Nothing by Mouth (NPO): Nil per os (NPO) is Latin for a medical instruction meaning to withhold oral food and fluids from a patient for various reasons.
  • Oxygen(O2): Self Explanatory
  • Surfactant: This soapy-like substance keeps air sacs in the lungs from collapsing and sticking together. Very premature babies are unable to make this substance in their lungs and are given a synthetic surfactant.
  • Tachycardia: This means a very fast heart rate.
  • Tachypnea: This means a very fast breathing rate.

 

MEDICAL PROCEDURES

  • Arterial blood gas: This sample of blood is taken from an artery. It is used to measure the oxygen, carbon dioxide and acid levels in the blood.
  • Bagging: This temporary procedure helps your baby breathe. A small bag is squeezed and oxygen or air flows through the mask on your baby’s face.
  • Blood gas: This measures oxygen, carbon dioxide and acid content in a small blood sample taken from one of your baby’s arteries.
  • Cardiopulmonary Resuscitation (CPR): This is a manual way for restarting breathing and a heartbeat, or for maintaining breathing and a heartbeat.
  • Complete blood count (CBC): This test counts number and types of blood cells and can be used to check for infection in your baby.
  • Computerized Axial Tomography (CAT or CT): This x-ray machine can capture cross sectional images of your baby’s tissues.
  • Continuous Positive Airways Pressure (CPAP): This means continuous positive low airway pressure. Your baby’s lungs are helped to stay expanded with the introduction of pressurized air. This helps her lungs while inhaling and exhaling. Sometimes your baby is given extra oxygen this way as well.
  • Echocardiogram: Ultrasound waves produce a picture of your baby’s heart, in this non-invasive procedure.
  • Electrocardiogram (ECG / EKG): This tracks electrical impulses in the heart.
  • Extubation: This procedure means the removing of your baby’s endotracheal tube.
  • Intravenous (by vein) (IV): Intravenous means “within a vein.” It usually refers to giving medications or fluids (solutions) through a needle or tube inserted into a vein, which allows immediate access to the blood supply.
  • Lumbar puncture (LP): This procedure extracts spinal fluid for testing. A needle is carefully inserted in the lower back and between vertebrae.
  • Nasal Continuous Positive Airway Pressure (Nasal CPAP): This stands for Continuous Positive Airway Pressure. Your baby is helped to breathe by small amounts of air and oxygen. It also maintains a small amount of continuous pressure to your baby’s lungs.
  • Phototherapy: The use of bililights to treat hyperbilirubinemia.
  • Spinal tap: The same as a lumbar puncture, this procedure extracts spinal fluid for testing. A needle is inserted in the lower back and between the vertebrae.
  • Total Parenteral Nutrition (TPN): nourishment provided intravenously

 

MEDICAL CONDITIONS

  • Apnea: Where there is no breathing for longer than 20 seconds.
  • Atrial Septal Defect (ASD): a hole in the wall between the two upper chambers of the heart
  • Bradycardia: This means your baby’s heart rate is below 100 beats per minute.
  • Brain bleed: This indicates hemorrhaging into some part of your baby’s brain.
  • Bronchiolitis: This means the bronchioles are inflamed or infected.
  • Bronchitis: This means the bronchial tubes are inflamed or infected. A condition marked by respirator-induced lung and bronchiole damage.
  • Bronchopulmonary Dysplasia (BPD): This condition may persist for years if your baby has underdeveloped lungs. The pressure from a ventilator may cause scarring or damage to your baby’s delicate lungs. In some cases, if your baby is very premature, they may require extended ventilator support. Some babies do go home on oxygen. The condition is also called Chronic lung disease or CLD.
  • Cerebral palsy (CP): Cerebral Palsy, disorder of the nervous system characterized by abnormal muscle tone and movement. This can occur from brain damage.
  • Chronic lung disease (CLD): See BPD, Bronchopulmonary dysplasia.
  • Dyspnea: This term is used to describe difficulty breathing.
  • Extremely Low Birth Weight (ELBW): Birth weight of under 800 g
  • Gastroesophageal Reflux Disease (GERD): This is a condition in which food or liquid travels backwards from the stomach to the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, causing heartburn and other symptoms.
  • Haemolysis, Elevated Liver enzymes, Low Platelets (HELLP): HELLP syndrome is a group of symptoms that occur in pregnant women who have hemolysis, elevated liver enzymes and low platelet count.
  • Hernia: Your premature baby may have a hernia. They are not unusual in premmies. Umbilical hernias can appear at the naval. Inguinal hernias can appear in the groin area. Both are caused by a part of the intestine coming through a small opening in the abdominal wall.
  • Hyaline membrane disease (HMD): A lack of surfactant in the lungs causes this form of respiratory distress (another name for Respiratory Distress Syndrome).
  • Hydrocephalus: A condition where cerebrospinal fluid has leaked into the brain.
  • Hyperbilirubinemia: This means there is too much bilirubin in the blood.
  • Hypercalcemia: This means there is too much calcium in the blood.
  • Hypercapnia: This means there is a higher amount of carbon dioxide in the blood than what is considered normal.
  • Hyperglycemia: This means there is a higher amount of sugar in the blood than what is considered normal.
  • Hyperkalemia: This means there is too much potassium in the blood.
  • Hypertension: This means high blood pressure.
  • Hyperthermia: This means a body temperature that is very high.
  • Hyperventiliation: This means very rapid breathing.
  • Hypocalcemia: This means there is too little calcium in the blood.
  • Hypoglycemia: This means there is too little sugar in the blood.
  • Hypokalemia: This means that potassium levels are too low in the blood.
  • Hyponatremia: Sodium levels in the blood that are too low.
  • Hypotension: This means low blood pressure.
  • Hypothermia: This means a body temperature that is very low.
  • Hypoxia: This means lack of oxygen.
  • Indomethiacin: This drug is sometimes used to close the patent ductus arteriosus.
  • Intracranial hemorrhage (ICH): This means bleeding that occurs in the brain.
  • Intrauterine Growth Retardation/restriction (IUGR): Result is of this condition is that the baby is small for its gestational age
  • Intraventricular haemorrhage (IVH): This means bleeding into the ventricles of the brain.
  • Jaundice: A condition caused by an excess of bilirubin in the blood. It can cause your baby to have a yellow tint.
  • Low Birth Weight (LBW): Under 2500 gr (5lb 8 oz) at birth regardless of GA.
  • Meningitis: This swelling affects the membranes found around the spinal cord and brain.
  • Patent ductus arteriosus (PDA): This describes a condition where the fetal blood vessel linking the aorta and the pulmonary artery does not close properly after birth. This is not an uncommon condition in premature infants.
  • Periventricular leukomalacia (PVL): A condition where areas of the brain are affected by lack of oxygen and/or blood supply which causes damage to brain tissue
  • Premature Rupture of membranes or Pre-labour Rupture of Membranes (PROM): Rupturing of membranes prior to the onset of labour
  • Pulmonary hypertension: This means that the blood vessels in the lungs are unable to relax and open.
  • Respiratory distress syndrome (RDS): Respiratory difficulty due to immaturity of lung tissues and deficiency of surfactant in the air spaces
  • Respiratory Syncytial Virus (RSV): A virus causing infections of the upper and lower respiratory tract in premmies.
  • Retinopathy of prematurity (ROP): This is seen in many premature infants. There is abnormal growth in the tiny blood vessels in the eye. The vessels have not fully developed when a baby is born prematurely.
  • Small for Gestational Age (SGA): This means a fetus or infant is smaller in size than normal for the baby’s gender and gestational age.
  • Sudden Infant Death Syndrome (SIDS): This is the unexpected, sudden death of a child under age 1 in which an autopsy does not show an explainable cause of death.
  • Urinary Tract (kidney or bladder) Infection (UTI): This is a bacterial infection of the urinary tract.
  • Ventricular Septal Defect (VSD): A hole in the wall between the two lower chambers of the heart
  • Very Low Birth Weight (VLBW): Birth weight under 1500 g

 

MEDICATION

  • Dexamethasone: This steroid is sometimes used in the treatment of chronic lung disease.
  • Diptheria, Pertussis and Tetanus. (DPT): The immunization your baby will receive against Diptheria, Pertussis and Tetanus.
  • Caffeine: Medication that stimulates breathing.

 

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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.
Unit Info

Most NICU’s allow parents to visit at any time during the day or night. Some units make the exception of no visitation during handover, since every baby has the legal right to privacy and therefore your baby’s privacy also needs to be protected. For this reason, you are only allowed to visit your own baby and take photographs or video of your own baby. Still for the same reason information regarding a baby will only be given to the parents and not to relatives, friends or even your GP.

Infection is a great risk to your little one, since she does not have the immunity yet to protect herself. There are certain measures in place to protect the babies. Some units do not allow siblings or grandparents to visit because of the risk of infection and the limited space in the unit. In all units there are a hand washing protocol and you will be informed on that, almost immediately after admission of your baby. You have to wash your hands at basins provided, every time you enter the unit and spray them with a disinfecting hand spray that you will find at your baby’s bedside. If you have an infection yourself, talk to the doctor or sister to discuss the management. You might not be allowed to visit your baby for a few days, but this is for her protection. During this time you may however phone at any time to inquire about her welfare.

You may feel very disappointed for not being able to have your baby with you. To make this easier you can do the following: you may bring a toy for your baby, but it must be new. If your baby is very small she may be over stimulated by music, therefore a quiet toy may be more applicable. You will get more information on premmie stimulation in the section on “Interacting with your baby”. Check the visiting hours for your specific unit with the unit manager and find out about the protocol regarding visits from family members such as grandparents and siblings. Also, ask the unit manager to inform you on where and when doctors can be contacted and what the protocol is on staff working with your baby. Is there a primary nurse looking after your baby or will it be different people all the time. Are you allowed in the unit during procedures performed on your baby? If this is different from your need, please discuss it with the unit manager.

Please contact the unit manager or ward secretary to get the information applicable to the unit where your baby is admitted.

ACCOMMODATION:

Mom can stay in the maternity unit until her gynaecologist discharges her. Thereafter some hospitals offer a lodging facility, which means that mom can stay in the maternity unit or another dedicated area as a “guest” and not as a patient anymore. A small fee is usually applicable for this service, since it is similar to renting a room from someone. Usually there is accommodation available close to the hospital as well. Ask the ward secretary to give you a list of the available accommodation for families of patients in the hospital and about the lodging and rooming-in policy of the hospital.

BIRTH REGISTRATION:

Every baby born in South Africa above the age of 28 weeks gestation, weighing more than 800 g and that showed any signs of life at birth, has to be registered at the Department of Home Affairs. This is an activity for the dads (if possible), because registration can be done while mom and your newborn are still in hospital. Within 25 days of your baby’s birth, you have to register her. It is important to register your baby as soon a possible, since registration with the medical aid can only be done once you have a birth certificate as proof of birth. The process is very simple. When you arrive at the offices of Home Affairs, you fill out a form for birth registration. These forms contain information such as the parents’ details and identity numbers. There is no cost to register a baby.

Online Government Services: Download the BI-154 form from the Department of Home Affairs website.

An alternative option offered by some hospitals is that you can register your baby at the hospital at a minimal cost and then you will receive the birth certificate by mail.

Private Service Providers (Little Steps only provides the links and does not support or suggest any of the services):

Bunny Hop frustration free registration (KZN and Pretoria only);

MEDICAL AID REGISTRATION

It is the parents’ responsibility to register the baby on the medical aid as soon as possible (within 3-7 days from the date of birth). WHAT TO DO?

  • Notify your medical aid of your baby’s condition.
  • Order a provisional birth certificate on the instruction form, which you must submit to your medical aid.
  • Inform them that you will call them with your baby’s ID number, as soon as you receive the birth certificate.

Your baby will receive a “Road to Health” card in the hospital at birth. This card contains information about the baby’s birth and immunisations. It is important that you receive this card on discharge and keep it safe; for no children are allowed into public schools without this prove of immunisations.

Email premmie@littlesteps.co.za
for more information