Routine Medical Procedures

From blood transfusions and echocardiograms to phototherapy and X-rays, we offer a full range of routine medical procedures to evaluate and supervise your baby during his or her stay in the NICU

Routine Medical Procedures We Offer

Blood Tests: Blood tests are necessary to monitor your baby’s condition. Small amounts of blood are taken from your baby to run these tests. These samples are obtained by pricking the heel, drawing blood from an umbilical catheter, or by inserting a small needle into a vein or artery to withdraw blood. Comfort measures are provided to lessen the pain associated with the test.

Blood Transfusions: Some premature babies may require a blood transfusion at some time during their hospital stay if the red blood cell count is too low. Red blood cells are usually given through an IV over several hours. While many people have concerns about blood transfusions, every effort is made to limit transfusions and to provide the safest blood possible. If the doctor thinks your baby will need more than one transfusion, the Minimal Donor Exposure Protocol will be discussed with you. If you have questions or concerns please talk to your baby’s doctors.

Culture: Blood, urine or other body fluids will be tested for the presence of bacteria. Early results of the cultures may be obtained in 24 hours. Final results take 72 hours.

Echocardiogram: In an unborn baby, blood circulates through the heart and lungs through a specialized blood vessel called a ductus arteriosus. This vessel sends much of the blood away from the baby’s developing lungs to the rest of the body. This blood vessel usually closes a short time after baby’s birth. For many premature babies, the ductus remains open for a period of time. Sometimes, in our infants, an echocardiogram is ordered to look for an open ductus arteriosis. The echocardiogram can also give information about how well the heart is working and about the structure of the heart. The echocardiogram uses sound waves that echo against structures in the heart to build up a detailed picture. This is similar to an ultrasound done during pregnancy.

Head ultrasound: A painless, noninvasive procedure that uses sound waves directed through the baby’s fontanel (soft spot) to construct a picture of the baby’s brain. A head ultrasound may be used to diagnose an intraventricular hemorrhage (IVH). With an IVH tiny blood vessels in the premature baby’s brain are fragile and may sometimes rupture resulting in bleeding. This bleeding can occur in different parts of the brain. The severity of the head bleed is determined by the amount of bleeding and its location in the brain. Some babies with an IVH may not develop symptoms, while others may have ongoing neurologic or developmental problems.

Intravenous (I.V.) Therapy: The health care team will determine the IV solution and/or types of feedings best suited for your baby’s needs. When your baby is ready to start feeds, IV fluids will be slowly decreased as feedings are increased. Your baby receives this nutrition in one of several ways:

Peripheral IV Catheter: A short, soft tube may be inserted into your baby’s vein to:

• Supply fluids and nutrition
• Send medication directly into your baby’s bloodstream
• Replace some of your baby’s blood

Because babies’ veins are small and fragile, an IV can come out easily or the IV site may become irritated. It may be necessary to restart the IV several times. Your baby’s arms, hands, legs, feet, and scalp are possible sites for peripheral IVs.

Peripherally Inserted Central Catheter (PICC): A PICC may be used if the baby requires IV therapy for an extended time. A very thin, long tube is placed in a vein in the arm, leg, or scalp and moved into the central circulation. The PICC usually remains in place longer than an IV, so the number of times an IV site must be changed is less. Some fluids cannot be given through a PICC, so a peripheral IV may also be needed. Some babies require long-term IV therapy through surgically placed central lines. A pediatric surgeon inserts the central line if needed.

Phototherapy: Jaundice, a yellow coloring of the skin, is very common for babies during the first few days of life. This condition is caused by an increased level of bilirubin. Babies whose bilirubin levels are too high will be placed under phototherapy lights or on a phototherapy blanket. Their eyes will be covered by patches to protect them from the bright lights. Phototherapy is absolutely painless. Your baby will also be undressed while under phototherapy to allow maximum skin exposure to the light. Your doctor will order a test to check the bilirubin level. As soon as the level has returned to normal, phototherapy will be stopped. Treatment usually lasts for two to seven days, or until the bilirubin levels are within normal limits. Sometimes phototherapy treatment is stopped and then restarted if the bilirubin levels rise again.

Retinopathy of Prematurity (ROP): The blood vessels within the eyes of premature infants and some full term newborn babies are not fully developed at birth. The arteries and veins of the retina are often still growing. The retina is the part of the eye that receives light through the pupil and sends the picture message to the brain. You might think of the eye as a camera and the retina as the film. Retinopathy of Prematurity (ROP) results when these blood vessels grow abnormally. Not all premature babies develop ROP. Babies at higher risk for developing ROP are those who weigh less than 1500 grams (3 lbs 5 oz) at birth or who are born at less than 30 weeks gestation. These babies will receive an eye exam when they are 6-8 weeks old to check for ROP.

The exam is done in the NICU by an ophthalmologist (eye doctor) and takes 5-10 minutes. Just like an adult who has an eye exam, the baby is given eye drops to dilate (widen) the pupils and numb the eye. The eye doctor will look at blood vessel growth and note any problems. The exam may show:

• Blood vessels are immature or still developing. The exam will be repeated in several weeks.
• Blood vessels are not growing correctly and could cause scarring on the retina when they heal. The exam will be repeated in 1-2 weeks.
• Blood vessels have continued to grow abnormally causing scar tissue to form, which can shrink and pull the retina loose from the inside of the eye. This is the most severe form of ROP. The doctor will talk to you about treatment to help protect your baby’s vision.

Your baby’s eye exam is important in the prevention and treatment of ROP so baby can have the best possible vision. With each eye exam the eye doctor watches for signs of ROP. Your baby may need eye exams for several weeks or months to make sure he reaches school age with the best possible vision.

Lumbar Puncture: In a procedure very similar to an epidural, a small needle is inserted into the baby’s lower back. Spinal fluid is removed and checked for signs of infection. Your baby may be started on antibiotics as a precaution before the final culture results are reported. Your baby’s doctor will decide the length of time your baby needs antibiotics. If the baby’s cultures are positive or there are other symptoms of an infection, antibiotics will be given through an IV. If the cultures are negative, antibiotics are often stopped after two to three days.

Umbilical Lines (UACs and UVCs): An umbilical venous catheter (UVC) is a long tube inserted into the baby’s umbilical cord vein. It is used to give IV fluids and medications. An umbilical arterial catheter (UAC) is inserted into the baby’s umbilical cord artery. Blood samples can be taken from the UAC and used to check levels of oxygen or nutrients in the blood. The umbilical cord does not have nerve endings so this is not a painful procedure.

X Rays: An X-ray is a quick, painless test that produces images of the structures inside your body. X-ray beams can pass through your body, but they are absorbed in different amounts depending on the density of the material they pass through. Dense materials, such as bone and metal, show up as white on X-rays. The air in your lungs shows up as black. Some people worry that X-rays aren't safe but the amount of radiation you are exposed to during an X-ray is very small.