High-Risk Newborns - Procedures and Equipment in NICU
NICUs are equipped with complex machines and monitoring devices designed for the unique needs of tiny babies. There are mechanical ventilators (breathing machines), oxygen, medications, and supplies for medical care. Furthermore, there is technology to monitor nearly every system of a baby's body including body temperature, heart rate, breathing, oxygen and carbon dioxide levels, and blood pressure. The following list includes some of the monitoring equipment often used in the NICU:
- heart or cardiorespiratory monitor
This monitor displays a baby's heart and breathing rates and patterns on a screen. Wires from the monitor are attached to adhesive patches on the skin of the baby's chest, abdomen, and leg.
- blood pressure monitor
Blood pressure is measured using a small cuff placed around the baby's upper arm or leg. Periodically, a blood pressure monitor pumps up the cuff and measures the level of blood pressure. Some babies need continuous blood pressure monitoring. This can be done using a catheter (small tube) in one of the baby's arteries.
A temperature probe is placed on the baby's skin with an adhesive patch. A wire connects the temperature probe to the overhead warmer (or isolette) to help regulate the heat needed to keep the baby warm.
- pulse oximeter
This machine measures the amount of oxygen in the baby's blood through the skin. A tiny light is taped to the baby's finger or toe, or in very tiny babies, a foot or hand. A wire connects the light to the monitor where it displays the amount of oxygen in the baby's red blood cells.
- transcutaneous oxygen/carbon dioxide monitor
This machine measures the amount of oxygen and carbon dioxide in the baby's skin. A small circular pad is taped on the baby's skin. The pad warms a small area of skin underneath and measures oxygen, carbon dioxide, or both. A wire connects the pad to the monitor and displays the levels. Because the transcutaneous monitor heats the skin, it must be moved to different places on the baby's skin periodically. The heating may leave a temporary reddened spot on the baby's skin, but this will fade. Transcutaneous oxygen levels are usually lower than levels of the pulse oximeter.
Ultrasound uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood blow through various vessels. In the NICU, ultrasound may be used to examine the heart, abdomen, and internal structures of the baby's brain. Ultrasound is painless and provides much information about a baby's health.
Portable x-ray machines may be brought to the baby's bedside in the NICU. X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. X-rays are taken for many reasons including checking the placement of catheters and other tubes, looking for signs of lung problems such as hyaline membrane disease, and checking for signs of bowel problems.
- computed tomography (Also called CT or CAT scan.)
A CT scan is a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays. CT scans also minimize exposure to radiation. CT scans are sometimes done to assess bleeding inside a baby's head. A CT scan is done in a special room and the baby will need a sedative medication so that he/she will be motionless for the exam.
- magnetic resonance imaging (MRI)
MRI is a diagnostic procedure that uses a combination of a large magnet, radio frequencies, and a computer to produce detailed images of organs and structures within the body. Like a CT scan, MRI is performed in a special area of the hospital. It is often done to examine a baby's brain stem, spinal cord, and soft tissues. The baby will need a sedative medication so that he/she will be motionless for the exam.
- endotracheal tube (ET)
This tube is placed through the baby's mouth or nose into the trachea (windpipe). The ET tube is held in place with special tape and connects to a mechanical ventilator (breathing machine) with flexible tubing. An x-ray is used to check the tube's placement. When a baby has an ET tube, he/she is unable to make sounds or cry.
- respirator or mechanical ventilator
This machine helps babies who can not breathe on their own or who need help taking bigger breaths. High frequency ventilators give hundreds of tiny puffs of air to help keep a baby's airways open. Ventilators can also deliver extra oxygen to the baby.
- continuous positive airway pressure (CPAP)
Through small tubes that fit into the baby's nostrils, called nasal CPAP, this machine pushes a continuous flow of air or oxygen to the airways to help keep tiny air passages in the lungs open. CPAP may also be given through an ET tube.
- extracorporeal membrane oxygenation (ECMO)
This is a special technique for babies with respiratory disease that does not respond to maximum medical care. With ECMO, blood from the baby's vein is pumped through an artificial lung where oxygen is added and carbon dioxide is removed. The blood is then returned back to the baby. ECMO is only used in specialized NICUs.
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