For women whose infants are born prematurely or ill however, the epicenter of their lives revolve around the NICU. This is the neonatal intensive care unit where babies are sent who are born too early, or develop problems during delivery or right after. Prematurity can occur after an early labor, or if they mother developed pre-eclampsia (high blood pressure), and sometimes after a Caesarian section.
Multiples are nearly always premature.
Not all babies who are cared for in teh NICU are premature, full term babies may unfortunately be born with heart, lung, other organ issues, or birth defects and must receive around the clock care and treatment as well. The'll get the attention they need in the NICU unit as well.
The nurses who staff these units are an exceptional group of caretakers. Their job is to nurture the growth of premature babies, and, in an often critical situation, to quickly respond to an emergency that may prevent the development of these newborns. They are an integral part of the team that must respond quickly in the first days of life so that the preemie can begin to flourish.
The nurses in NICU must deal with a number of health issues around the clock and are on the forefront of the care of these fragile babies. Even their strongest patients are still in a critical stage, where each piece of the care they receive is vital to their health.
Nurses who work in a level 4 NICU care for the babies who are the sickest. The good news is that more than 95 percent of very premature babies survive. In this unit babies as young as 24 weeks receive support, and surgery if needed. Level 3 provides care for babies born at more than 28 weeks. These caregivers observe all types of severe and fearsome health problems. Among the most frightful are:
14 Necrotizing Entrocolitis (NEC)
This medical condition is the leading cause of death in premature infants. It is an infection and inflammation of the intestine. 355 babies die from this per year. Ironically, the earlier the baby is born, the later signs of NEC appear. The symptoms are an inability to feed, bloody stools, distended abdomen and gastric problems.
The baby’s health grows worse rapidly and may cause severe intestinal damage. This occurs in preemies within the first 2 weeks after birth and up to 3 months after birth. Doctors believe it happens when the immune and digestive systems don’t form in the correct way.
Treatment for this in NICU is between 7-10 days. The baby is fed intravenously and given antibiotics. Doctors believe that the disease is much less common in babies who are breast fed.
13 Microcephaly Due To The ZIKA Virus
The Zika virus has been getting a lot of attention lately, causing the most fear among pregnant women. In February, the World Health Organization declared a global health emergency over the virus and its link to microcephaly. Zika is carried by mosquitoes and very dangerous for the unborn baby. A pregnant mother may transmit the virus via the placenta or during delivery.
Before birth, the fetus can be directly affected and birth defects such as seizures, deafness, blindness and even pregnancy loss are possible. There is a direct correlation between microcephaly where a child is born with an underdeveloped head and the Zika virus. The size of the infant’s head may be much smaller than the heads of other babies. Usually this can cause developmental issues.
In the United States, the virus was bought over from Brazil. The area most affected is Puerto Rico where there are more than 10000 cases. The virus began to spread to Florida this year.
More than 3565 cases have been diagnosed in the US in the general population, the majority in those who had traveled abroad. 3 cases of babies born with birth defects and three pregnancy losses have been recorded. Aggressive mosquito control in Florida has hopefully helped stopped the spread of the virus.
Pregnant women are advised not to travel to affected countries in Latin America and other nations.
There are no known cures for Zika, but work on 3 types of vaccinations is promising.
12 Patent Ductus Arteriosis (PDA)
Before birth, the two major arteries of the heart called the aorta and the pulmonary artery are connected by a blood vessel. Called ductus arteriosus, this vessel is vital to the circulation of
blood. When a baby is born, the vessel is supposed to close up. If it remains open, oxygen rich blood from the aorta mixes with oxygen poor blood flowing through the pulmonary artery. This places stress on the baby’s heart.
This type of medical problem is called a “congenital heart defect,” because it is present at birth. The good news is that even if the baby develops PDA, if the heart is normal the vessel can possibly shrink thereby solving the problem.
Another challenge that arises when the heart vessel does not close is to keep the ductus arteriosus open to maintain blood flow and oxygen levels in case surgery is needed to correct any other heart defect.
PDA is treated with medicine and surgery, and occurs in about 8 out of every 1000 preemies.
11 Reinopathy Of Prematurity (ROP)
A highly dangerous disease that affects vision, ROP occurs in 14-6,000 babies in the United States. Babies born before 31 weeks are at the highest risk. When a baby is born early the blood vessels on the retina are not fully developed. The retina is a light sensitive layer that lines the back of the eye. They may begin to grow so fast that the retina becomes damaged.
ROP happens when the blood vessels on the retina grow improperly and damage the retina. Sometime leakage and bleeding from the eye occurs. A retina can become detached if scar tissues are formed and pull the retina away from the back of the eye. This is the main cause of problems leading to blindness in cases of ROP.
Babies with severe ROP can have vision problems or blindness, and about 4-600 babies each year unfortunately do become legally blind from this disease.
Babies born prematurely have more risk factors for ROP, as they often have respiratory distress, slow heart rate, blood problems, heart disease and infection. A pediatric ophthalmologist is brought in to do a ROP exam if the baby is born before 30 weeks, or weighs less than 3 pounds at birth.
Even if the baby is born after 30 weeks and weighs more than 3 pounds at birth, if he displays other risk factors, a ROP test is given.
Treatments for this disease include laser surgery (which burns the scar on the sides of the retina stopping abnormal blood vessels form growing), cryotherapy, which uses a metal probe to freeze the sides of the retina so abnormal blood vessels and pulling on the retina won’t continue.
Although many babies with ROP don’t have to be treated, the sad part is that even with treatment, some babies may lose their vision, or suffer other eye problems in life such as glaucoma, which is damage to the eye’s optic nerve. The faster a baby is treated, the better the chance that blindness won’t develop.
10 Intracranial Hemorrhage (IVH)
In simplest terms, this medical emergency is bleeding within the skull. Babies who are born more than 10 weeks early are the most at risk. Their brain blood vessels are not fully developed. Babies are rarely born with it, and bleeding usually begins in the first days of life.
There are four grades of bleeding, and the highest grade-4, involves blood clots which can led to hydrocephalus, or swelling of the brain. When the brain swells, it is not getting enough oxygen. There may be no symptoms, or some in premature babies which include apnea (breathing problems), lethargy, and seizures.
Every baby under 30 weeks in NICU gets an ultrasound which screens for IVH. Another is done around the due date, that is when the baby should have been born. There is no way to stop the bleeding, but the key is to treat the symptoms the infant may be having. For instance, if there is fluid causing pressure on the brain, a spinal tap will relieve the pressure.
A blood transfusion can be given to improve blood pressure. Treatment must be given as fast as possible so that long term problems don’t develop. Less than half of these babies have further problems, but severe bleeding can lead to developmental delays.
9 Birth Defects
Most birth defects have no known cause and can happen to premature babies as well as full term infants One out of every 33 babies born each year have some sort of birth defect. These include congenital heart defects, spina bifida, and cleft lip and palate. Pre-term babies born between 24 and 31 weeks are twice as likely to have major birth defects.
Congenital heart disease is a structural defect in the heart. During pregnancy, the heart is a tube that develops into a complex structure. There are many small opening between the chambers of the heart. If there is a defect, surgical intervention may be needed soon after delivery.
Spina bifida is a birth defect where the backbone and membranes around the spinal cord do not close up. This may lead to difficulty in walking, problems with the bladder, hydrocephalus (too much fluid in the brain). Certain types of spina bifida require surgery within a day or two after birth in order to close the opening in the vertebrae.
The roof of the mouth is called the palate. This is formed between the sixth and ninth weeks of pregnancy. If the tissue that makes up the roof of the mouth doesn’t fuse completely during the pregnancy, an opening in the lip or roof of the mouth a cleft occurs. There is usually not a definite cause, though genes and environment may play a part.
Women who smoke during pregnancy or diabetes diagnosed before have an increased risk of having babies with a cleft lip or palate. Surgery is usually recommended to repair the problem within the first year of the baby’s life.
8 Infant Respiratory Distress Syndrome (IRDS)
Lung diseases is one of the most common problems in the premature infant. Babies born before 28 weeks of pregnancy are susceptible to this breathing disorder. In fact, almost all of them develop this due to the fact that the lungs are not able to make a liquid that coats the inside of the lungs called surfactant.
This liquid helps keep lungs open when the baby is born. Without it, the baby’s lungs can collapse and a lot of effort is needed to breathe. If the baby doesn’t breathe in enough oxygen, the brain and other organs can be damaged.
IRDS occurs in the first hours after birth, and some symptoms are fast breathing and heart rate, as well as blue discolored skin. Apnea, or periods when the infant stops breathing occurs. The baby’s condition may worsen before it gets better after 2-3 days. If the infant still has trouble breathing by their due date, they may have BPD or bronchopulmonary dysplasia, another lung disease.
Ironically, some of the treatments used to save the lives of RDS babies can actually cause BPD. The treatment for IRDS may start as soon as the baby is born. The surfactant is replaced, breathing is helped by a ventilator or a machine designed to help infants breathe better called NCPAP, and oxygen therapy.
Although treatments are well advanced, IRDS is the most common cause of death in the first month of life in premature babies.
7 Persistent Pulmonary Hypertension (PPHN)
The very first problem the trained nurse searches for in a premature newborn can occur as soon as a baby takes their first breath. The blood vessels in the lungs are designed to relax so that blood can freely flow through them. This is the way oxygen travels to the blood. In babies who have PPHN this dilation does not occur, which can lead to a lack of oxygen in the body.
Other complications can include brain damage and heart birth defects.
Premature babies are more at risk for PPHN, as are babies whose mothers had problems in pregnancy, such as PROM, a premature rupture of the membrane, low levels of amniotic fluid, and those who smoke while pregnant.
The main sign of PPHN is that the baby has trouble breathing, and their skin may turn bluish, which is called cyanosis. An echocardiogram can show whether there is increased pressure in the lungs.
Treatment of PPHN is based on the goal of improving the baby’s lung and heart function. A ventilator is used to help the baby breathe, and medicines to help the heart pump blood through the lungs are administered. In more serious cases, a baby is given treatment with an ECMO machine which takes over the work of the hearts and lungs for a while so that the organs can rest and heal.
6 Intraventricular Hemorrhage (IVH)
The smallest babies, the ones weighing less than 3 pounds are those most at risk for an intraventricular hemorrhage (IVH) which is bleeding in the brain. This occurs in the first four days of life because blood vessels in the brain of these babies are not fully developed, and they are extremely fragile.
Premature babies are usually born during the time when then blood vessels are still developing. Babies who have unstable blood pressure, and respiratory conditions are more susceptible to IVH.
There may be no symptoms, but the most common are breathing pauses, lethargy, changes in blood pressure. All babies who are born earlier than 30 weeks have an ultrasound of the head to screen for IVH. A second ultrasound is done around the original due date.
A full term baby will not develop IVH. There is no way to stop the bleeding except to try to stabilize the infant and treat the symptoms the baby is having. A blood transfusion may be given to improve blood count. There are four grades of bleeding, and grades 1 and 2 involve a small amount which mostly leave no long term problems.
Grade 3 and 4 are more serve and can form blood clots, increasing fluid to the brain. The baby would then be in danger of developing hydrocephalus, and other developmental delays.
When the premature baby has an infection, but his immune system hasn’t developed entirely, the body may damage its own organs and tissues while trying to fight off the infection. These infections are usually bacterial, and can be located in the lungs, brain, urinary tract and abdominal organs. Babies are at a great risk for sepsis.
Because preemies go through invasive procedures, they are more susceptible to infections caused by placing catheters or tubes on their skin which may carry bacteria from the skins surface inside the body. Bacteria can also enter the baby’s body during pregnancy labor or delivery, or if the mother has an infection herself during pregnancy.
Some symptoms are fever above 100.4 degrees, or lower than 97 degrees, fast breathing, fewer wet diapers than usual, a racing pulse. Sometimes the illness is hard to spot, and in many cases it clears up by itself.
Problems may occur because sepsis can get worse very quickly. This can lead to very low blood pressure of even organ failure. Blood and urine tests are taken, and sometimes a spinal tap to rule out meningitis, an infection around the spinal cord membrane.
Antibiotics, intravenous fluids and oxygen are the treatments given to infants.
4 Babies Born Drug Addicted
A pregnant mother who uses opiates, anything from the clearly dangerous heroin to what she may presume are “safe” prescription drugs such as codeine and Vicodin is risking the life of her unborn child.
When the baby is delivered, they begin to suffer withdrawal symptoms much as an adult would who tries to stop drug abuse. Unfortunately, the proportion of babies in the United States suffering symptoms of withdrawal has more than doubled in the last decade.
These babies require very intensive medical care as they may have central nervous system issues ranging from unstable body temperatures to seizures, tremors, and feeding problems.
The baby must stay in NICU for several weeks after birth and are given methadone in low doses, the same drug used to treat addicts in withdrawal. Methadone can successfully ease their symptoms, but later on there may be developmental problems. Mothers who use drugs are playing with the lives of their unborn children.
Very distressing to see in a newborn is a birth defect of the abdominal, or belly wall. Gastroschisis occurs early during pregnancy. A hole occurs which allows the intestines and sometimes other organs to extend outside the body, usually on the right side of the belly button.
The fact that the intestines are outside the body, not covered in a protective sac, and exposed to amniotic fluid can cause the bowel to become irritated. It can then become twisted or swell.
About 1800 babies are born in the U.S. every year with gastroschisis. The cause is usually unknown, or may be related to genes or chromosomes. Certain things in the environment, such as what the mother eats or drinks, which medicines she uses during pregnancy may be part of the reason this develops. Women who smoke or drink are more likely to have babies with this defect.
Gastroschisis can be diagnosed during pregnancy or after delivery. The treatment is surgery soon after delivery of the infant to put the abdominal organs back inside the body and repair the fissure in the abdominal wall.
Upon entering the NICU, it is not uncommon to see babies in incubators looking like they are tanning themselves in the Florida sun. They even have eye masks on, (very movie-star-ish).
In preemies, as well as full term babies, a condition commonly evaluated is a yellowish discoloration of the skin, whites of the eyes, and mucus membrane. Jaune means yellow in French. Neonatal jaundice is a symptom of a condition which causes increased level of bilirubin the blood.
Bilirubin is formed by red blood cells breaking down, is normally metabolized in the liver, and excreted from the bowels. This usually happens because the newborn’s liver is immature, or when a newborn doesn’t receive enough milk if the mother is breastfeeding.
Luckily, most cases of jaundice (also known as icteric) which are usually visible from around the second day after birth and last until day 8 in a normal birth, or around 2 weeks in premature birth are easily treatable by phototherapy, a special light treatment which helps the body get rid of the excess bilirubin. The baby lays naked under a lamp called a bili-light. Eyes are covered to protect them.
It is the more severe cases of jaundice that are worrisome. It may indicate a problem with their digestive system, or an incompatible blood type with their mother. This may cause the need for a blood transfusion, a serious procedure in a newborn.
1 Perinatal, Natal, Or Birth Asphyxia
This truly devastating medical condition results from a deprivation of oxygen to a newborn. This lasts long enough during the birth process to cause harm to the brain. The heart, liver and other organs can also be damaged but it is usually the brain that is most affected.
When a mother’s blood pressure drops during delivery, or something else interferes with the blood flow to the baby’s brain, asphyxia may occur. Inadequate circulation or impaired respiration are two other causes. 2-10 per 1000 infants born at term, and more of those born prematurely can develop asphyxia. It is estimated that 4 million neonatal deaths a year occur due to this condition.
Some symptoms of prenatal asphyxia are poor color, low muscle tone, difficulty breathing and a low Apgar score. If the infant survives through resuscitation, then they are transferred to NICU where the treatment is called ABCD.
A-airway must be opened, B- breathing established often with medical intervention, C- Circulation through chest compressions and medications, and D-Drugs to help maintain proper breathing. It is estimated that 900,000 total infants around the world die from birth asphyxia, making it the leading cause of death in newborns.