Common health conditions treated at NICU

A premature baby often cannot keep control over its body temperature. Especially, if your twins were born too early and are of very low birth weight, they wouldn’t be able to generate heat and keep themselves warm.  This is because your twins didn’t have enough body mass and fat accumulation at the time of their birth. Whereas babies who were born full term will be able to keep their body temperature under control, as they had a complete growth in their mother’s womb. The ability to keep themselves warm is more important for a baby to have normal and continuous growth.

If your twins are with you at home and you feel they are losing weight constantly with less intake, they might be losing their body heat. It is time for you to consult with their doctor whether NICU care is needed. Never take a chance following the general saying, that a baby will initially lose from its birth weight and then gain gradually.

Treatment :

Your twins will be kept in a warmer for quite some time. Their body temperature will be continuously monitored and the warmer will adjust its temperature accordingly to keep the babies warm. This will support the babies energy to be utilized for its physical growth. They will be slowly weaned out of the warmer and when they are able to control their body temperature and have gained some good weight, they should be ready to go home.

Image: Feeding Baby

Feeding can be a more common problem with preemies. Born with very low body weight and immature organs they wouldn’t be able to take a feed on their own(breastfeeding/bottle) for quite some time. There will be problems in sucking, swallowing and digesting. They will need special feeding techniques until they are ready to get the feed directly from their mother or bottle. This requires their stay at the NICU for a reasonable period.

Treatment :

In the beginning, they will be given minimal feeds to invoke their intestines. This will start with a 1 ml or 2 ml feed at regular intervals and gradually increase as your twins mature. Very small babies will be fed with IV lines. Once they are better enough, they will get feeds through feeding tubes.

On the next developmental sign, they will be fed through sterilized syringes(WITHOUT NEEDLES). This will be like a pre-training for your twins to start with the breast/bottle feed. Initially, the nurse will push the feed through the syringe. The babies will slowly learn to suck themselves from the syringe. Here the nurse will still have the control of the amount of feed the babies can suck, as he/she keeps a hold on the plunger.

The quantity of the feed can increase as high as 50-75 ml per feed and it depends on each baby. The amount of intake can differ even between your twins. One will take the feed faster and more. Others might show some delay. It is perfectly normal as each baby is unique.

From here I would like to emphasize this point -> Never bring a comparison between your twins on any subject at any point in their life. Since you have them both of the same age you will definitely be tempted to compare everything about them. But make sure to restrain yourself. Though born together they are still individuals with their own body and mind.

Coming back to feeding with syringes, once this routine is well established, the baby will be ready to be breastfed or bottle fed. But this can still depend on other factors like their body weight(whether they have reached an eligible body weight ). 

In some scenarios, even after your twins are out of the NICU, they might still need to be fed through syringes. The nurses will train you on how to feed with a syringe during the discharge. Once your twins are proclaimed ready for a direct feed, you can slowly start bottle or breastfeeding with proper guidance.

The feeding techniques may vary with each care provider and be different from the ones discussed above. Follow the doctor’s advice on this and never intend to try anything on your own, as this might result in choking issues and harm your twins.  

Reflux is usual in babies both full-term and preterm. But as like other conditions, preemies tend to have more reflux. When the milk in the stomach comes out to the esophagus, the baby may throw out or spit up.  Infants will generally outgrow this condition as they cross one year.

However, in some cases, it might be severe making the babies resist feeds resulting in poor weight gain. Your twins may feel restless after feeds as the feed comes up to the esophagus. They often throw out but at times can breathe in or swallow the content which will have adverse effects. At times the milk might even come through the nose making you scared.

Though this is a very common condition it’s better not to be lethargic and take adequate care for your twins during feeds. Before getting discharged from NICU be sure to take the needed advice from your medical practitioner. Understand the precautions to be taken or the first aid to be given on encountering reflux.

Treatment :

Make sure to give minimal but more frequent feedings. This will reduce the reflux, help the baby to hold the contents of the stomach and digest easily. After feedings, keep the baby in a semi-upright position and gently pat the baby on the back. Once the baby burps, there will be some relief. However, there are chances to spit up during burping.

Keep the baby in semi-upright position for around twenty minutes. This can control the milk from moving out of the stomach. Lay the baby to sleep on its left side after feeds. This can sometimes manage the reflux.

Before practicing any of this get a nod from your doctor. If your twins have severe reflux, doctors may even prescribe some medications. 

Medical Name :

Gastroesophageal Reflux (GERD)

Your twins become anemic when they have a very low count of red blood cells. Babies usually accumulate the iron required for creating the red blood cells during the last few months of pregnancy. So if they were born premature, they will be iron deficient and become anemic. Also, frequent blood samples taken to monitor the preemie’s health can also reduce the red blood cells count. Anemic babies tend to have low blood pressure and high heart rate. Anemia is determined through a CBC test(Complete Blood Count).

Treatment :

While in NICU, your twins CBC levels are periodically determined to make sure they are not anemic. Based on the severity, doctors may advise iron supplements or drugs and blood transfusion in some cases.

Image: Phototherapy

Jaundice can be found in any newborn baby either premature or full term, however it’s more common in preterm. It is caused by the increased levels of bilirubin in the blood. Bilirubin is a byproduct which is released when the blood cells undergo a breakdown. This bilirubin is generally recycled by the liver. If the liver is not mature enough or cannot handle the high levels of bilirubin produced, it will result in jaundice. The baby’s body and whites of the eyes will turn yellowish which is a more direct sign. It can be confirmed with a blood test to determine the bilirubin levels.

Treatment :

Phototherapy is a process of keeping the babies under a blue light which will help to break down the bilirubin. Your twins will be kept under phototherapy with an uncovered body except for the eyes and genital areas which will be covered. They will get this treatment for few hours/day until their bilirubin levels are under control.

If the bilirubin levels are too high it can cause brain damage. So the NICU staff will be continuously monitoring the levels. In some extreme cases, a blood transfusion might be prescribed.

If your twins were born premature and well before 30 weeks they are more likely to have this condition. This condition is in fact termed as Retinopathy of Prematurity as it is seen mostly in preemies. Babies who were born with low birth weight or were administered with oxygen during their initial few days may also have this condition.

In case of premature birth, the retinal blood vessels are not grown completely. After birth they will have abnormal growth, resulting in bleeding or detachment of the retina. The retina is the main part of the eye which will determine the visual image we see and send signals to the brain. If this is not treated early, it might result in vision loss.

Treatment :

An ophthalmologist will visit the NICU periodically and check all the babies for this condition. If identified and found mild it can be treated easily. If found severe, the doctor may perform laser therapy (once or twice) to stop the bleeding. Following this, he/she will prescribe an eye drops which has to be administered to your twins for a certain period.

The doctor will also advise for a periodic check-up for few years to make sure there isn’t any problem with the retina of the babies. Irrespective of RoP, babies born prematurely are more likely to develop issues like squinting or myopia( shortsightedness ). So a frequent and routine checkup with an ophthalmologist is necessary for your twins.

Medical Term :

Retinopathy of Prematurity ( ROP )

There are chances for your twins to develop a bacterial infection which affects the bloodstream. The infection might have happened during delivery or from close contact with anyone having a bacterial infection or even through the IV lines.

With NICU caring for more babies, infections can happen easily. The NICU staffs strive hard to keep the environment clean and tidy. This is why even parents are not allowed to visit the babies in certain NICUs.

The infection can be determined through a blood and urine test. Babies suffering from this condition will often have a varying temperature or low blood pressure or inconsistent sugar levels or breathing problems or not eat well and seem lethargic.

Treatment :

This condition is often treated with antibiotics. If left untreated it can cause meningitis or any other serious damage. So babies with this condition are closely monitored.

Medical Term :

Sepsis

Babies are sometimes diagnosed with low blood sugar levels or glucose shortly after birth. It is because they have excess insulin or they do not produce enough glucose.

This is more probable if they were born to a diabetes mother or were born smaller in size against the gestational age or had a serious infection during birth. In such cases, their glucose levels will be continuously monitored.

Your twins may encounter continuous sweating or seizures, take poor feedings, feel restless which will indicate the doctors to advise for a blood and urine test to determine the sugar levels.

Treatment :

Glucose solutions are administered through IV lines to maintain the sugar levels. Your twins will be frequently fed to keep up their glucose levels which will be stable in a few days or weeks. If not, they will be prescribed with some medications to keep up the sugar levels and extreme cases might even undergo surgery to reduce the insulin secretion.

Medical Term :

Hypoglycemia

This condition can be determined during your pregnancy through an Ultrasound or Doppler study. The growth of the babies will be identified to be less than the normal rate. They will be developing slowly in the uterus as compared to other babies of the same gestational age.

This can be due to problems in the placenta or if the mother was carrying multiples or if the mother had high blood pressure, extreme diabetes, anemia or had smoking or drinking habits.

This can, in turn, cause several other health conditions in the babies like respiratory problems, low blood sugar levels, low body temperature, feeding problems, less resistance to infections, low birth weight, high red blood cells count etc.,

Treatment :

Based on how badly the growth of the babies has affected, the doctor may advise for early delivery with a c-section as the baby cannot withstand the vaginal delivery pressure. After birth, the baby might have many complications which have to be treated in NICU. Once the babies have gained a reasonable weight and are out of all the health problems and feeding on their own, they should be ready to move out of medical supervision.

Medical Term :

Intrauterine growth restriction ( IUGR )

This condition refers to the babies who are born big more than 4.5 kg. But this will be a very rare case for twins.

The chances of delivering a big baby are more for the mother who had too much weight gain or advanced diabetes or had more than needed nourishment during pregnancy or had a huge baby before.

Treatment :

If not diagnosed early, this condition can result in complications for the mother and the baby during pregnancy, delivery and after birth. Doctors would often advice for a c-section as vaginal birth can harm the baby. This condition often leads to low sugar levels, high blood pressure in the baby which need to be treated in the NICU.

Medical Term :

Macrosomia

This condition is more probable for babies who are born prematurely before 32 weeks. However, this can occur even with the full term babies. In case of premature babies, the intestine may not be mature enough to perform digestion. This may damage some tissues in the intestinal wall, causing the bacteria in the intestine to invoke more damage and severe infection in the bloodstream.

The death of the intestinal tissues can be caused by low blood flow or oxygen to the bowel at the time of birth or any infection or intolerance to feeding due to the immaturity of the bowel. If your twins are affected with this condition the more noticeable signs would be a swollen abdomen, blood in the poops, respiratory issues, constipation, and feeding problems. An x-ray can confirm the disorder.

Treatment :

Once the condition is diagnosed, oral feedings will be completely stopped and the baby’s nutrition will be administered through IV lines. The stomach contents will be drained and an abdominal x-ray would be performed at timely intervals to keep a check on the condition. The doctor will start with antibiotics and the baby’s bowel movements will be continuously analyzed for any blood. If there is severe damage then surgery may be performed to remove the infected part of the intestine.

Medical Term :

Necrotizing Enterocolitis (NEC)

Some babies may have their intestines protruding out of the abdominal wall through a hole near the belly button. In certain cases other organs like gallbladder, stomach and liver can also be seen outside the babies body. This birth defect can be determined through the ultrasound scans during pregnancy. The specific reason which causes this condition is unknown. 

Treatment :

This condition will be noticed immediately after birth. If the protrusion of the organs is mild, surgery will be conducted to move the organs back into the belly and the hole will be closed. If the condition is severe with many organs grown out of the body, then they will be slowly moved inside following a particular process.

After the surgery the baby may have problems like intestinal tissues getting damaged, causing infections or feeding problems or issues with digestion. The babies will need NICU care for quite some time until they are ready to be out of medical supervision.

Even after reaching home, parents should look for signs like a swollen stomach, constipation, less feeding, vomiting or fever and communicate with their medical practitioner to ensure everything is fine with their baby.

Medical Term :

Gastroschisis

In very tiny babies who are born too premature, there can be bleeding in certain parts of the brain. This is because their brain vessels are very fragile and can easily bleed. This can happen in the immediate few days after birth and can be diagnosed through an ultrasound. The signs for a baby having this condition may be like uncontrollable cry, breathing problems or anemia. Very severe cases can have low blood pressure and sometimes seizures.

Treatment :

There isn’t any specific treatment for this and the baby will be monitored round the clock. Ultrasounds will be taken frequently to monitor the severity of the bleeding. Doctors will try to keep the baby’s blood pressure under control. Mild bleeding will cure by itself however severe conditions will take time and might cause complications in future like seizures or cerebral palsy necessitating adequate care for the baby throughout the childhood.

Medical Term :

Intraventricular Hemorrhage (IVH)

Cerebrospinal fluid flows through the brain to the spinal cord. When this fluid flow is obstructed then it will get collected in the brain. The obstruction may be due to any blocks or the inability of the blood vessels to absorb it or if the brain produces more cerebrospinal fluid. All these can happen due to any infections during pregnancy or genital defects or due to other disorders like bleeding in the brain.

Babies with such condition will often have a swollen head. Other symptoms may be like vomiting, seizures or poor feeding. An ultrasound scan and MRI (Magnetic Resonance Imaging) will confirm the collection of the fluid in the brain. 

Treatment :

Mild cases will be closely monitored. If the fluid collection is severe, then surgery will be performed to place a shunt in the brain which will open into the chest or abdominal area. This will help the excess fluid to drain out to the other parts where it will be absorbed.

In some cases, a hole will be created between the ventricles to allow the fluid to flow out of the brain. In any case, babies diagnosed with this health condition should have periodic consultation with their medical practitioner to ensure there aren’t any abnormalities developed again. Also, they might need a consultation with an occupational therapist.

Medical Term :

Hydrocephalus

This is a type of injury that happens in the tissues surrounding the ventricles(fluid-filled cavities) of the brain. This area of the brain is called the white matter that connects the brain and the body muscles. So an injury here means it can impact the nervous system and physical mobility of the baby in the future. Also, there can be developmental delays resulting in ailments like cerebral palsy or spasticity(tightening of the muscles).

Health conditions like bleeding in the brain can cause this brain injury and it can still happen without any reason especially with the premature infants. Generally doctors advice an MRI and ultrasound scan of the head in all the premature infants to identify if any brain injury is present.

Treatment :

There is no specific treatment for this condition. While in the NICU, the baby will be closely monitored for the heart, lung and kidney functions. Doctors will advise for consultation with therapists to cope with the possible developmental delays.

Medical Term :

Periventricular Leukomalacia (PVL)

If your twins were born premature, then they may have irregular breathing. The baby may take a long breath, then a short one and stop. If the breathing stops for more than 15-20 seconds then the baby has to be continuously monitored. Any other health conditions like a damaged intestine or slowly growing babies can also cause irregular breathing. This irregularity will, in turn, lower the heart rate of the babies. 

Treatment :

Babies will have sensors on their chest and will be continuously monitored for their breathing and heart rate. If the breathing stops for a certain period, the monitor will beep to alarm the NICU staff. They will immediately stimulate the baby to breathe by rubbing the back or tapping the feet.

Once the baby matures and comes close to the 39 weeks gestational age, the irregularity will slow down. In some cases, doctors may advise for medications or fix a nasal device to push a stream of air which will clear the airways and keep them open.

Medical term :

Apnea

The lungs of your twins may be damaged or scarred due to several factors like an infection or pneumonia or long usage of assisted respiratory machines like ventilators or oxygen supply and more. Premature babies generally have immature lungs and they rely on respiratory support. This can, in turn, affect the lungs. This can be determined through a chest x-ray which the doctors usually prescribe for premature babies who had ventilator support or oxygen supply.

Treatment :

Doctors prescribe medications to facilitate normal breathing. Some babies might need the ventilator support/oxygen therapy for more time resulting in a longer stay at the NICU. Gradually their lungs will improve in a few years however some of them might develop conditions like asthma in later stages of life.

Medical Term :

Chronic lung disease (CLD) or Bronchopulmonary Dysplasia (BPD)

While in the womb, the babies develop fluid in the lungs which help the baby to grow. When they are born this fluid secretion will stop and the remaining fluid will be re-absorbed by the lungs. This can cause the newborn to breathe rapidly for the first few hours. But if this continues after 4 hours of delivery, doctors may look for the possible causes. Conditions like pneumonia or an infection in the blood or issues with the lungs can cause rapid breathing. 

Treatment :

Babies with this condition may need an oxygen supply to have stable blood oxygen levels. Slowly they should be out of this condition within 12-24 hours. Usually, this condition never leads to any other health issues but rarely cause some lung problems for a few days.

Medical Term :

Transient Tachypnea of Newborn (TTN)

The surfactant is a substance produced in the lungs which expands the lower portion of the lungs and helps the babies to breathe air after birth. The immature lungs of the preemies do not produce the required amount of surfactant thereby resulting in breathing problems.

In addition to premature birth, there may be other causes like quick labor or diabetes mother or low blood supply to the baby during delivery. Your twins may have rapid or shallow breathing, decreased urine output, irregular breathing or abnormal movement of the chest muscles during breathing.

Treatment :

Preemies with respiratory problems have to stay with ventilator support and oxygen supply until their lungs are mature. But the dependency on the ventilators has been considerably reduced by giving artificial surfactant immediately after birth through a breathing tube. This might be repeatedly given based on each baby’s requirement. 

Medical Term :

Respiratory distress syndrome (RDS)

While in the womb, the baby receives oxygen through the umbilical cord. The lungs don’t need much blood supply. So blood is not circulated to the lungs and diverted to other organs through a fetal blood vessel called ductus arteriosus.

After birth, with the first encounter of the breathing air, the baby’s blood vessels in the lungs will relax and allow a normal flow of blood. This will help the babies to inhale oxygen. Also, the fetal blood vessel will close within a day of the birth.  

If this fetal blood vessel is still open, the blood will not be reaching the lungs. There will be high blood pressure in the lungs and breathing becomes a problem. Babies with this condition may have rapid breathing and heart rate or low oxygen levels or a bluish tint of the skin indicating the lack of oxygen. Chest x-rays and CBC tests can help confirm this condition.

Treatment :

This condition has to be treated immediately and with the utmost care as it can lead to complications like brain damage.  A full oxygen supply will be given to the baby. Ventilators will be used to assist the baby in breathing. Sometimes Nitric oxide is given through the ventilators which will help to relax the blood vessels in the lungs and improve the blood flow to the lungs. Some new ventilation techniques like ‘High-frequency Oscillation ventilation’ may also be used to increase the oxygen levels in the blood.

Medical Term :

Persistent Pulmonary Hypertension of the Newborn (PPHN)

The lung infection is very common in preemies and newborns who are sick. This condition will be indicated through irregular breathing or changes in breathing rate or difficulty in breathing. Doctors will check if there is more fluid in the lungs through a chest x-ray. If required they will take a sample of the lung fluid and test for the kind of infection.

Treatment :

Based on the type and severity of the infection doctors will prescribe the needed drugs usually an antibiotic. Babies may be given with an additional supply of oxygen.

Medical Term :

Pneumonia

Babies are often seen with a slow heart rate. This may be due to irregular breathing or low oxygen levels or heart disease. This can be determined through a pulse monitor attached to the baby.

Treatment :

This condition usually corrects itself, when the underlying cause is identified and treated. Babies are often treated with medicines or respiratory support.

Medical Term : 

Bradycardia

While I was discussing high blood pressure in the lungs, I mentioned about a fetal blood vessel called ductus arteriosus. When the baby is in the womb, this blood vessel acts as a passage for the blood to flow through different blood vessels bypassing the lungs.

Once the baby is born, this fetal blood vessel closes, so that the blood flows through the lungs. In some babies, this fetal blood vessel stays open causing an irregular flow of blood through the body. This results in breathing problems.

A breathing problem associated with a heart murmur will indicate the condition. An ultrasound of the heart can confirm this.

Treatment :

Babies with this condition will be under close supervision. Doctors may administer medicines to close the ductus arteriosus. In some cases, surgery may be performed to close this blood vessel.

Medical Term :

Patent Ductus Arteriosus (PDA)

Aorta is the main artery which sends blood to the other blood vessels from the heart. Sometimes this aorta may be narrow interrupting the free flow of the blood. This can be identified by symptoms like rapid breathing, unresponsiveness, irritation or feeding problems.

In cases which are not severe the symptoms like chest pain, dizziness or slow growth may occur only after few years and not immediately after birth. Variations in heart murmurs, pulse and blood pressure will be the first indication. The condition can be confirmed through an Echocardiography, chest x-ray and Heart CT.

Treatment :

The narrowed part of the aorta will be surgically removed and the open ends will be sutured together. If a major part of the aorta is removed, an artificial device or any of the baby’s artery itself will be used to fill the space. In some cases, doctors may try to widen the narrowed portion of the aorta by using a balloon which will be blown inside the blood vessel. In any case, babies diagnosed with this condition should have periodic consultations with a cardiologist for lifelong.

Medical Term :

Coarctation of the Aorta

The septum is the inner wall of the heart which divides the left and right sides of the upper and lower chambers. The right side of the heart receives the oxygen-poor blood from the body and pumps it to the lungs. The left side of the heart receives oxygen-rich blood from the lungs and circulates to the other parts of the body. Thus septum acts as a separation between the two sides and makes sure the oxygen rich and oxygen-poor blood doesn’t get mixed up. 

Some babies have a hole in this septum valve thereby mixing the oxygen rich and oxygen poor blood. Due to this, the heart may have to work hard to manage the blood circulation. These are called septal defects. They are of two types Atrial septal defect ( A hole in the septum which separates the upper chambers of the heart) and Ventricular septal defects ( A hole in the septum which separates the lower chambers of the heart).

Septal defects can be hereditary or can occur in children with genetic disorders or simply to any child with no reason. A heart murmur can indicate the doctor of a possible heart defect. The septal defects can be determined through a cardiac catheterization, echocardiography, EKG and chest x-ray. 

Treatment :

Atrial septal defects and Ventricular septal defects are diagnosed and treated differently. The treatment also depends on the size and location of the hole. In general small holes will heal by themselves and major conditions may require surgery to patch the hole. 

This condition refers to a combination of four congenital heart disorders which block the flow of blood to the lungs. The four disorders will be

A hole in the septum (wall) separating the two sides of the lower chamber(Left and right ventricles) of the heart. This will cause the oxygen rich and oxygen poor blood to mix up resulting in irregular blood flow. – Ventricular Septal Defect

The muscular valve of the right ventricle will be thicker. This will block the flow of the blood to the lungs from the heart. – Right Ventricular Hypertrophy

The aortic valves which open to the aorta and carries oxygen-rich blood are abnormal and rises above both the ventricles instead of connecting to the left ventricle alone. This can cause some oxygen-poor blood to enter into the aorta and get circulated to the body which should have been originally sent to the lungs. – Overriding Aorta

The pulmonary valve which connects the right ventricle to the pulmonary artery(Which carries oxygen-poor blood to the lungs) thickens/narrows thereby sending less than normal amount of blood to the lungs. This will cause the heart to work harder to pump more blood to the lungs. – Pulmonary Stenosis

All these defects will reduce the amount of oxygen in the blood thereby turning the baby’s skin color to become bluish. This condition can lead to dizziness or seizures or irregular heartbeats or infection in the layers of the heart. Diagnosis will be done through a chest x-ray, electrocardiogram, echocardiogram, and cardiac catheterization.

Treatment :

This condition requires surgery for fixing up all the four defects. A permanent solution or a temporary fix will be carried out in the surgery based on the severity and the baby’s health stability. This will need continuous followup with a cardiologist for a lifetime to ensure that the babies are keeping good.

Medical Term :

Tetrology of Fallot (ToF)

The two major arteries that carry blood from the heart – the pulmonary artery and Aorta are reversed and connected to the inappropriate chambers.

Normally oxygen-poor blood is taken from the heart through the pulmonary artery to the lungs, then the oxygen-rich blood reaches the heart and travels to the other parts of the body to the Aorta. When these two major arteries get reversed the oxygen-rich blood from the lungs will get to the heart and travel back again to the lungs instead of reaching the other body parts. This will keep the oxygen-poor blood to circulate throughout the body and the baby will become bluish.

Baby may not take proper feeding and have shortness of birth. Like other defects, this condition can also be determined through a chest x-ray, electrocardiogram, echocardiogram, and cardiac catheterization.

Treatment :

An immediate temporary fix will be done through medication or a small procedure to keep the fetal blood vessel ductus arteriosus to remain open or to create a hole in the atrial septum wall. These steps can result in a mixing of the oxygen-rich and oxygen-poor blood circulating within the body. A permanent fix will be done through a surgery where the two arteries will be reversed to sit in the correct position.