Oxygen is carried around the body by red blood cells. Anaemia is when the body does not have enough haemoglobin (red blood cells contain haemoglobin) to carry the oxygen around properly. The blood test to check the red blood cell, haemoglobin etc.is called a "full blood count" and is usually done every week for most babies. If the haemoglobin level is low the baby may look pale and need more oxygen than usual. Small babies become anaemic because they make fewer red blood cells and their red blood cells also last for a shorter time. Sometimes the baby needs a blood transfusion to "top up" their own red blood cells. Sometimes the baby will begin to make his own red blood cells and not need a blood transfusion. Many babies are given iron medicine every day to help keep their haemoglobin at a good level.
Stopping breathing for short periods is called apnoea ("apneer"). Premature babies often have apnoea because the parts of the brain that control breathing are immature. If apnoea happens the baby will usually start to breathe again himself quite quickly or will start to breathe after being stimulated (gently stroking the feet, hands, side or back). If the baby does not start breathing after about 20 seconds the staff will give some oxygen to the baby, sometimes using a little mask over the face to carefully blow some oxygen into the nose and mouth. The babies in Neonatal Unit are monitored for apnoea with little machines that pick up their breathing pattern - they will alarm if the breathing stops. Many babies are given caffeine medicine every day to help stimulate their breathing until they are bigger.
A slow heart rate is called bradycardia. It is detected by the heart rate monitor. Small babies often have periods of apnoea and bradycardia. It will usually improve when the breathing starts again.
Chronic Lung Disease
This is a chest condition that sometimes affects premature babies who have needed machines and oxygen to help their breathing in intensive care. Occasionally it means that they need oxygen for several months and they may go home with oxygen installed in the house.
Small babies or babies who have been very poorly often have problems digesting their milk. That is why it is best to give babies their mother's breast milk, at least to start with, as it is the most easily digested milk. To begin with, the babies are often given very tiny amounts of milk every few hours. It is gradually increased if the baby is "tolerating" the milk. This can take a few days or a few weeks. Babies who don't tolerate their milk don't digest it properly and it stays in the stomach. The nurses can see this when they test the feeding tube. Sometimes the baby may vomit or become poorly. It is common for babies in Neonatal Unit to have their feeds stopped for a few hours or stopped for a few days then restarted again.
Premature babies often have this problem because the muscles at the stomach opening are immature. This causes the stomach to bring its contents up into the back of the throat. Sometimes the baby will vomit. It makes the baby uncomfortable and it may cause apnoea. Certain positions can help, for example having the baby's head slightly higher than the body. Many babies are given anti-reflux medicines every day to help and they sometimes go home with these medicines.
This is a low blood sugar level. Small babies can have low blood sugar levels because they have very few energy stores in the body. It is made worse if the baby is poorly or becomes cold after birth or if mum is a diabetic. Low blood sugar levels are checked with blood tests and sometimes treated with an intravenous glucose drip.
This is bleeding inside the brain. Brain fluid fills in spaces (ventricles) inside brain. Premature babies can bleed in these spaces. A large bleed inside the brain may affect the brain itself and cause damage. A regular ultrasound scan is done to monitor this problem.
Many babies have jaundice, including big healthy babies. Jaundice happens because the newborn baby has to break down the extra red blood cells that all babies have when they are in the womb. A by-product substance called bilirubin is produced as a result. Premature babies can't remove the bilirubin as effectively because their liver is immature so it remains in the body longer. It makes the baby look yellow. If the level of bilirubin becomes too high the baby can become ill. Jaundice can also be caused by infection or by a blood group difference between mum and baby. This blood group difference causes extra red blood cells to be broken down and so more bilirubin is produced. Jaundice is often treated with special lights (phototherapy) that help to reduce the bilirubin level by acting directly upon the baby's skin. If jaundice level is very high/not responding to phototherapy, more intensive therapy (exchange transfusion: baby's blood is exchanged with donor blood) is required.
Necrotising Enterocolitis (NEC)
NEC is a disease of the intestine. Premature babies are at more risk to develop this disease. It causes infection and inflamation of the intestines. Babies can become very unwell with distension of the belly, green vomit / aspirate, blood in stool and low blood pressure. Initial treatment is stopping feed and commencing anti-biotics. Babies requiring a lot of support (breathing machine, medication to support blood pressure, preforation of intestine etc.) might need paediatric surgical assessment and transfer to paediatric surgical ward.
Patent Ductus Arteriosus (PDA)
When babies are in the womb they have a small connection in the heart between the blood vessels to their lungs and the blood vessels to their body. This connection is called the ductus arteriosus and is normal for all babies in the womb. After birth the connection closes. Sometimes in premature babies the connection stays open. Sometimes it closes, and then reopens. This is called a patent (open) ductus arteriosus (PDA). It can cause breathing problems and often a heart murmur. Usually the PDA closes itself after a little while. If the PDA is big and affecting baby's circulation, we tend to use medication to close it. Sometimes babies need an operation to make the PDA close.
Poor weight gain
Small or poorly babies can have problems growing and gaining weight. It's sometimes necessary to give them special intravenous drips that contain extra nutrition (TPN-Total Parenteral Nutrition) for a while. Quite often they need extra nutrition in their milk to help them gain weight.
Respiratory Distress Syndrome (RDS)
This happens to premature babies whose lungs are immature. Their lungs do not have enough of a special substance called surfactant. Surfactant is produced in everyone's lungs and helps us to breathe naturally. Premature babies are often given surfactant medicine into their lungs after they are born to help with RDS. They usually need support from CPAP / breathing machine.
Retinopathy of prematurity (ROP)
Premature babies' eyes continue to develop after they are born. Sometimes the blood vessels at the back of the eye develop abnormally especially if the baby has needed a lot of extra oxygen. There are 3 types of ROP (stage 1, stage 2 and stage 3). Stage 1 and stage 2 usually get better by themselves. Stage 3 affects a small number of babies. There is a risk of blindness and so all babies who are at risk are regularly checked by Ophthalmologist as their eyes develop. Babies with Stage 3 ROP/PLUS disease are assessed for laser treatment by ophthalmologist.
This is another word for infection especially in the blood. Infections can affect babies before birth, during labour, during the birth or afterwards in the Neonatal Unit. Handwashing is the best way to prevent the spread of infection. Small and poorly babies can be badly affected by infections. Their immune system is immature and and the infection may rapidly spread around their body. For this reason, premature and poorly babies will often be given a course of antibiotics while we wait for the infection test results. Tests to look for infections include blood tests where a small specimen of the baby's blood is watched in the laboratory to see if any infection is growing. This test takes a few days before we have a result. Other test (Lumbar puncture) look for infection inside the baby's spinal fluid. X rays are taken to help to look for infections of the chest and the abdomen.