The complete resource for NICU families from admission to discharge and beyond

Procedures

Undiagnosed hearing loss in a newborn baby can permanently harm that child’s speech and language development. It is now the law in all 50 states that every newborn baby undergo a hearing test before s/he leaves the hospital after birth. As many as 6 in every 1,000 newborn babies born in the United States will be born with hearing problems. As many as 20% (20 of every 100) premature and sick post-NICU babies will have serious hearing loss as a result of their problems after birth. A specialized newborn hearing screen performed just prior to discharge is the best way to identify babies who may have hearing problems. The test done in the NICU doesn’t hurt your baby and doesn’t make a definitive diagnosis. Babies receiving a “refer” on the newborn hearing screen need to be thoroughly evaluated by a hearing specialist, an audiologist, to be certain. Most babies referred to the audiologist will NOT have hearing problems, but hearing loss is so very important that it’s better to be safe than sorry! After discharge from the NICU, your pediatrician should continue to test your baby’s hearing. If your child is not babbling and starting to say words during his/her first years of life (see “How old is my baby”), you need to tell your pediatrician about your concerns.

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RetinaThe eyes in extremely premature babies – like everything else – are very immature at birth and are not intended to develop in the oxygen-rich environment found outside of the womb. It is a cruel fact of NICU life that the very same life-saving oxygen being given to your baby through what every type of respiratory support s/he is receiving can also cause the blood vessels in the retina of the eye (the part that actually allows you to see) to develop abnormally. If this abnormal development is allowed to progress, it can cause irreparable vision deficits or even blindness. This disease is called retinopathy of prematurity, or ROP, and is somewhat preventable and largely treatable. Starting at about 4 – 6 weeks after birth, or around 32 wks PMA, whichever is later, a specially trained pediatric ophthalmologist will begin to perform periodic eye exams on your baby. Your baby will receive eye drops an hour or so before the exam to numb the eyeball and to dilate the eye to allow the back of the eye to be clearly visualized. The ophthalmolgist is looking to see how far out from the center of the eye the blood vessels have developed, and if they are developing normally. A fully mature eye has blood vessels all the way to the edge of the circle; the closer the blood vessels are to the center of the retina, the more immature. Your baby is at risk for developing ROP until the eye is fully mature, so periodic exams must be performed to monitor this development. Here is a picture of a fully mature retina.

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Putting IVs into tiny baby veins is one of the most difficult procedures a neonatal nurse performs – and one of the most important. Your baby may need an intravenous line for medications, or for fluids and nutrition until s/he is eating entirely into his/her tummy. We use very small catheters, but the medications can be irritating to the vein and the IV may not last more than a day or two before a new one must be started. The best places for IVs are where there’s not much fat so that the vein can be easily seen through the skin. Typically, the first places are the hands and the feet but, over time, these veins are used up and new sites must be found. The scalp is a good place for IVs because there’s no fat to obscure the veins and the baby doesn’t move his/her head around much (which can loosen the catheter). Although parents are frequently disturbed by the idea – and the sight -- of a catheter in their baby’s scalp, it is no different than an IV in the hand or the foot. It is NOT dangerous to your baby! Occasionally, some of your baby’s hair may need to be clipped to access the vein. If so, ask your NICU nurse to save it for you as a memento of your baby’s first haircut! Nurses are typically sensitive to parents’ distaste of scalp IVs, and only use the scalp when no other suitable sites are available.

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