Equipment in the NICU: what does what?
You may feel shocked initially, seeing all the medical equipment, which they treat your baby with. Noises, beeps, clicks, alarms and flashing lights from the machines seem strange at first, but over time, you will become familiar with the equipment and learn how each device helps your baby.
There are many different types of technology devices in the intensive care sector of a NICU, including various types of ventilators, monitors and life support devices. Below you will read some more detailed information that can help you identify the types of equipment in the NICU.
Scales / E-scales
The scales may not be one of the most modern equipment in the NICU, but is one of the most important. Each meal, either intravenous or medication one is pre-calculated, based on the weight of your baby. That is why it is vital that the weight is accurate, timely, and accessible at any time of day. Measuring the weight of your baby is one of the main morning tasks in the NICU, the child is measured at the same time and in the same way every day. Then the weight is recorded in its health card. The net weight is consistent with the weight of the diaper as well as any medical equipment attached to your baby. Usually, it is recorded in grams and is calculated with accuracy of up to +/- 5 grams.
This is a device which recognizes the cardiac and respiratory activity. Sometimes, it is called cardiac activity monitor. Adhesive patches, connected by cables, are put / stuck to the breasts, abdomen, arm or leg of the baby. The cables are connected to a device that records cardiac activity of the baby, heart strokes per minute and the number of breaths. If the heart rate or breathing of your baby are too fast or too slow, the machine will notify a staff member via an alarm.
Equipment, assisting baby’s breathing
Oxygen and oxygen mask
Oxygen can be provided directly in the incubator of the premature baby or through an oxygen mask and is often used when the child can breathe independently, but still needs supplemental oxygen.
This is a plastic tube which passes behind the ears and ends with two nozzles, which are inserted into the nostrils of the child. The nasal cannula is attached to the oxygen cylinder or to a portable oxygen generator, or to one that is attached to the wall in the hospital, via a tube, in which oxygen flows through the two tubes delivering supplemental oxygen to the premature baby. Low-flow oxygenation –this is a method for supplying oxygen to the baby via a thin, soft, plastic tube placed in the nostrils. The tubing is attached to the baby's nostrils and oxygen is delivered through small holes that are placed just under the nose of the baby.
When the premature baby needs additional intake of oxygen, often both the air and the oxygen go through a moisturizer first. It helps through moisturizing and warming oxygen.
Continuous positive airway pressure. Many premature babies need help with breathing. One or two plastic tubes are placed in the baby's nostrils and oxygen is provided under pressure in small quantities. Providing oxygen under pressure helps the lungs remain expanded and reduces the efforts that are necessary for your baby to breathe. To ensure that the pressure / oxygen enters the respiratory tract of the baby, it is important that the mouth is closed. Sometimes, this is achieved with the use of a small leather strap. It keeps the airway open during sleep and prevents breathing pauses in infants with apnoea and other breathing problems. The mask does not breathe instead of your baby, the air flow is under such a pressure that is necessary for your baby's breathing.
If the CPAP is not sufficient to support your baby's breathing, a small plastic tube (ETT - an endotracheal tube) is inserted through the nose or mouth of the baby into the trachea. The airway tube enters the lungs of the baby and allows the flow of oxygen or air under pressure directly into the lungs. The endotracheal tube is connected with a ventilator (or respirator) - a machine that provides warm and humid air in the lungs of the baby. It can breathe entirely instead of your baby, or just assist his breathing. The amount of oxygen, the pressure and the number of breaths per minute can be adjusted so that they are best suited for your baby's needs. Sometimes, a ventilator that can sway the chest of the baby is used (high-frequency ventilator). It provides a lower pressure, but much faster. Both ventilators will be explained in detail by the specialists in the NICU.
Serves to increase the oxygen concentration around the baby.
Nasal or oral feeding tube
The gastrointestinal tract of preterm babies is immature, which means that these babies often have difficulties in digestion. It is important that premature babies receive good sources of food to help them develop and grow. Any premature baby has specific nutritional needs that will be determined by the physician who cares for the baby. Premature babies cannot be fed orally at the beginning. That is why, it is necessary they receive important nutrients via blood vessels (parenteral nutrition - nutrition, which is done through infusion of nutrients in the form of solutions directly into the blood). When the baby is stabilized, it can start receiving breast milk or infant formula. The time may vary, depending on the condition of the baby. Since premature babies are unable to be fed directly from the breast or a bottle until gestation week 32-34, they can be fed through a thin, flexible tube (probe). Feeding by a tube is done through the nose or mouth directly into the stomach (nasal and oral gavage). The nasal tube is inserted through the baby's nose and the oral one in his mouth and throat to the stomach. Feeding can begin in small portions to prepare the gastrointestinal tract to digest. Mothers of premature babies can express their breast milk and their babies could be fed with it through a tube. Although there are specially developed formulas, breast milk remains the ideal source of nutrition for prematures and babies born at term.
The intake of breast milk reduces the risk of:
- Nosocomial infections
- Necrotizing enterocolitis (NEC)
- Chronic lung disease
Umbilical venous and arterial catheters
When a baby is in the womb, it is fed through the umbilical cord. After birth, the navel can be used to insert is a small catheter, through which nutrients, in the form of a solution or medications, are inserted, the blood pressure can be measured or blood samples could be taken from.
Premature babies are usually cared for in an incubator, where their temperature is regulated and they receive intravenous fluids safely in a stable environment. Incubators have small holes that allow doctors and nurses to perform manipulations, and you to touch your baby. The incubator preserves the warmth of the baby through humid air that is fed into it, which is important, because the hot, dry air from the outside can harm premature babies who are vulnerable and their skin is delicate. Premature babies have difficulty controlling their own temperature and can lose a lot of water through the skin. Incubators prevent this from happening. They also protect your baby from the noise in the NICU, infections and unnecessary contact.
Oxygen analyzer of the air in the incubator
This is a device inside the incubator, which monitors the amount of oxygen in the air inside.
A bed, which is maintained warm and allows for easy access to the baby at any time during his stay in the NICU. This is an open bed that has special heaters. Some sick babies are placed in such beds instead of being in an incubator, if they often need to be hugged / drawn out, or if they are too large to be placed in an incubator, but are still in need of intensive care.
Phototherapy is used for the treatment of neonatal jaundice. The neonatal jaundice is characterized with an excess of bilirubin in the blood, which causes the skin and sclera (white of the eye) to become yellowish. The baby is exposed to special blue light which reduces the level of bilirubin in the body. The eyes are covered with a mask to prevent injury. Ultraviolet light treatment can increase the risk of moles in childhood. Since the increase of the mole is associated with an increased risk of skin cancer, ultraviolet light is not used for the treatment of neonatal jaundice. Instead, blue light having a specific wavelength is used, which does not bear any risks. Treatment can be in the form of phototherapy and / or with blanket for phototherapy.
This is a portable device for phototherapy to treat neonatal jaundice. The name (Biliblanket) is a combination of bilirubin and blanket. Other names used are a system for home phototherapy, a bilirubin blanket or a blanket for phototherapy. Phototherapy is done by a lamp that emits blue light on the baby's skin. This technology uses fiber optics that emit bright light to treat jaundice in babies. The blanket is placed directly on the baby's skin and fiber optics are used to transport the light sources to it. Light absorption leads to bilirubin reduction.
It shines with bright blue light. The lights are placed over the baby’s incubators or bed and the baby is usually dressed only in diapers and wears a blindfold. Jaundice usually disappears in the third week after birth. Jaundice is common (in about 70% of babies).
The intravenous catheter is a thin, flexible tube inserted in one of the major veins of the baby. It can be placed in the arm, the leg, the head or the umbilical cord. Most babies in the NICU have an intravenous catheter for insertion of fluids, nutrients and medications. Instead of injecting your baby every few hours, the systems allow certain medications to be introduced continuously. Doctors may use these medications to control heart function, blood pressure, or pain for relief. Sometimes, an intravenous catheter is required for a longer period of time and / or to deliver larger volumes of fluids and medicines, and for this purpose they use a central catheter. It is placed in the larger and central veins of the chest, neck or groin. This type of catheter lasts longer and requires less frequent replacement, which means less discomfort for your baby.
Infusion pump / syringe pump
A syringe pump is used for neonatal infusion therapy. The syringe pump is a device which permits a slow and dosed introduction of the medications, electrolyte solutions and fluids for parenteral nutrition. Dose adjustment of the inserted medication can be carried out during the process of work. There is a possibility for simultaneous application of several medications. Infusion pumps go together with a syringe and extension cords that connect with an abocath. It is necessary that the nurse has provided in advance a lasting venous pathway, which is checked for patency. After the syringe pumpis connected to the patient, the nurse sets the speed and time for the substance introduction. It has an alarm system and a fault or the completion of the medication insertion starts an alarm that notifies the staff.
If your baby needs to measure the amount of its urine or take a urine sample, sometimes a catheter might be inserted. It is soft and is being removed as soon as necessary.
Monitor for following vital parameters
Monitor wires are attached to sensor pads placed on the baby. This gives important information on how the major operating systems in the body of the baby work. Information from several different types of monitors is often combined into one device that emits via a TV monitor type.
It indicates the amount of oxygen in the blood to your baby using an infrared light sensor. It is usually attached to the hand or the leg of the baby. It is very important because too much or too little oxygen could cause health problems in the long term.