The premature baby ward

First Impressions

No question, the premature and neonatal ward is a wonderful setting! But as a stranger, you feel like you are on another planet. Hard to imagine that many premature babies spend the first three months of their lives at this station. It smells like hospital, it is very warm and the light sources are sometimes bright neon tubes. Do not worry: the more familiar the environment becomes, the better you get to know caregivers and doctors, the safer you will feel.

The Maternity and Infant Station staff

The nurses are all specially trained for these stations. For example, they also test your child's hearing and vision. There is a chief or senior medical officer who is responsible for the medical care of the newborn and other paediatricians. There are also cleaning staff and a technician who takes care of the equipment.

Equipment

Heat Bed and Incubator

The Heat Bed is a clear plastic box on wheels. Incubators, on the other hand, have a lid, bullseye-like doors and double-glazed walls to keep the heat inside. Air temperature, oxygen content and humidity can be regulated. A cloth can shield the light if necessary.

The open incubator and the warming bed have no lid, but the heat can still be stored by certain devices. At one end of the bed is possibly a pole with shelves, a bow, a canopy and a radiant heater from above. Also, a heat pad from below can warm the cot.

Under the incubator there is a closet for your baby's diapers, cotton balls, rompers and other things.

Pleasant Warmth

Either a device measures your baby's skin temperature or the nurses do it and regulate the temperature if necessary. If a meter is present, it will regulate the temperature in the incubator and sound an alarm if it gets too hot or too cold.

Ingestion

A baby who can not be breastfed or fed with a bottle gets food through a thin plastic tube. This tube is passed through the nose or mouth (naso-gastric or oro-gastric tube) - and passes through the esophagus into the stomach. The free end is attached to the cheek with a plaster.

A baby who can not digest the food or who is too ill receives liquid food intravenously. A fine plastic tube is inserted into a vein on the arm, leg, head or stomach.A plaster prevents the hose from slipping.

Heart Rate, Respiration, and Blood Pressure

Your baby's heartbeat can be checked by a sensor on his hands or feet.

Breathing is monitored by a sensor that attaches to your child's chest or abdomen - there are also sensors in the mattress. If your baby stops breathing, or if the respiratory and heart rates are abnormally high or low, an alarm will sound, which of course immediately calls a nurse on the scene.

Incorrect alarm is not unusual and is usually due to the release of a sensor. The part of the brain that is responsible for an adult baby breathing automatically does not necessarily work reliably in premature babies. This can lead to apnea - ""respiratory arrest"" - during these times the baby will be breathing for 15 to 20 seconds.

Blood pressure is checked with a small arm or leg cuff. If your baby is attached to a catheter, it will be monitored by a monitor that is part of that catheter.

Sometimes heart rate, blood pressure, oxygen supply, temperature and respiration are displayed on a monitor at the same time.

How to Monitor Oxygen Delivery

In babies who have difficulty breathing, it is important to monitor oxygen and carbon dioxide in the blood. This can happen in different ways:

  • A blood gas analyzer measures the oxygen and carbon dioxide levels in samples taken from an artery using a fine tube attached to a thin needle (which is immediately removed after laying) is introduced into an artery on the abdomen, wrist or ankle. Sometimes even a small sensor directly in the artery measures the oxygen content. Blood gases can also be measured in samples taken from the baby's heel.
  • A pulse oximeter (monitor for measuring oxygen saturation) has a sensor that reacts to infrared light that illuminates the skin. This device registers whether the blood in the skin is red and oxygenated or blue and low in oxygen. For when there is a lack of oxygen, the blood first flows out of the skin to the more important organs. A lack of oxygen shows up first on the skin. If the oxygen content is too low, an alarm will be triggered.
  • A transcutaneous monitor has a sensor that is activated by heat and measures the oxygen and carbon dioxide levels where the blood flows through heated skin.

Breathing Help

1. For babies who can breathe on their own but need extra oxygen, oxygen-enriched air is enough. This air is either piped directly into the incubator or into a Plexiglas box over the child's head. And the oxygen-rich air can also be supplied through a thin plastic tube, the opening of which is under the baby's nose.The nursing staff can regulate both the oxygen concentration and the air supply.

second For example, babies who need a bit of breathing assistance can use positive pressure ventilation called PEEP (positive end-expiratory pressure or positive end-expiratory pressure). This method maintains a positive pressure in the lungs during exhalation, which has several benefits.

third A mechanical ventilator (respirator) ""breathes"" for a baby that is too underdeveloped or too weak to independently and effectively pump oxygen-rich air into the lungs. Typically, a respirator is used for respiratory distress syndrome and for repeated apnea (respiratory arrest attacks). (See Respiratory Distress Syndrome.)

There are two types of mechanical ventilators:

  • One that takes over breathing altogether. In this case, the baby usually gets sedatives.
  • One who allows breathing through the baby. In this case, the baby can breathe independently. However, if it stops breathing or does not breathe deeply enough, the respirator responds to the baby's breathing or weakens breathing.

A ventilator blows air through wide, ribbed tubing that ends in a tube that is then passed through the nose or mouth into the trachea. The baby receives at regular intervals (as with regular breaths) moist, oxygen-rich air with slight overpressure supplied, which flows into the lungs. In the breaks, the carbon dioxide-containing air escapes from the lungs. The fan is set to allow 20 to 40 breaths per minute. You will hear a light click with every breath.

Sometimes babies are ventilated at high frequency (high frequency ventilation). Then very quickly small amounts of air are pumped into the lungs. And if an apparatus called an oscillator is used, the child's chest will vibrate.

It is the goal of caregivers that a baby does not need a ventilator as soon as possible. But it is not uncommon for premature babies to rely on a fan every now and then until they can breathe all by themselves.

If a baby has been using a ventilator for a long time and is still not breathing well enough to get enough oxygen, the doctor may introduce a tracheostomy tube under the larynx into the trachea. (Through a tracheotomy) This leaves mouth and nose free and can be removed as soon as the baby can breathe on its own.

Treatment for Jaundice

In a light treatment, the ill baby is exposed to bright blue or blue-green light (not ultraviolet). This can be a separate device - or a device that belongs to the intensive child's bed. Eye protectors or orange head protection should shield the eyes of the child.

A bilirubinometer is an apparatus that measures the amount of bilirubin in the blood serum of a baby with jaundice. This serum is the liquid part of the blood and is separated using a centrifuge.

Blood is being analyzed

Some babies need to be tested for blood gases, hemoglobin, platelets, bilirubin and sugars.

Some premature babies can not regulate blood sugar themselves because they have no sugar reserves. A low blood sugar level (hypoglycaemia) makes her nervous and frightening. Non-treatment can, in the worst case, lead to cramping and brain damage. Regular blood glucose tests - sometimes every hour for very small or sick babies - warn caregivers if the level of sugar drops too much.

Other Examinations

Your baby's head is regularly examined at weekly intervals - if necessary more often - by ultrasound. This way, problems such as bleeding, bruising or scarring in the brain can be detected early.

Radiographs show that the probes and tubing are in place. They help to monitor the lungs and to clarify any problems.

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