Busy

The NICU is keeping me very busy. I hope to blog some more soon.

But what about SIDS?

Many of the babies in the NICU are placed on their abdomen. This raises many concerns from the parent about sudden infant death syndrome (SIDS). The reason the infants are their stomach is because since they are so small it is difficult for them to breath. They have to try hard to inhale and push out their chest. By placing them on their belly it is easier for them to breath as well as digest their food. They are not at a risk of SIDS for two main reasons 1) they are on ventilators that are delivering them oxygen constantly and an alarm will sound if they stop breathing 2) the nurse are in the unit all the time and keep for close eye on their patients for any potential problems.


Reference:
Merenstein, G.B., Gardner, S.L. (2006). Handbook of Neonatal Intensive Care (6th ed.). St. Louis, MO: Mosby Elsevier.

MINIMAL STIMULATION PLEASE!

Because these infants are born early they cannot tolerate much stimulation. It is hard for many parent to not touch and stroke and rub their baby. For term babies this is perfectly fine but for premature babies it is not ok. Over stimulation of these infant can cause them to become agitated and drop their heart rate. The reason for this response is because their nervous system is overly sensitive to touch. While it is ok for the parents to place their hand on the baby they do not need to stroke the baby.


Reference:
Merenstein, G.B., Gardner, S.L. (2006). Handbook of Neonatal Intensive Care (6th ed.). St. Louis, MO: Mosby Elsevier.

Surfactant

Surfactant is naturally produced in our lungs. Its purpose is to keep the alveoli from collapsing or sticking together. In the premature infant their lungs do not produce surfactant because the lungs are the last thing to mature some where around 34 weeks. In the NICU we can give infants surfactant. They receive this at birth after being intubated and shortly after birth. This has helped many preterm babies survive and have their lungs mature quicker and not have stay intubated and on a ventilator as long.


Reference:
Merenstein, G.B., Gardner, S.L. (2006). Handbook of Neonatal Intensive Care (6th ed.). St. Louis, MO: Mosby Elsevier.

What is ROP?

Retinopathy of Prematurity (ROP) is a condition that occurs in infants less than 3 pounds and born under 31 weeks. What happens with ROP is that abnormal blood vessels grow in the eye, these vessels are very fragile and break causing bleeding and scaring. The bleeding causes the retina to become displaced and detach, causing blindness. It is believed that rapidly fluctuating oxygen levels cause ROP. Currently the NICU that I am in is participating in a double blind study to see if a certain eye drop is helpful in preventing ROP.


Reference:
Merenstein, G.B., Gardner, S.L. (2006). Handbook of Neonatal Intensive Care (6th ed.). St. Louis, MO: Mosby Elsevier.

Ventilation and Oxygenation

Many infants that come in to the NICU require oxygen support. There are many different way that oxygen can be delivered to the infants such as, nasal cannula, Oxygen hood, Nasal continuous positive airway pressure (NCPAP), Synchronized intermittent mandatory ventilation (SIMV), NCPAP with bump rate, and High frequency ventilation jet, and assist control method.
When infants are on nasal cannula they receive a small percentage oxygen and sometimes they only receive air. These babies are more stable and only require a little bit of assistance. Infant on a hood require a stronger oxygen concentration. The hood is shaped like a square and is placed over the infants head. The oxygen concentration can be adjusted up and down based on the needs of the baby. The infant must remain under the hood to have any type of oxygen concentration. Oxygen concentration can be as high as 100% ( FYI 21% is room air, what we breath normally). NCPAP consist of two prongs that are inserted into the infants nares. With NCPAP oxygen concentration can be adjusted from 21% to 100% the difference between NCPAP and the previous two is. NCPAP delivers pressure to keep the alveoli (the place were gas exchange occurs in the lungs) open. If the alveoli are unable stay open this would cause collapse of the lungs. On the SIMV setting the infant is intubated ( has tube down his mouth). On this setting a set oxygen concentration and a set pressure are delivered. This setting allows the infant to breathe spontaneously with out ventilator support. SIMV mode also delivers a set number of breath when the infant does not breathe with a set amount of pressure to keep the lungs open. NCPAP with bump rate is a combination of NCPAP and SIMV mode. The infant has the nasal prongs as in NCPAP and the set pressure as before but the ventilator delivers a set number of breaths to the infant regardless of when and if the infant breathes. When an infant is on a jet they are requiring alot of assistance. The jet delivers a large amount of a small number of breaths. The jet can deliver over 400 breaths per minute. On assist control method the ventilator delivers a set number breaths but also allows the infant to breath spontaneously. This mode is similar to SIMV however with the A/C mode when the infant breaths spontaneously the ventilator still support and by delivering the same amount of pressure he would receive if the ventilator breathed for him.

Reference:
Merenstein, G.B., Gardner, S.L. (2006). Handbook of Neonatal Intensive Care (6th ed.). St. Louis, MO: Mosby Elsevier.

Whats all that gunk on my baby?

Most neonates are very small and loose water very easily. When they loose water their sodium (normal sodium is 135-145) is increased causing electrolyte imbalances. When their sodium is increased, indicating that they are dry we place a substance called aquaphor on them to keep the moisture in and maintain a normal sodium level. When the sodium is low, indicating it is diluted and the baby is holding on to water, the aquaphor is withheld. It is very important to monitor lab values periodically to ensure the infants sodium level is within the normal range.


Reference:
Merenstein, G.B., Gardner, S.L. (2006). Handbook of Neonatal Intensive Care (6th ed.). St. Louis, MO: Mosby Elsevier.