Useful Neonatal Info. Glossary.

About premature babies.

Links.

Heart Murmur

The word murmur describes an extra, swishing sound made as the blood flows through any of the heart's chambers or valves. A murmur is heard through a stethoscope as the heart beats. Because a child's heart is very close to the chest wall, subtle noises can be heard more easily. Many factors may cause murmurs in children, and the condition is usually benign. It is estimated that at least 85 percent of babies will have a murmur during the first 24 hours after birth. This is caused by the normal closure of a blood vessel and usually goes away within 48 hours. Older children also develop heart murmurs, but the vast majority are benign and will tend to come and go, although up to 15 percent will retain this sound into adulthood. These are termed innocent murmurs. It is felt that the sounds are caused by the eddies that form from the blood being squeeezed out of the heart. In other words, these murmurs are caused by turbulence of blood flow -- not by a defect in the heart -- and are of no significance except to cause anxiety in the parent.

Why do babies cry?

Babies cry for the same reason adults talk — to communicate. Crying is the only way for infants to tell us when something is wrong. But while the baby may know what’s wrong, it’s often more difficult for new parents to decipher the meaning of their baby’s cries. As your baby grows, you will learn to recognize and differentiate among her various cries. Newborns sometimes cry up to four hours a day, and each cry can send a different message.

I'm in pain
Generally unmistakably loud and sudden, with long high-pitched shrieks followed by a pause and then a wail. If you are unable to find a minor cause, you should call your healthcare provider immediately if this type of crying persists and the baby is inconsolable.

I have gas
Gas is very common in infants, affecting more than half of all newborns. Gas bubbles can cause discomfort, making baby cry and stopping them from sleeping. Many infants with gas will also pull their legs up, lying in a curled position to help relieve their discomfort. Infants' MYLICON® Drops can provide safe, effective relief for your baby by gently breaking up the gas bubbles.

I'm lonely or bored
Often your baby’s coos will turn to a wail if she doesn’t get the attention she wants or needs. Rest assured that no amount of love, cuddling, hugging, and caring will spoil your baby in the first six months, so go ahead and pick her up.

I’m tired or uncomfortable
If your baby’s cries are whiny, nasal, and continuous, chances are she’s overtired, about to have a bowel movement, too warm, too cold, or otherwise uncomfortable.

I just need to cry
If your baby is "good" all day, sometimes she just needs to release energy by crying. This usually occurs at the end of the day, or the "witching hour."

I’m cranky
Some babies are just fussy by nature. Irritable crying varies in duration and occurs randomly, without an apparent cause.

Mastitis

Mastitis is an infection of the breast. It usually only occurs in women who are breastfeeding their babies. The most common bacteria causing mastitis is called Staphylococcus aureus. In 25-30% of people, this bacteria is present on the skin lining normal, uninfected nostrils. It is probably this bacteria, clinging to the baby's nostrils, that is available to create infection when an opportunity (crack in the nipple) presents itself. Usually, only one breast is involved. An area of the affected breast becomes swollen, red, hard, and painful. Other symptoms of mastitis include fever, chills, and increased heart rate.The antibiotics dicloxacillin and erythromycin are both used to treat mastitis. Breastfeeding should be continued, because the rate of abscess formation (an abscess is a persistent pocket of pus) in the infected breast goes up steeply among women who stop breastfeeding during a bout with mastitis. Most practitioners allow women to take acetaminophen while nursing, to relieve both fever and pain. As always, breastfeeding women need to make sure that any medication they take is also safe for the baby, since almost all drugs they take appear in the breastmilk. Warm compresses applied to the affected breast can be soothing. Prognosis for uncomplicated mastitis is excellent. About 10% of women with mastitis will end up with an abscess within the affected breast. An abscess is a collection of pus within the breast. This complication will require a surgical procedure to drain the pus. The most important aspect of prevention involves good handwashing to try to prevent the infant from acquiring the Staphylococcus aureus bacteria in the first place. Read more about mastitis on this external web page.

Synagis and other Immunizations

Preemies discharged between early Fall and late Spring usually get their first dose of Synagis before going home. Synagis protects them against RSV (respiratory syncitial virus). It is usually given only to preemies born at less than 32 weeks gestation or those born at 32 to 35 weeks if they have other risk factors, such as chronic lung disease. Synagis is given again later as monthly shots in the pediatrician’s office or a special clinic until the end of RSV season in early Spring.

You can read an article about Immunizations for Preemies from Preemie Magazine by clicking here, and consult the official Childhood Immunization Schedule by clicking here.

Reflux

Being a baby means spitting up now and then. But some babies spit up or throw up more than usual, and they are said to have gastroesophageal reflux – or reflux, for short. What happens when babies have reflux? They swallow their food, and it travels normally down their esophagus into the stomach. But while their stomachs are churning away, the lower esophageal sphincter opens, letting some of the food escape back up the esophagus. Sometimes, but not always, it goes all the way out of the mouth. All babies (in fact, all adults, too) have some reflux. Research shows that healthy infants have about 24 episodes of reflux in 24 hours. Reflux is only characterized as problematic when someone has too much of it, or it causes other complications. If there’s no anatomic abnormality, reflux will almost always eventually go away on its own. Babies reflux will probably get better by around six months of age, and disappear by age one or two.

Preparing for Discharge

The discharge of a preemie from the hospital isn't a single event, but a process. That process is designed to assure the medical staff that the infant can survive and thrive outside the hospital, and it prepares parents to take care of the baby on their own.

Some nurseries send infants home on apnea monitors if the infants have mild apnea that does not cause a change in color or heart rate or require stimulation to make the baby breathe again. Doctors will decide if your baby needs a monitor; if so, anyone who will be alone with the infant at home will need to attend a training session on using the monitor and learn how to perform infant cardiopulmonary resuscitation (CPR).

One of the most common reasons for a preemie to go home with a monitor is that she's otherwise ready to leave the hospital, but is still having episodes of apnea or bradycardia. Although apnea of prematurity usually disappears by the time preemies are 36 to 38 weeks of gestational age, occasionally it persists even after their due date. Other reasons a home monitor may be recommended include: apnea due to other causes such as reflux or seizures; the baby has had an apparent life-threatening event; the baby needs home oxygen; the baby has a tracheostomy tube. Home monitors sound an alarm if the baby stops breathing for more than a certain number of seconds or her heart rate is too fast or too slow.

Gastroenterologist

Gastroenterologist - (also know as GI doctor) a medical doctor who specializes in diagnosing and treating people with diseases of the gastrointestinal tract, the stomach, and the intestines.

Typical Medecines Used for Preemies:

Zantac is in a group of drugs called histamine-2 blockers. It works by reducing the amount of acid the stomach produces. It is used to treat and prevent ulcers in the stomach and intestines. It also treats conditions in which the stomach produces too much acid, such as Zollinger-Ellison syndrome. Zantac also treats gastroesophageal reflux disease (GERD) and other conditions in which acid backs up from the stomach into the esophagus, causing heartburn.

Reglan increases the rate at which the stomach and intestines move during digestion. It also increases the rate at which the stomach empties into the intestines and increases the strength of the lower esophageal sphincter (the muscle between the stomach and esophagus). Reglan is used to treat diabetic gastric stasis (slow movement of the stomach), which causes symptoms such as nausea, vomiting, heartburn, decreased appetite, and prolonged fullness after eating. It is also used to treat gastric reflux or heartburn (the regurgitation of stomach acid into the esophagus), prevention of postoperative nausea and vomiting, prevention of nausea and vomiting associated with cancer chemotherapy, facilitation of small bowel intubation, and to facilitate x-ray examination of of the stomach and intestines.

Poly-Vi-Sol Multivitamin Supplement Drops provide an excellent source of 9 vitamins. Read about it here.

NPO:

Abbreviation for nothing by mouth (from the Latin Nil per os or Nihil per os).

Corrected Age:

Actual age - Number of weeks premature = Corrected age. A baby who arrives early has two crucial dates that you can use for measuring her progress. One is the day she was born, the other is her official due date, when she would have been in the uterus for around 40 weeks. The time that has elapsed from the first date is her actual age: the time from the second date is her corrected age. When you are looking at what your baby is able to do (her development progress) you need to think about both these dates. Especially, in the first year, the gap between them can make a great deal of diffirence to how quickly she matures, what she can cope with, and when. After the first year, the gap usually become increasingly less obvious, as most premature children tend to catch up in their second or third years. All babies, including term babies, have their own personal timetables, and these can vary a good deal.

Some facts: Premature/preterm/prem baby is a baby born before spending 37 weeks in the uterus. Gestational age(GA) isthe amount of time your baby has spent in the uterus. If she is 25 weeks gestational age she has spent 25 weeks growing in the uterus. This means she is about 15 weeks early, as most babies arrive between 38 and 41 weeks GA. Extremely premature: born having spent 24 to 28 weeks in the uterus. Very premature: born having spent 29 to 34 weeks in the uterus. Moderately premature: born having spent 35 to 37 weeks in the uterus.

Low birthweight baby is a baby who weighs less than 5 1/2 pounds (2500g) at birth. Most premature babies are also low birthweight. However, the two terms do not mean the same thing, because some babies can spend all 40 weeks in the uterus, but still be smaller than usual when they arrive. Very low birthweight baby is a baby born weighing less than 3 1/3 pounds (1500g). Extremely low birthweight baby: a baby born weighing less than 2 1/4 pounds (1000g). Term baby: a baby who has spent the full amount of time developing in the uterus - between 38 and 41 weeks. Viability limit: how early a premature baby can be born and still live. Different hospitals have slightly different limits for the age at which they feel a premature baby can be helped. Although a very few babies have survived after being born at 22 weeks, viability limits usually fall somewhere between 23 and 25 weeks. Read about an exception.

A Preemie's Feeding Journey:

A young preemie’s feeding journey usually proceeds through three steps:

  1. Parenteral nutrition, meaning that it bypasses the baby’s digestive system and goes directly into his bloodstream, through an IV or other catheter;
  2. Gavage feedings, in which a baby is fed breast milk or formula through a tube that goes from his mouth or nose into his stomach;
  3. Drinking from a nipple – breastfeeding and/or bottle feeding.
Gavage is a French word meaning “cram” or “stuff”. Gavage feeding involves a very small, soft tube going through your baby’s mouth or nose, down to his stomach. An OG tube (which goes through the mouth and stands for oro-gastric) is generally preferred because babies breathe through their noses. An NG tube (which goes through the nose and stands for naso-gastric) is good for some older preemies who have a strong gag reflex, and for those who are already nippling or breastfeeding, but need extra calories through gavage. Insert a gavage tube through a baby’s mouth or nose is a painless procedure that usually doesn’t bother preemies at all. The nurse slides the gavage tube down the back of the baby’s throat, down his esophagus, and into his stomach. She secures the tube in place by taping it under his nostril, or beside his mouth. When it’s a mealtime, the nurse connects a plastic syringe to the baby’s gavage tube, pours in the right amount of breast milk or formula, gives the plunger one gentle push, and lets the liquid flow down into the tube by grativity. Sucking on a tiny pacifier, while he’s being gavage fed, can help a preemie rehearse for the next step on his feeding journey, nipple feeding.

Anemia:

All infants become anemic (develop a shortage of red blood cells) during their first two to three months of life, because natural secretion of EPO (erythropoietin, a hormone that stimulates the production of red blood cells) temporarily falls – causing a slow-down in the creation of new red blood cells. A newborn will become gradually more anemic, until her red blood cells reach a low enough level to switch back on the secretion of erythropoietin. It’s a natural cycle that doesn’t cause any problems in most full-term newborns and a lot of preemies. Your baby’s doctor will monitor her hemoglobin (the substance in red blood cells that carries oxygen) and hematocrit (the concentration of red blood cells in her blood), to make sure they don’t fall too low – and that she starts producing new red blood cells when she should. But the natural cycle is more pronounced and lasts longer in preemies. That’s because small preemies grow very rapidly, and need to make a lot more blood to keep up with their increasing body size. At the same time, their red blood cells are depleted by frequent blood draws, and their levels of erythropoietin are lower than in term babies. In fact, this early anemia is so universal in preemies that it has been dubbed "anemia of prematurity".

Blood Transfusion:

During their first days of life, many preemies, especially while on ventilators or receiving intravenous nutrition, have blood drawn frequently to monitor their blood chemistries. All of these draws deplete the number of circulating blood cells. Because a premature baby’s bone marrow, which is responsible for making blood cells, is still immature, it usually can’t replace them fast enough. As a result, he develops anemia (a low number of red blood cells). Red blood cells deliver oxygen throughout the body, so without enough of them, a baby’s tissues won’t get the oxygen they need to function and grow. If anemia isn’t treated soon enough, it can be dangerous, but fortunately, one or more blood transfusions can easily solve this problem.

Meconium Plug Syndrome:

Meconium obstruction of prematurity is a distinct clinical condition that occurs in very low birth weight infants, predisposing them to intestinal perforation and a prolonged hospitalization if not diagnosed and treated promptly. Clatworthy et al first described meconium plug syndrome in 1956 as "intestinal obstruction due to the inability of the colon to rid itself of the meconium residue of 9 months of fetal life".

Thrombocytopenia:

Thrombocytopenia is commonly observed in very low birth weight (VLBW) neonates with sepsis. It is an abnormal decrease in the number of platelets in circulatory blood. Thrombocytopenia is the most common hemostatic abnormality in newborn admitted to Neonatal Intensive Care Unit. The early diagnosis of Neonatal Thrombocytopenia and assessment of the underlying primary pathologic process play an important role in reducing the risk of life-threatening complication of neonatal thrombocytopenia.

Apnea:

Premature babies and babies with other medical conditions sometimes do not breathe regularly. A baby may take a long breath, then a short one, then pause for 5 to 10 seconds before starting to breathe normally. This is called periodic breathing. It usually is not harmful, and the baby will outgrow it. However, premature and sick babies also may stop breathing for 15 to 20 seconds or more. This interruption in breathing is called apnea, and it may be accompanied by a slow heart rate, also called bradycardia. Babies in the NICU are constantly monitored for apnea and bradycardia (often called “A’s and B’s”).

Sometimes, if it’s very mild, apnea of prematurity isn’t treated at all. Some babies have more frequent or severe episodes of apnea, when they need more vigorous stimulation or extra oxygen. Very young preemies, who are more prone to apnea, are often put on medication early, even before they have severe episodes of apnea, as a preventive measure.

There are two common medications for apnea: caffeine and a drug called theophylline (or aminophylline), which babies metabolize into caffeine. Although it’s a startling thought – your newborn being given a double espresso, hold the cup – caffeine is very effective at stimulating respiration, which is just what your baby needs. (Once her apnea of prematurity goes away, the medication will be stopped, and she’ll lose her caffeine privileges).

It will be a few years before your preemie learns the ABC’s. But she may be quite familiar already with A’s and B’s – of the NICU variety. The expression A’s and B’s is shorthand for episodes of apnea (a pause in breathing) and bradycardia (a slow heart rate), two of the most common problems of premature babies. These episodes frighten parents, and keep nurses busy attending to all the beeping alarms. But doctors only worry about them if there’re unusually severe, or if they appear to be a sign of some underlying illness. Most of the time is that your preemie’s control of her breathing is immature.

What causes apnea in premature babies? The complex physiological system that regulates everyone’s breathing and heart rate is not yet fully developed in preemies. Sometimes, the immature respiratory center in your preemie’s brain may forget to send a signal to breathe – and breathing movements stop. Other times, her brain may remember to send the signal to breathe, and her chest will move as it should, but the muscles that are supposed to keep her upper airway open become lax – so airflow to the lungs stops. The failure to send the signal to breathe can be brought on by deep sleep, or a lack of oxygen. Apnea may be triggered by stress – resulting from common procedures, like suctioning mucus from the baby’s airways, or from a change in temperature, as when she’s placed on a cold scale to be weighed. Apnea can even happen in response to seemingly normal action like feeding, having a bowel movement, stretching, or excessive bending of the neck.

Jaundice:

Jaudice itself does not usually cause harm to a baby. However, a very high bilirubin level can result in more serious problems, especially for premature babies. For this reason, the baby’s bilirubin level is checked frequently. If it gets too high, he will be treated with special blue lights (phototherapy) that help the body break down and eliminate bilirubin.

Sepsis:

This is a potentially dangerous infection of the bloodstream which indicates that a germ is present which the baby has difficulty fighting off. Certain lab tests, cultures, and X-rays can help diagnose this condition, which is considered when a baby demonstrates certain symptoms, such as temperature instability or irregular blood sugars. The condition is treated with antibiotics, and the baby is monitored closely for an improvement in symptoms.

X-rays:

X-rays provide pictures of a baby’s lungs, bones and other internal organs. These pictures help the baby’s doctor plan her treatment and monitor her progress. A baby may receive several lung x-rays each day if she has serious breathing problems. She will be exposed to a little radiation from these x-rays. The amount is so low it should not affect her health now or in the future. The baby will not need to be moved to the radiology department for this test; it is done right at her incubator.

Feeding:

Premature infants, especially those less than 1250 gm at birth are extremely difficult to feed. For unknown physiologic reasons oral feeding also called enteral feeding is not well tolerated in these immature babies. Because of this challenge these infants require intravenous fluids solution called parenteral nutrition (TPN). Intravenous nutrition is inadequate because it cannot supply sufficient calories for growth both of body and brain. The composition of intravenous nutrition is also toxic to the liver. In premature infants feeding tolerance is limited due to immaturity of gastrointestinal tract. Motor patterns of the gastrointestinal tract differ greatly in preterm infants as compared to adults. These differences in gastrointestinal motor function in premature neonates translates into less efficient gastric emptying and slower intestinal transit time. It usually manifests as residual feeds in the stomach prior to the next scheduled feeding and may be associated with abdominal distention, bile-staining aspirates, or lack of stooling. In most instances the gastric residuals are benign and relate to immature gastrointestinal motility, however they may also be an early indication of bowel obstruction, ileus or necrotizing enterocolitis. Thus, feeding intolerance often leads to temporary cessation of feeds, and prolongs the time to reach full feeds, as well as the time on parenteral nutrition (which predisposes the infants to nosocomial infection, hepatic dysfunction), and prolonged hospitalization.

Central line:

An intravenous line inserted into a vein, often in the arm, and threaded from there into a larger vein in the body close to the heart. Used to deliver medicines or nutritional solutions that would be irritating to smaller veins. That's how they feed her Intravenous line: Most premature and sick babies cannot be fed immediately, so they must receive nutrients and fluids intravenously (through a vein). A doctor or nurse will insert a very small needle or tube into a tiny vein in the baby’s hand, foot, arm, leg or scalp. It is taped in place, and attached to a thin plastic tube (IV line), which goes to an IV pump connected to a pole next to her incubator. A baby also can receive medications and blood through the IV line.

Being a Preemie Parent:

No one asks to be a preemie parent. It's an experience that changes your life forever. It can be scary at times, and has its ups and downs. But it's also extremely rewarding, because we know first-hand just how precious life is. As Albert Einstein once said: "There are two ways to live your life. One is as though nothing is a miracle. The other is as if everything is."

Preemie’s development chart:

Since preemies are born earlier, their development is different than full-term babies. You need to subtract the number of months born before term to get a corrected age for a preemie. However, your preemie can catch up faster with full-term babies, if you help them with some of these suggestions:
1. Provide smarter milk
2. Provide smarter food
3. Wear your baby in a carrier
4. Talk more to your baby
5. Read to your baby
6. Play with your baby
7. Play music to him

Right: Birth Weight
Data: Months Below:Perfomance		 Up to 1500 grams (3lbs5oz) Up to 1750 grams (3lbs14oz) Up to 2000 grams (4lbs7oz) Up to 2500 grams (5lbs8oz)
Lifts and holds head lying on the tummy 3-4 2.5-3 2-2.5 1-2
Holds eye contact 2-3 2-2.5 1-2 1-1.5
First smile 3-4 2-3 2-2.5 1-2
Responds on a smile and talk of a parent 4-5 3.5-4.5 3-4 2-3
Holds the head and holds eye contact, studies faces 5-6 5 4 3-4
Starts mumbling 6 6 5.5 4.5
Turns head to sound 5-6 4-5 4-4.5 3-4
Loud laughing 6 5.5 5 4.5
Grasps hanging toys 6 6 5 4.5
Finds not visible source of the sound 6 6 5-5.5 4.5
Distinguishes close people from strangers 6.5 6 6 5.5
Starts crawling on the tummy 8-8.5 7.5-8 6.5-7 6-6.5
Mumbles more 7.5 7 6 5.5
Turns to the tummy 7.5 7 6.5 6
Turns from the tummy to the back 8-8.5 7.5-8 6.5-7 6-6.5
Transfers toys from one hand to the other. Has more accurate reach and grab 12.5 12 11.5 11
Takes a toy if offered by a parent 6.5-7 6.5 6 5.5
Easily grabs a toy from different positions 7.5-8 7.5-8 7 6-7
Begins babbling 8 7.5 7 6-7
Babbles more, may begin to say words (e.g., “ma-ma”,”da-da”) 9.5-10 8.5-9 8-8.5 8
Feeds self, holding bottle or cup to drink 9.5-10 9.5 9 8
Crawls well 10-11 10 9 8.5
Finds an object if asked “where?” 11.5-12 10.5-11.5 10-11 9-10
Plays with toys for a long time 10 10 9 8.5
Sits by self 11-12 10-11 9-10 9
Pulls self up to stand 11-12 10-11 9-10 9
Plays with toys in different ways: swinging, switching from hand to hand 11.5 11 10.5 9.5-10
Repeats words after adults 13-13.5 13 11-12 11-12
Stands with support 11-12 10-11 9-10 9
Stands by self 12-13 11.5-12 11-11.5 11-11.5
Cruises holding on to furniture 12.5-13 11-12 10-11 10
Climbs into a chair and back 13-14 12-13 11-12 10-11
May say a few intelligible words (e.g., “ba” for ball after the first year after the first year after the first year after the first year

 

Info courtesy of www.francesca07.com

End of Useful Info Page.

© 2007 Francesca Maria.


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