NICU Terminology & Dictionary

• NICU – Neonatal Intensive Care Unit 
• Your baby may be in different types of beds during their NICU stay to help keep them warm and hydrated. Preterm babies have very thin skin and are not able to keep their temperatures normal on their own.
  • Incubator – a clear plastic box that provides heat and humidified air to keep babies warm. There are arm holes and the top can be lifted for doctors and nurses to be able to treat your baby.
  • Radiant Warmer – a type of bed that provides warmth from above but is open allowing for doctors and nurses to have easier access to treat your baby.
  • Omni Bed - a type of bed that can be open and work like a radiant warmer or closed and work like an incubator.
  • Open Crib – this is an open crib like your baby would be sleeping in at home. Once babies are older and able to maintain their temperature, they will be in this type of bed. Closer to discharge and when medically ready, infants will be placed ABC: A- Alone, B-on their Back, C = in a Crib for Safe sleep practices to decrease risk of Sudden Infant Death Syndrome SIDS.

• Intraventricular Hemorrhage (IVH) – Premature babies born before 32 weeks are at risk of bleeding in their brain, especially in the 1st week of life. The NICU cares for your baby in a way to decrease this risk as much as possible. The team will obtain a head ultrasound sometime during the first week and again closer to your baby’s time of discharge. Your team will discuss your baby’s results and what they mean after the ultrasounds are performed.

• A/B/D’s -Apnea/bradycardia/desaturation – pause in breathing (apnea) associated with decreased oxygen level (desaturation) or decreased heart rate (bradycardia)
  • very common in premature babies due to immaturity of brain
  • Can be treated with caffeine but babies will grow out of them as they mature
  • These need to be gone before going home and often is the last thing keeping a premature baby in the NICU
• CPAP – continuous positive airway pressure provided through a nasal cannula or face mask
  • Bubble CPAP vs Ram CPAP – different types of machine that provided CPAP and have different types of face mask/nasal cannula
• NIPPV – non-invasive positive pressure ventilation – provides CPAP plus additional extra puffs of higher pressure air to mimic breathing but it is not coordinated with baby’s own breaths
• High flow nasal cannula (aka high flow, HFNC) – special oxygen set-up that adds humidity and gives a little more pressure/breathing support than just oxygen into the nose
• Intubation – this is when a breathing tube is placed in your baby’s mouth to their lungs when they need help breathing
• Ventilator – this is a machine that will breathe for your baby when they require a breathing tube. There are a lot of different settings on this machine that the medical team will talk about on rounds each day and adjust to help your baby breathe the best.
• Tachypnea – breathing fast
• Sats – aka oxygen saturations = level of oxygen in the blood
• RDS – Respiratory distress syndrome = premature baby lung disease in the first days of life from low surfactant (among other things) that can cause baby to breath fast or work harder to breathe
• Chronic Lung Disease/BPD (bronchopulmonary dysplasia) – This is a general term for baby’s that are born premature and require breathing support for a long time. There are a lot of reasons why premature baby’s lungs may require longer breathing support.

• ROP (Retinopathy of Prematurity) – this is an eye disease that premature babies born before 32 weeks are at risk for due to immaturity of the blood vessels in their eye.
  • Premature babies will begin receiving eye exams by the eye doctor (ophthalmologist) between 1-2 months of age depending on how early they were. The eye doctor will continue to do exams throughout the rest of the baby’s NICU stay and after the baby goes home
  • It is important that families attend all follow up visits with ophthalmology post discharge

• Bradycardia – low heart rate
• Tachycardia – high heart rate
• PDA – patent ductus arteriosus = remnant of the way the blood flows through the body in the uterus that bypasses the lungs (because in the uterus, the lungs do not need much blood flow, all oxygen comes from the placenta/mom)
  • Usually closes by itself in the first 1-2 days of life, but often takes longer in preterm babies
  • If still open and big, may contribute to difficulty breathing or tolerating feeds
  • Your team may attempt to close with medicine (Ibuprofen or Tylenol)
  • If still causing problems and didn’t close with medicine, the team may discuss closing with a special device by the cardiologist or with a surgery.

CBC – Complete Blood Count

• Hematocrit: % of blood that is red blood cells
  • Normal numbers vary widely, but generally we don’t get worried until less than 21%
  • Some babies are more sensitive to low numbers and have more apnea when too low, so may need a blood transfusion before it reaches 21%
  • All babies (term and preterm) have a natural decrease in this number in the first 1-2 months of life
  • Some providers prefer to discuss Hemoglobin, which measures essentially the same thing (“normal” is ~7-14)
• White blood cell count (WBCs): number of white blood cells (aka immune system cells) in the blood
  • Normal levels vary widely and depend on the lab running the test
  • May indicate an infection if too high or too low, but very nonspecific
• Differential: break-down of the different types of white blood cells
• Platelet count: number of blood-clotting cells
  • Normal varies a bit between laboratories, but generally 150,000-400,000 (often the value will be read off as 150-400)
  • Don’t have to worry too much about bleeding until under 50,000 (and won’t have spontaneous bleeding until less than 10,000)
    
    

Electrolytes or BMP (Basic Metabolic Panel) – Concentration of Electrolytes/Salts in the Blood

• Sodium: normal ~135-145
• Potassium: normal ~3.5-5.5
• Chloride: normal ~95-108
• Bicarbonate (may also call it CO2, although that is a bit of a misnomer): normal ~20-28
  • Calcium: normal ~8-10
• Some places prefer to look at ionized calcium (i-Cal), normal ~1.1-1.3
• Magnesium: normal ~1.8-2.5
• Glucose (aka blood sugar): normal depends on baby’s age, generally want it to be 60-180 (in the NICU; different for adults)
• BUN/creatinine: measure of kidney function
  • In the first few days of life, it is basically all from Mom’s blood (creatinine usually ~0.7-1, BUN <20)
  • Should slowly decrease to ~0.1-0.3ish (creatinine) and <10 (BUN)
    
    

Bilirubin: Byproduct of Red Blood Cell Break-down

• Usually metabolized by the liver and disposed of in poop/urine
• All babies have immature livers and have a build-up of bilirubin in the blood after birth
• Some babies have more red blood cell break-down than others (for a lot of different reasons), so have higher bilirubin levels
• If the bilirubin gets too high, it can be dangerous, however the level that is dangerous gets higher as babies get older (i.e. what is dangerous on day of life 1 is less dangerous on day of life 3).
• Phototherapy (aka bili lights): blue light causes the bilirubin molecules in the skin to change into a form that can be disposed of in the urine
  
  

LFTs: Liver function tests, checked periodically while receiving IV nutrition

• AST/ALT/GGT: generally looking for inflammation in the liver
• Albumin: most abundant protein in the blood; general marker of adequacy of nutrition
  
  

Blood gas (also: ABG/CBG/VBG = arterial/capillary/venous blood gas)

• Measures level of carbon dioxide (CO2) and acid (pH) in the blood, among a few other things
• Can be very difficult to interpret depending on exactly what’s going on with the patient – affected by tons of things
• pH: normal 7.35-7.45, but may be a bit lower if checking a venous gas and not really dangerous until <7.25 or so
• dCO2: normal 35-45, but generally ok for a baby to be as high as 55 (and isn’t dangerous in and of itself if higher than 55, but the baby probably needs more help breathing at that point)

• Lines – your baby may require different types of lines to provide hydration and nutrition during their NICU course
• PIV – peripheral intravenous catheter – this is a temporary type of line that can be used for IV fluids or nutrition. The amount of catheter inside the vessel is small and therefore easy to fall out or go bad. This type of line is good for short term use or while waiting to get a longer term line
• UVC/UAC – umbilical venous catheter/umbilical arterial catheter – These are lines that are used when the baby is first born and placed through the belly button. These lines are secure and able to go into the big central blood vessels so the team can provide the best nutrition and also sample your baby’s blood to check all their labs. These are short term line because they are a risk of infection if left in too long.
• PCVC/PICC – percutaneous central venous catheter/ peripherally inserted central catheter – these are similar lines that the name depends on if it was placed at bedside by a specially trained nurse/doctor or by a special type of doctor called interventional radiologist. This line is a temporary line to provide appropriate nutrition
• Tunneled CVC- a central venous catheter placed by pediatric surgeons or interventional radiologists to provide long term nutrition.

• TPN – Total parenteral nutrition = nutrition (glucose, protein, and lipids/fat) given by IV
• NG/OG/G (nasogastric/orogastric/gastric) tube – small tube going from the nose/mouth to the stomach in order to deliver food when baby isn’t able to eat by mouth
  • Premature babies often require NG tubes for nutrition as they don’t have the coordination to eat by mouth until closer to 34 weeks corrected gestational age.
  • Critically-ill full term infants also often require NG tubes for nutrition
• Enteral nutrition – any food given into the stomach/intestines; by far, the preferred route
• PO – “per os” = by mouth
• NPO – “nil per os” = nothing by mouth
• Fortification/Fortifier – premature and critically-ill babies sometimes require extra calories and vitamins to grow. The fortifier adds extra calories to give your baby the best nutrition for growth.

• Anterior fontanelle – soft spot on the head
• Corrected gestational age/post-conceptual age– this is the number of weeks the baby would be if they were still inside mom
• Newborn screen – this is a blood test managed by the state of Illinois that tests for various treatable diseases. This test often needs to be repeated on babies born early because some of the tests are not accurate in preterm babies.
• Car seat test – prior to discharge, preterm babies will be placed in their car seat for a few hours while on the monitors to confirm they are safe to go home in their car seat. Babies born early sometimes do not have enough head control/muscles to be in the car seat for a long period of time. Proper positioning will be determined and family provided with education prior to discharge for safe use of the car seat. Alternatively, car beds are available as needed for select patients.