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Breastfeeding Overview Giving birth to a premature or other high-risk baby (or babies) does not mean you cannot breastfeed. Actually, the opposite may be the case. There is even more reason to provide your own milk for, and eventually breastfeed, a premature or a sick newborn. Providing your milk for your baby lets you participate in your baby's healthcare in a very crucial way. Because the benefits of mother's milk are so important to the high-risk newborn, you are able to do something for your baby th...

Apnea of Prematurity What is apnea of prematurity? Apnea is a term for the absence of breathing for more than 20 seconds. It can occur in full-term babies, but is more common in premature babies. The more premature the baby, the greater the chances that apnea will occur. Apnea may be followed by bradycardia - a decreased heart rate. When breathing slows, the heart rate also slows. A common term for apnea with bradycardia is "As and Bs." What causes apnea of prematurity? Apnea of prematurity may be due t...

Newborn Complications There are several newborn complications that may occur and require clinical care by a physician. Listed in the directory below are some, for which we have provided a brief overview. Birth Defects Birth Injuries Jaundice Hypoglycemia Transient Tachypnea of the Newborn Thrush

When a Baby Has Difficulty After Birth All the baby's body systems must work together in a new way after birth. Sometimes, a baby has difficulty making the transition. Health assessments, including the Apgar test performed right after birth, can help determine if a baby is doing well or having problems. If there are signs the baby is not doing well, treatment can be given right in the delivery room. The physician and other members of the healthcare team work together to help the baby clear excess fluid ...

Blood Glucose - Hypoglycemia What is hypoglycemia? Hypoglycemia is a condition in which the amount of blood glucose (sugar) in the blood is lower than normal. What causes hypoglycemia? Hypoglycemia may be caused by conditions that: lower the amount of glucose in the bloodstream prevent or lessen storage of glucose use up glycogen stores (sugar stored in the liver) inhibit the use of glucose by the body Many different conditions are associated with hypoglycemia, including the following: inadequate matern...

Delayed or Not Enough Milk Production When milk production is delayed or not enough: A delay in the time when milk "comes in" sometimes occurs after the birth of a high-risk baby. Also, it is not unusual to experience a drop in the amount being pumped after several weeks. A drop may be gradual or it may occur suddenly. Do not wait to get help if milk production is ever a concern. The sooner you intervene, the better. Ask a certified lactation consultant (IBCLC - International Board of Certified Lactatio...

Heart Disorders There are many heart disorders that place a newborn at higher risk and require clinical care by a physician or other healthcare professional. Listed in the directory below are some, for which we have provided a brief overview. Blood Circulation in the Fetus and Newborn Patent Ductus Arteriosus (PDA) Congenital Heart Disease

Hemolytic Disease of the Newborn What is hemolytic disease of the newborn (HDN)? Hemolytic Disease of the Newborn is also called erythroblastosis fetalis. This condition occurs when there is an incompatibility between the blood types of the mother and baby. "hemolytic" means breaking down of red blood cells "erythroblastosis" refers to making of immature red blood cells "fetalis" refers to fetus What causes hemolytic disease of the newborn (HDN)? HDN most frequently occurs when an Rh negative mother has...

Hernia (Umbilical / Inguinal) What is a hernia? A hernia occurs when a section of intestine protrudes through a weakness in the abdominal muscles. A soft bulge is seen underneath the skin where the hernia has occurred. In babies, a hernia usually occurs in one of two places: around the belly-button in the groin area A hernia that occurs in the belly-button area is called an umbilical hernia . A hernia that occurs in the groin area is called an inguinal hernia . What causes a hernia? A hernia can develop...

Topic Index The Neonatal Intensive Care Unit (NICU) Assessments of Newborn Babies Caring for Babies in the NICU Common Conditions and Complications Parenting in the Neonatal Intensive Care Unit (NICU) Breastfeeding the High-Risk Newborn Taking Your Baby Home Glossary Every family looks forward to the birth of a healthy newborn. It is an exciting time with so much to enjoy. In some cases, though, unexpected difficulties and challenges occur along the way. Some newborns are considered high risk. This mean...

Human Immunodeficiency Virus (HIV) What is human immunodeficiency virus (HIV)? Human immunodeficiency virus (HIV) causes acquired immune deficiency syndrome (AIDS), which kills or impairs cells of the immune system and progressively destroys the body's ability to fight infections and certain cancers. The term AIDS applies to the most advanced stages of an HIV infection. How is HIV spread? HIV is spread most commonly by sexual contact with an infected partner. HIV may also be spread through contact with ...

Hyaline Membrane Disease / Respiratory Distress Syndrome What is hyaline membrane disease? Hyaline membrane disease (HMD), more commonly called respiratory distress syndrome (RDS), is one of the most common problems of premature babies. It can cause babies to need extra oxygen and help breathing. The course of illness with hyaline membrane disease depends on the size and gestational age of the baby, the severity of the disease, the presence of infection, whether or not a baby has a patent ductus arterio...

Hydrocephalus What is hydrocephalus? Hydrocephalus is a condition in which there is a lack of absorption, blockage of flow, or overproduction of the cerebral spinal fluid (CSF) that is found inside the ventricles (fluid-filled areas) of the brain. This may result in a build up of fluid that can cause the pressure inside of the head to increase and the skull bones to expand to a larger-than-normal appearance. What causes hydrocephalus? Click Image to Enlarge Hydrocephalus occurs in approximately one out ...

Hydrops Fetalis What is hydrops fetalis? Hydrops fetalis is a severe, life-threatening problem of severe edema (swelling) in the fetus and newborn. It is also called hydrops. There are two types of hydrops: immune - results when the mother's immune system causes breakdown of red blood cells in the fetus. This is the most dangerous problem of blood group incompatibility between the mother and baby. non-immune - the most common type; can result when diseases or complications interfere with the baby's abil...

Hyperbilirubinemia and Jaundice What is hyperbilirubinemia? Hyperbilirubinemia is a condition in which there is too much bilirubin in the blood. When red blood cells break down, a substance called bilirubin is formed. Babies are not easily able to get rid of the bilirubin and it can build up in the blood and other tissues and fluids of the baby's body. This is called hyperbilirubinemia. Because bilirubin has a pigment or coloring, it causes a yellowing of the baby's skin and tissues. This is called jaun...

Hypocalcemia What is hypocalcemia? Hypocalcemia is a condition in which there is too little calcium in the blood. A common form of hypocalcemia in babies is called neonatal hypocalcemia. This condition may occur at different times with different causes, including the following: early hypocalcemia - occurs in the first three days of life. late hypocalcemia - develops between the fifth to tenth days of life, usually after several days of formula feedings. Some formulas have high levels of phosphate which ...

Hypospadias What is hypospadias? Hypospadias is a malformation that affects the urethral tube and the foreskin on a male's penis. The urethra is the tube that carries urine from the bladder to the outside of the body. Hypospadias is a disorder in which the male urethral opening is not located at the tip of the penis. The urethral opening can be located anywhere along the urethra. Most commonly with hypospadias, the opening is located along the underside of the penis, near the tip. What causes hypospadia...

Infection in Babies Fighting infectious diseases today is much easier than in the past. Proper hygiene and proper precautions, along with numerous vaccines and rapidly advancing medical technology, help prevent many infections. However, a newborn baby has limited ability to prevent and fight infectious diseases. Special care may be needed for babies who develop an infection before, during, or after birth. Prevention is the key to fighting many infectious diseases. At any time of life, but especially dur...

Intravenous Line and Tubes Because most babies in the NICU are too small or sick to take milk feedings, medications and fluids are often given through their veins or arteries. Babies may also need frequent lab tests and measurements of blood oxygen levels. There are several ways a baby may receive fluids and medications and have blood drawn without additional needle sticks, including the following: intravenous line (IV) Babies may have an IV placed in a hand, foot, or scalp, where veins are easily acces...

Large for Gestational Age (LGA) What is large for gestational age (LGA)? Large for gestational age (LGA) is a term used to describe babies who are born weighing more than the usual amount for the number of weeks of pregnancy. LGA babies have birthweights greater than the 90th percentile for their gestational age, meaning that they weigh more than 90 percent of all babies of the same gestational age. The average baby weighs about 7 pounds at birth. About 8 percent of all babies weigh more than 4,000 gram...

Low Birthweight What is low birthweight? Low birthweight is a term used to describe babies who are born weighing less than 2,500 grams (5 pounds, 8 ounces). In contrast, the average newborn weighs about 8 pounds. Over 8 percent of all newborn babies in the United States have low birthweight. The overall rate of these very small babies in the United States is increasing. This is primarily due to the greater numbers of multiple birth babies who are more likely to be born early and weigh less. Over half of...

Meconium Aspiration What is meconium aspiration? Meconium aspiration occurs when a baby breathes in amniotic fluid containing meconium (the baby's first stools). What causes meconium aspiration? Before or during labor, the fetus sometimes passes the meconium stool into the amniotic fluid. It is not clearly understood why this happens. It may be a natural event, but it is also thought to be related to fetal distress in some babies. When the thick meconium mixes into the amniotic fluid, it is swallowed an...

Milk Collection and Storage Milk collection and storage: The following are general guidelines for collecting and storing breast milk when using a hospital-grade electric breast pump. If the NICU gives you more specific instructions, follow their recommendations. Getting ready: Before you begin to pump: Be sure to read the instruction manual for the breast pump and collection kit you are using. (Both items should be manufactured by the same company.) Breast milk is not sterile, but you do not want to int...

Moving Towards Breastfeeding Moving toward breastfeeding: There is no "one size fits all" method for achieving effective breastfeeding with a high-risk baby, because each baby and each situation is different. Give your high-risk baby extra time to learn to breastfeed, and let the baby set the pace for learning. Learning to breastfeed effectively is a process that may take days or weeks for premature and many other high-risk babies. However, you and your baby can become a breastfeeding team if you are pa...

Necrotizing Enterocolitis What is necrotizing enterocolitis? Necrotizing enterocolitis (NEC) is a serious intestinal illness in babies. "necrotizing" means damage and death of cells "entero" refers to the intestine "colitis" means inflammation of the colon (lower part of the intestine) Although NEC may develop in low-risk newborns, most cases occur in premature babies. NEC is more common in babies weighing less than 1,500 grams (3 pounds, 4 ounces). What causes necrotizing enterocolitis? It is not clear...

Neonatal Abstinence Syndrome What is neonatal abstinence syndrome? Neonatal abstinence syndrome (NAS) is a term for a group of problems a baby experiences when withdrawing from exposure to narcotics. It is estimated that 3 to 50 percent of newborn babies have been exposed to maternal drug use, depending on the population and area of the country. What causes neonatal abstinence syndrome? Almost every drug passes from the mother's blood stream through the placenta to the fetus. Illicit substances that cau...

Nutrition and Fluids Nutrition for babies in the NICU: Feeding babies in the NICU is quite different from feeding healthy babies. When babies are sick or premature, they are often not well enough to breastfeed or take a bottle. Premature babies may not be able to suck effectively, or their gastrointestinal tracts may not be mature enough to digest feedings. Babies who are medically unstable are often unable to take regular feedings. Babies with umbilical catheters and those on mechanical ventilators may...

Online Resources - High-Risk Newborn This Web was compiled from a variety of sources including the online resources listed below, but is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided here is for informational purposed only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding your condition. This page contains ...

Overview of Blood What is blood? Blood is the life-maintaining fluid that circulates through the body's: heart arteries veins capillaries Click Image to Enlarge What is the function of blood? Blood carries the following to the body tissues: nourishment electrolytes hormones vitamins antibodies heat oxygen Blood carries the following away from the body/tissues: waste matter carbon dioxide What are the components of blood? Human blood consists of about 22 percent solids and 78 percent water. The component...

Parenting in the Neonatal Intensive Care Unit (NICU) Parenting in the NICU: In most cases, you can be with your baby in the NICU at any time. The staff of the NICU will give you instructions on special handwashing techniques before entering the area. Sometimes, masks are needed. Occasionally, during a procedure, or when the hospital staff are making "rounds," parents may be asked to wait for a few minutes before coming into the area. Although most NICUs permit visitation of babies by other family member...

Persistent Pulmonary Hypertension What is persistent pulmonary hypertension (PPHN)? Persistent pulmonary hypertension (PPHN) is also known as persistent fetal circulation. In this condition, a newborn baby's circulation changes back to the circulation of a fetus, where much of the blood flow bypasses the lungs. Who is affected by persistent pulmonary hypertension? About one in every 500 to 1,500 babies develops PPHN. It occurs most often in full-term or post-term babies after a difficult birth, or birth...

Physical Abnormalities There are many physical abnormalities that may require clinical care by a physician or other healthcare professional. Listed in the directory below is some additional information regarding physical abnormalities, for which we have provided a brief overview. Cleft Lip/Palate Pyloric Stenosis Diaphragmatic Hernia Omphalocele Hernia (Umbilical / Inguinal) Hydrocephalus Spina Bifida Clubfoot Developmental Dysplasia of the Hip (DDH) Anorectal Malformation Hypospadias

Pneumothorax What is pneumothorax? Pneumothorax is a lung disorder in which air in the lungs leaks out through holes in the lung tissue into the spaces outside the lung airways. Pneumothorax is one type of lung disorders called air leak syndrome. A baby can have more than one form of air leak. Types of air leaks include the following: pneumothorax - air leaks into the space between the chest wall and the outer tissues of the lungs. pneumomediastinum - air leaks into the mediastinum (the space in the tho...

Polycythemia What is polycythemia? Polycythemia is a condition in which there are too many red blood cells in the blood circulation. It is the opposite of anemia, which results from too few red blood cells in the blood circulation. Polycythemia is also called plethora. What causes polycythemia? Polycythemia may be caused by the following: increased red blood cell production: A fetus with chronically lowered oxygen levels responds by producing extra red blood cells. Some chromosomal abnormalities may cau...

Postmaturity What is postmaturity? The normal length of pregnancy is from 37 to 41 weeks. Postmaturity refers to any baby born after 42 weeks gestation or 294 days past the first day of the mother's last menstrual period. Less than 6 percent of all babies are born at 42 weeks or later. Other terms often used to describe these late births include post-term, postmaturity, prolonged pregnancy, and post-dates pregnancy. What causes postmaturity? It is not known why some pregnancies last longer than others. ...

Prematurity What is prematurity? A baby born before 37 weeks of pregnancy is considered premature, that is, born before complete maturity. Slightly fewer than 12 percent of all babies are premature. Overall, the rate of premature births is rising, mainly due to the large numbers of multiple births in recent years. Twins and other multiples are about six times more likely to be premature than single birth babies. The rate of premature single births is slightly increasing each year. According to the Natio...

Pyloric Stenosis What is pyloric stenosis? Pyloric stenosis is a problem that affects babies between 2 and 8 weeks of age and causes forceful vomiting that can lead to dehydration. It is the second most common problem requiring surgery in newborns. The lower portion of the stomach that connects to the small intestine is known as the pylorus. In pyloric stenosis, the muscles in this part of the stomach enlarge, narrowing the opening of the pylorus and eventually preventing food from moving from the stoma...

Respiratory Disorders There are many respiratory disorders that place a newborn at higher risk and require clinical care by a physician or other healthcare professional. Listed in the directory below are some, for which we have provided a brief overview. The Respiratory System in Babies Hyaline Membrane Disease / Respiratory Distress Syndrome Pneumothorax Chronic Lung Disease Meconium Aspiration Apnea of Prematurity Transient Tachypnea of the Newborn Persistent Pulmonary Hypertension

Respiratory Syncytial Virus (RSV) What is respiratory syncytial virus (RSV)? RSV is the most common cause of bronchiolitis (inflammation of the lower airways) and pneumonia in babies. It is an illness that often occurs in yearly outbreaks in communities, school classrooms, and daycare centers. In the United States, RSV is more common in winter and spring months. What causes respiratory syncytial virus (RSV)? RSV is spread from respiratory secretions through close contact with infected persons or contact...

Retinopathy of Prematurity What is retinopathy of prematurity? Retinopathy of prematurity (ROP) is a disorder of the blood vessels of the retina (the light sensitive part of the eye). ROP is most common in premature babies. Generally, the more premature the baby and the lower the birthweight, the greater the risk for developing ROP. This disorder has in the past been called retrolental fibroplasia. What causes retinopathy of prematurity? The exact mechanism of ROP is not fully understood. The retina is ...

Sepsis What is sepsis? Sepsis is a term for severe infection that is present in the blood and spreads throughout the body. In newborns, it is also called sepsis neonatorum or neonatal septicemia. What causes sepsis? Sepsis can develop following infection by microorganisms including bacteria, viruses, fungi, and parasites. Infection in babies can be contracted during pregnancy, from the mother's genital tract during labor and delivery, or after birth from contact with others. Sepsis in a newborn is more ...

Small for Gestational Age What is small for gestational age (SGA)? Small for gestational age (SGA) is a term used to describe a baby who is smaller than the usual amount for the number of weeks of pregnancy. SGA babies usually have birthweights below the 10th percentile for babies of the same gestational age. This means that they are smaller than 90 percent of all other babies of the same gestational age. SGA babies may appear physically and neurologically mature but are smaller than other babies of the...

Special Care Providing special care for sick and premature babies: There have been many advances in the care of sick and premature babies, not just in technology and medicine, but also in meeting the special emotional and developmental needs of these babies. In the NICU, babies are often subjected to tests, procedures, noises, and lights - very different from the warm, dark, comfort of the mother's womb. Some babies are too sick to be held or have difficulty comforting themselves when not being held. Pr...

Spina Bifida What is spina bifida? Spina bifida, also called myelodysplasia, is a condition in which there is abnormal development of the back bones, spinal cord, surrounding nerves, and the fluid-filled sac that surrounds the spinal cord. This neurological condition can cause a portion of the spinal cord and the surrounding structures to develop outside, instead of inside, the body. The defect can occur anywhere along the spine. What are the types of spina bifida? The types of spina bifida include the ...

Substance Exposure During pregnancy, nearly every substance taken by a woman passes from her blood stream through the placenta to her fetus. Substances that cause drug dependence and addiction in the mother also cause the fetus to become addicted. When a mother uses illicit substances, including legal drugs such as alcohol and cigarettes, she places her unborn baby at risk for many problems. Many substances affect fetal growth and development, as well as the long-term health of the baby. A mother using ...

Sudden Infant Death Syndrome (SIDS) What is sudden infant death syndrome (SIDS)? Sudden infant death syndrome (SIDS) is the sudden and unexplained death of an infant under 1 year of age. SIDS is sometimes called crib death because the death occurs when a baby is sleeping in a crib. It is the major cause of death in babies from 1 month to 1 year of age, occurring most often between two and three months of age. The death is sudden and unpredictable; in most cases, the baby seems healthy. Death occurs quic...

Taking Your Baby Home Although parents are excited to take their baby home after days or weeks in the NICU, it may cause many parents some anxiety. When a baby is ready for discharge depends on many factors. Each baby must be individually evaluated for readiness and the family must be prepared to provide any special care for the baby. The American Academy of Pediatrics (AAP) has proposed discharge guidelines for high-risk newborn babies. The following general information about discharge is based on thos...

Testing and Lab Procedures Babies in the newborn intensive care unit (NICU) need frequent examinations and monitoring as part of their care. Although many tests require drawing blood from your baby, they are necessary to help monitor your baby's condition and to identify potential problems. Common tests or lab work in the NICU may include the following: blood typing - to check the blood group (A, B, O) and the Rh factor (positive or negative) testing for anemia (too few red blood cells) or polycythemia ...

The Neonatal Intensive Care Unit (NICU) The birth of a baby is a wonderful yet very complex process. Many physical and emotional changes occur for mother and baby. A baby must make many physical adjustments to life outside the mother's body. Leaving the uterus means that a baby can no longer depend on the mother's circulation and placenta for important physiologic functions. Before birth, breathing, eating, elimination of waste, and immunologic protection all came from the mother. When a baby enters the...

The Respiratory System in Babies Click Image to Enlarge What is respiration? Respiration is the act of breathing: inhaling (inspiration) - taking in oxygen exhaling (expiration) - giving off carbon dioxide What makes up the respiratory system? The respiratory system is made up of the organs involved in the interchanges of gases and consists of the: nose mouth (oral cavity) pharynx (throat) larynx (voice box) trachea (windpipe) bronchi lungs The upper respiratory tract includes the: nose nasal cavity eth...

Thrombocytopenia What is thrombocytopenia? Thrombocytopenia is a condition in which there are too few platelets - the cells produced in the bone marrow that are needed for clotting. What causes thrombocytopenia? Thrombocytopenia may be caused by infections in the fetus or newborn such as rubella, syphilis, and bacterial or viral infections. It can also develop when a mother's immune system produces antibodies against the baby's platelets. Some medications taken by the mother or given to the baby can cau...

Topic Index - High-Risk Newborn High-Risk Newborn Home The Neonatal Intensive Care Unit (NICU) Assessments of Newborn Babies Caring for Babies in the NICU Warmth and Temperature Regulation Nutrition and Fluids Testing and Lab Procedures Intravenous (IV) Line and Tubes Procedures and Equipment Special Care Common Conditions and Complications Prematurity Very Low Birthweight Low Birthweight Small for Gestational Age Large for Gestational Age Postmaturity Infant of Diabetic Mother Respiratory Disorders The...

Transient Tachypnea of the Newborn What is transient tachypnea of the newborn (TTN)? Transient tachypnea of the newborn (TTN) is a term for a mild respiratory problem of babies that begins after birth and lasts about three days. Other terms for TTN are "wet lungs" or type II respiratory distress syndrome. "transient" means temporary "tachypnea" means fast breathing rate What causes transient tachypnea of the newborn? It is thought that slow absorption of the fluid in the fetal lungs causes TTN. This flu...

Trisomy 18 and 13 What are trisomies? The term trisomy is used to describe the presence of three chromosomes, rather than the usual pair of chromosomes. For example, if a baby is born with three #21 chromosomes, rather than the usual pair, the baby would be said to have "trisomy 21." Trisomy 21 is also known as Down syndrome. Other examples of trisomy include trisomy 18 and trisomy 13. Again, trisomy 18 or trisomy 13 simply means there are three copies of the #18 chromosome (or of the #13 chromosome) pr...

Turner Syndrome What are monosomies? The term monosomy is used to describe the absence of one member of a pair of chromosomes. Therefore, there is a total of 45 chromosomes in each cell of the body, rather than 46. For example, if a baby is born with only one X sex chromosome, rather than the usual pair (either two X's or one X and one Y sex chromosome), the baby would be said to have "monosomy X." Monosomy X is also known as Turner syndrome. What is Turner syndrome? Turner syndrome is a genetic disorde...

Very Low Birthweight What is very low birthweight? Very low birthweight is a term used to describe babies who are born weighing less than 1,500 grams (3 pounds, 4 ounces). Only a few babies, 1.5 percent, are born this tiny. However, the overall rate of very low birthweight babies in the US is increasing. This is primarily due to the greater numbers of multiple birth babies who are more likely to be born early and weigh less. Babies with very low birthweight look much smaller than other babies of normal ...

Vision and Hearing Newborn babies arrive equipped with wonderful abilities to see and hear. Although their vision is not as sharp as that of an adult's, newborn babies show responses to the mother's face in the earliest days of life. Babies also have remarkable responses to sounds. They startle with loud noises and often become quiet to the mother's voice. Sometimes, babies have problems with vision or hearing. These problems may be due to a birth defect, or may be caused by the effects of prematurity. ...

Vitamin K Deficiency Bleeding (Hemorrhagic Disease of the Newborn) What is vitamin K deficiency bleeding? Vitamin K deficiency bleeding (VKDB) is a bleeding problem that occurs in a newborn during the first few days of life. VKDB was previously called hemorrhagic disease of the newborn. What causes vitamin K deficiency bleeding? Babies are normally born with low levels of vitamin K, an essential factor in blood clotting. A deficiency in vitamin K is the main cause of VKDB. Who is affected by vitamin K d...

Warmth and Temperature Regulation Warmth and temperature regulation: Babies are not as adaptable as adults to temperature change. A baby's body surface is about three times greater than an adult's, compared to the weight of his/her body. Babies can lose heat rapidly, as much as four times more quickly than adults. Premature and low birthweight babies usually have little body fat and may be too immature to regulate their own temperature, even in a warm environment. Even full-term and healthy newborns may...

Adding to Mother's Milk Is a mother's own milk enough? Certain nutrients occur at the same levels in premature milk as in term milk. Also, the overall calorie count is the same for both. Human milk contains lower levels of some nutrients than artificial formulas. Sometimes, lower nutrient levels are beneficial for premature babies. For instance, protein and sodium are at higher levels in premature milk than in mature milk, yet they still are low when compared to the amount in most artificial formulas. B...