Medical Procedures

Every baby admitted to a NICU requires special treatment, whether it is something as simple as a humidicrib to keep warm, or as complex as a ventilator to help with breathing. Because of these special needs, each baby will require a number of medical procedures and treatments to help determine how they should be treated and to monitor their progress.

Many of these procedures are explained below:

• Administration of IV fluids: These fluids consist of glucose, salt, protein, vitamins and fats (lipids) and all the chemicals that are needed to balance our body. These fluids are essential for the progress of your baby while he or she is unable to feed. They run through the intravenous lines into the baby’s bloodstream.
• Arterial line: This is a similar procedure to the drip, except that an artery is used instead of a vein. It is more difficult and takes longer to insert. This small tube is inserted for the purpose of checking blood pressure continuously or blood sampling.
• Blood testing: This is one of the most frequent procedures done in the NICU. Blood can be sampled through arterial lines or umbilical lines, or from a heel prick or vein puncture. Close monitoring of your baby’s blood is very important and can alert medical staff to potential problems before they become more serious. Your baby may have a blood test upon admission to check their blood gases to see whether they need additional oxygen, mechanical ventilation and/or sugar to maintain a normal level in the body.
• Blood transfusions: These are often necessary, especially in premature babies, to maintain a safe level of haemoglobin. Adult donor blood is processed in the blood bank after it has been tested negative for several viruses including HIV, hepatitis and cytomegalovirus (CMV).
• Endotracheal intubations: A tube is inserted through the baby’s nose or mouth into the main airway (trachea or windpipe) to help the baby to breathe. The tube is then taped firmly to the baby’s face to ensure that it does not dislodge. If this tube becomes blocked (or if the baby pulls it out), it may need to be replaced. When the tube is in place, the baby will make no sounds, even when he or she looks like they are crying.
• Eye checks: The eyes are at risk in very small premature babies. As these babies approach their due date or if they are more than 28 days old, their eyes are routinely checked by an ophthalmologist for any evidence of damage. Before the examination, eye drops will be placed in the eyes so the doctor can see the retina (back of the eye) and determine if the blood vessels are developing normally.
• Head ultrasounds: Premature babies are at risk of bleeding in the brain and this can be detected by ultrasound scans of the baby’s brain. This is similar to scanning, which most women have during pregnancy, and is painless and harmless. It does not involve radiation.
• Hearing test: Your baby will have a hearing test either before they leave hospital or after discharge. It is important that you attend this appointment as premature babies and babies who have been very sick have an increased risk of hearing loss. Results of the hearing test will be discussed by appropriate personnel and follow-up reviews may be organised if your baby does not immediately pass in one or both ears.
• Infection screens and antibiotics: If your baby is unwell and it is possible that an infection is present, a screen is performed, which can include blood tests, testing urine for infection, a lumbar puncture and a chest X-ray (looking for pneumonia). While waiting for the results, antibiotics will usually be started and if no infection is found, they may be stopped.
• Intercostal drain insertion: Sick babies can experience a condition called pneumothorax. This is a life-threatening and potentially dangerous condition caused by the escape of air from the baby’s lungs into the chest cavity. A small, flexible plastic tube can be placed into the baby’s chest cavity to remove trapped air or fluid, allowing the lungs to expand. This tube is generally removed after a couple of days.
• Intravenous line or drip: This is the insertion of a drip needle (cannula) into the vein and can be difficult and time consuming. These are usually put into a vein in the arms or legs, but may be put into veins on the scalp. If your baby is old enough, pain relief with sucrose can be provided during this procedure.
• Lumbar puncture: Meningitis is a risk for babies and can only be diagnosed by a lumbar puncture examination. A needle is used to withdraw a small amount of cerebrospinal fluid from below the spinal cord on the lower back and samples are sent for testing.
• Magnetic Resonance Imaging (MRI): This is an imaging technique that uses magnets and computers to produce a detailed picture of tissue, which may be difficult to see on an X-ray or ultrasound.
• Mechanical ventilation: A ventilator is a machine that delivers measured breaths and oxygen through an endotracheal tube. It may take over the baby’s breathing completely or help support the baby’s own breathing efforts. The amount of oxygen, air pressure and number of breaths per minute can be regulated to meet each baby’s individual needs.
• Medication administration: Most babies will require various medications during their time in the NICU.
• Newborn screening test: A blood test is used to detect hypothyroidism, galactosaemia, phenylketonuria and cystic fibrosis. It can assist with the early diagnosis of over 30 different congenital metabolic disorders. In Australia, this test is performed from two to four days of age; a few small drops of blood are collected onto a special absorbent paper and then sent for testing. If your baby is born very early or is small at birth, this may be repeated again at 28 days of age.
• Other ultrasounds: Other organs apart from the brain (e.g. the heart and kidneys) can be scanned by ultrasound. Ultrasound scans of the heart are called echocardiograms.
• Phototherapy: Light is beamed onto the baby’s skin to reduce the severity of jaundice. The eyes are usually protected with cloth eye shields and your baby may be put into a humidicrib while phototherapy is being used.
• Tube feeding: A form of feeding where a small plastic tube is passed through the nose or mouth into the baby’s stomach. Milk and medications are given directly into the baby’s stomach.
• Umbilical line: Small tubes are inserted into the vessels that enter the baby at the umbilical cord. These can be used instead of intravenous lines for the first week of life.
• Urine tests: Like blood tests, urine tests can tell a great deal about a baby’s overall health and condition. Urine tests can help determine how well the kidneys are functioning and whether your baby has an infection. They may be collected by cotton balls in the nappy, a small plastic bag placed over the genitalia, a catheter in the bladder or a direct bladder tap, where a small needle is inserted into the bladder and removed immediately afterwards.
• Weighing: Your baby is weighed soon after delivery, and then regularly during their NICU stay. During the first week it is possible that your baby may lose some weight; this is normal especially for very small babies.
• X-rays: X-rays of the chest are necessary if your baby is on a ventilator or having trouble breathing. Many babies need more than one X-ray if their condition changes. X-rays can also be used to check for problems in the baby’s abdomen, bone structure or to check that tubes and intravenous lines are in the right position.