Common Problems in NICU

Common Problems of NICU

Prematurity

A full-term pregnancy usually lasts 40 weeks. When a baby is born before 37 weeks of gestation, he/ she is called premature or preterm. The Neonatal Intensive Care Unit is specially designed to care for premature and sick babies. When your baby is admitted to the NICU, the nurses and doctors monitor closely for changes in skin color, breathing, heart rate, temperature, and blood chemistry values. The baby will remain in NICU until he/ she can breathe and feed independently and is gaining weight. The mother should be comfortable and confident handling the baby and there is no medical issues prior to discharge

Nutrition

Reflex sucking is seen before 28 weeks, but a coordinated “suck-swallow-breathe” pattern usually does not occur until 34 to 36 weeks of gestational age. Until your baby can suck from your breast or a bottle, the baby is fed intravenously (called TPN) or mother’s milk and in the absence of it, a nutrient-rich formula by a naso-gastric tube or ryle’s tube (a soft, flexible tube passed through the nose or mouth into the stomach). When premature babies reach the gestational age of about 34 to 36 weeks, most can begin feeding from breast or bottle.

The best milk for all types of babies remains the mother’s milk. This has many advantages and is encouraged in all our neonatal units. If the baby is incapable of taking feeds directly from the breast for any reason, the mother is encouraged to express her  milk which is then given via a paladai or naso gastric tube.

Warmth

Premature babies have very little body fat and thinner skin than full-term babies, so they can easily become cold. Such babies are placed under a radiant warmer, which is a flat, open bed with heat lamps e in the hood. This bed allows NICU staff to monitor your baby while keeping him warm.

In infants born before 31 weeks the evaporative water loss is the route of heat loss and this has to be kept at a minimum. Such babies are usually cared for in another equipment to keep the baby warm called an incubator which is a safe and toughened plastic, enclosed bed with warmed and/or moist air or oxygen with temperature regulator.

Respiratory Distress Syndrome

Respiratory distress syndrome or hyaline membrane disease (HMD) is a condition in which the baby’s immature lungs do not produce enough of surfactant, a chemical needed to keep the air sacs of the lungs open during expiration (breathing out), which is required for exchange of oxygen (O2 ) and carbon dioxide (CO2 ). If this occurs it becomes hard for your baby to breathe and she begins to “grunt,” and breathe faster-signs which suggest the baby is struggling to breathe effectively. Because of the lack of surfactant, the lungs are “stiff” (difficult to expand). She may require additional oxygen and/ or additional surfactant.

Sepsis/ Infection

All newborn infants, especially those who are premature, are susceptible to infection because their immune systems, which provide a natural defense against infection, are not mature at birth. Hence it is easy for an infection to spread. An infection can come from the uterus, during delivery, or afterwards. In NICU precautions such as scrubbing and gowning, are essential to decreasing the risk of infection. An infection is generally treated with a group of medicines called antibiotics for a specified duration.

Effective handwashing is a single most important intervention which has shown to reduce the incidence of infection. All our units follow strict handwashing protocol and the same is expected of parents when they visit the NICU

Apnea, Bradycardia, Cyanosis (ABC)

While still inside the womb, a baby receives all his oxygen through the umbilical cord. At birth, he has to start breathing for himself. Because his brain is still maturing, he sometimes “forgets” to breathe. If this period of not breathing is 20 seconds or longer, it is called apnea and his heart often begins to slow down. This slow heartbeat is called bradycardia if the baby’s heart rate drops below l00 beats per minute for any length of time associated with apnoea. Sometimes the baby’s skin takes on a bluish tinge, especially around the eyes and mouth. This is referred to as cyanosis.
 

Neonatal Jaundice

Jaundice means yellow discoloration of the skin and eyes. There are various reasons for jaundice but nearly all newborn babies become jaundiced after 2 or 3 days of life. Your doctor will keep a watch on it by doing blood tests. If jaundice occurs too early or if it is very high, it is necessary to find the reason. Jaundice is generally treated with phototherapy, where the baby is placed under a special blue colored light till the bilirubin levels improve.

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