Common medical procedures

Any baby admitted in the NICU requires special treatment / procedures, regardless of whether there is a need for an incubator to keep it warm or a ventilator to help it breathe. Due to these special needs, each baby will be subjected to a number of medical procedures and tests to determine how it should be treated and how much time should its progress be monitored.

Infusion of intravenous fluids

These liquids pass through the veins into the blood of the baby and consist of sugars, salts, proteins, vitamins and fats (lipids), and all chemical substances, which are needed for optimal growth. These fluids are essential for the progress of your baby while it is unable to eat.

Arterial route

This is similar procedure for infusion, except that an artery is used instead of a vein. This is a more difficult process and takes longer to implement. This small tube is inserted to maintain continuous blood pressure measuring or blood sample taking.

Blood tests

This is one of the most common procedures performed in the intensive care unit. Blood can be taken from the arterial route, the umbilical vein, from the heel or vein puncture. Close monitoring of the he blood of your baby is very important and can alert medical staff for potential problems before they become more serious. Your baby may have a blood test immediately after it is admitted, to check blood gases and to see if it needs supplemental oxygen, mechanical ventilation and / or glucose, to maintain its normal level in the body.

Blood transfusion

It is often necessary, especially in premature babies, so that a safe level of hemoglobin is kept. An adult can donate blood in the blood bank after a test for certain viruses, including HIV, hepatitis and cytomegalovirus (CMV), and after they prove negative.

Endotracheal intubation

A thin tube is inserted through the nose or mouth of a baby into its airways (trachea or windpipe) to help the baby breathe. The tube is then attached tightly to the baby's face, to ensure that it will not be removed. If this tube is occluded (or if the baby is pulling it), it might be needed to be replaced. When the tube is in place, the baby does not produce any sounds, even when it seems like crying.

Examination of the eyes

The eyes of very small premature babies are exposed to risks. For this reason, periodic examinations by an ophthalmologist must be made. Drops will be put in the eyes of the baby before the examination, in order to enable the physician to see the retina (the back of the eye) and to determine whether it develops normally.

Transfontanelle ultrasound - TFU

Premature infants are at risk of brain hemorrhage, and this may be detected by ultrasound scans of the brain of the baby. Transfontanelle ultrasonography (TFU) is an ultrasound examination, which is non-invasive and completely safe, which means that it can be done regularly. This exam provides neonatologists with important information about the status of the child's brain. The method can be used to the moment of closure of the large fontanel of the head. Early diagnosis is crucial for timely and adequate treatment. Transfontanelle ultrasonography (TFU) is a tremendous advantage over the computed axial tomography - CAT (scan), the nuclear magnetic resonance, and the ordinary X-ray, which are associated with radiation. Transfontanelle ultrasonography (TFU) gives information about the status of brain folds, the cortex, the cerebral ventricles, the movement of cerebrospinal fluid; the development of the brain; for postoperative brain condition; the presence or absence of: brain edema, brain hemorrhage, brain abnormalities, brain tumors, prenatal abnormalities and so on.

Трансфонтанелна ехография

Hearing exam

Your baby will have a hearing exam whether before leaving the hospital or shortly thereafter. It is important not to skip this exam, because premature babies or very sick babies are at risk of hearing loss. The test will be carried out by a specialized professional and might be repeated over time, if your baby has problems with one or both ears.

Checking for infections and antibiotics

If your baby is not well, and if there is an infection, a test / examination, which may include blood tests, urine test for possible infections, a lumbar puncture or an image / x-ray examination might be done. While waiting for the results, often a preventive antibiotic treatment is started, and if it turns out that there is no infection, the treatment is stopped.

Intercostal drainage

Some premature babies can develop pneumothorax. It is life-threatening for the baby and is generally a dangerous medical condition caused by the release of small bubbles / air sacs of the lungs of the baby to his chest. Small, flexible plastic tube may be inserted into the baby's chest to remove the collected air or fluid to help the lungs to unfold. In principle, this tube is removed after a few days.

Intravenous route / infusion

This means placing a thin needle (cannula) into a vein. It can become very difficult and can take some time. It is usually inserted into a vein in the arm or the leg of the baby, or on the head. If your baby is big enough, painkillers could be given during this procedure.

Lumbar puncture

Meningitis is very dangerous for babies and can only be diagnosed by a lumbar puncture. A needle is used, through which a small amount of cerebrospinal fluid (CSF) is taken from the lower part of the spine and the sample is sent for testing.

Magnetic Resonance Imaging (MRI)

This is a test which gives a picture of the tissue that can not be seen in X-ray or ultrasound exam. MRI is a modern, non-X-ray method to display all layers of different organs, parts and structures in the body. This diagnostic method may be applied for obtaining detailed images of the nervous system, the brain, the spinal cord, the soft tissues (which are enclosed or surrounded by bone), the skeleton, the muscles, the joints, the cardiovascular system, the organs in the pelvis, the breasts, the fat tissue and others.

Mechanical ventilation

The ventilator is a machine that delivers a predetermined quantity of oxygen and pressurized air through a tube inserted into the trachea / throat of the baby. It can completely replace the breathing of your baby or assist his breathing (depending on the% of oxygen). The amount of oxygen, air pressure and respirations per minute can be adjusted according to the needs of your baby.

Newborn Screening Test

A blood test is done for the detection of hypothyroidism, phenylketonuria and congenital adrenal hyperplasia. This test can help to provide early diagnosis of over 30 different congenital metabolic disorders.

Other ultrasound examinations

Other organs besides the brain (e.g. heart and kidney) may be checked by ultrasound. The ultrasound examination of the heart is called echocardiography.


When the baby has jaundice, it is placed under a special lamp that helps him overcome it faster. The eyes are usually protected with a bandage and your baby can be put into an incubator for the duration of phototherapy.

Feeding through a tube

This is a way of feeding, in which a small plastic tube is placed through the mouth or nose into the stomach of the baby. Milk and medicines are delivered directly into the baby's stomach through it.

Umbilical vein route

A small tube is inserted into a vessel through the navel of the baby. This can be used instead of an intravenous system in the first days of the life of the baby.

Urine test

As well as the blood test, the urine test can tell a lot about the health of your baby. The test can show how its kidneys work and whether the baby has an infection. It can be collected by cotton balls placed in a diaper, a small plastic bag / collector which is attached to the genitals of the child, or through a catheter that is removed immediately after the urine is withdrawn.


Your baby’s weight will be measured shortly after birth and then regularly while in the NICU. It is quite possible that your baby could lose some weight during the first weeks after birth, it is normal for most babies, especially very small ones.

X-ray exam

An X-ray examination of the lungs of the baby is needed if your baby is on a ventilator / intubation or having troubles breathing. Some babies need more than one X-ray exam, depending on their condition. An X-ray exam can also be used for viewing the baby's tummy, the bone structure and to see if the tubes and intravenous systems are installed properly.

Welcome to  "All About Premature Babies" website.
This is a project of "Our premature babies" Foundation based in Bulgaria. The book is a result of a team’s hardwork that includes doctors, psychologists, breastfeeding consultants and premature babies parents. The common information about premature babies which you can find here will help you understand better the situation you've been facing.
Please keep in mind that some of the information related to the neonatal intensive care units is prevalent only in Bulgaria.

We hope that this website and the book are going to help you to be more informed, calm and confident. We wish you and your baby best of luck and health.

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