Neonatology
Glossary
A, B, C, D, E, F, G, H, I, J, L, M, N, O, P, R, S, T, U, V, Z
Albuterol
- A inhaled drug which dilates the airways to
make it easier to breathe. Used to treat bronchospasm,
which occurs with chronic lung
disease.
Anemia - A red blood
cell count (See: hematocrit)
which is less than normal. Occurs nearly universally
in premature infants (anemia of prematurity) and
may result in the need for blood
transfusions.
Antibiotic - A drug which kills bacteria;
administered for the purpose of treating a possible
or definite bacterial infection.
Arterial Line - A catheter placed into
a peripheral artery (See: peripheral
arterial line) or umbilical artery (See: umbilical
lines) for the purpose of drawing blood samples
and monitoring blood pressure.
Apnea - Lack of air
movement into the lungs. This can be due either
to an infant not trying to take breaths (central
apnea), or an obstruction of the airway causing
air flow to cease despite the infant making attempts
to breathe (obstructive apnea). Both the central
and obstructive types of apnea are very common
in premature infants. Central apnea in prematures
is referred to as "apnea of prematurity",
and is often treated with caffeine.
Apnea Monitor - For use at home following
discharge from the hospital, an instrument that
monitors continuously for events of apnea
or bradycardia. If an event
occurs, it is recorded in the monitor's memory,
and an alarm sounds.
Appropriate for Gestational Age (AGA)
- Birth weight between the 10th and 90th percentile
for gestational age.
BAER (Brainstem Auditory Evoked
Response - See: Hearing Screen.
Bagging - The use of
a rubber bag connected to an oxygen supply, which
is squeezed by hand to force oxygen into the lungs
via a face mask or endotracheal
tube.
Bilirubin - A yellow
substance produced by the breakdown of hemoglobin,
the red oxygen-carrying substance in blood cells.
(See: hyperbilirubinemia,
jaundice, phototherapy)
Birth defect - See congenital
defect.
Blood Culture -
A blood sample drawn for the purpose of determining
whether bacteria are present in the blood. The
sample is processed by the microbiology laboratory,
and results are usually available within one to
three days. If bacteria grow from the blood, they
will be identified, and the optimal antibiotic
treatment for the bacteria will be determined
by the laboratory. (See: Sepsis
workup)
Blood Gas - A blood test used to determine
the amounts of oxygen, carbon dioxide, and acidity
in the blood. Information from this test is used
to adjust ventilators and therapy for lung diseases.
This is one of the most common tests in the ICN,
and may be performed using blood from an artery
(arterial blood gas [ABG]), vein (venous blood
gas [VBG]), or heelstick (capillary
blood gas [CBG, "cap gas"]).
Blood Transfusion -
The administration of blood (red
blood cells), supplied by the blood bank,
through an intravenous line
to correct anemia. Used
to improve the oxygen carrying capability of the
blood. Other blood products can be transfused
as well (See also: platelets,
plasma). All blood products
are supplied by the blood bank.
Bradycardia - Excessively
slow heart rate. Usually transient and often associated
with apnea and desaturation.
Bronchopulmonary Dysplasia (BPD) - Same
as chronic lung disease.
Bronchospasm - Sudden
constriction of the airways, resulting in difficulty
with breathing. May require treatment with albuterol,
bagging, and may cause desaturation
and bradycardia until the
episode resolves. Most common in infants who have
been on a ventilator for some
time, or who have chronic lung
disease.
Caffeine
- A drug which stimulates the respiratory center
of the brain, and is used to treat apnea
of prematurity. Consumed by adults in coffee and
soft drinks, caffeine has fewer side effects and
less stimulant activity in infants.
Car Seat Test - Performed prior to an
infant's discharge home, he/she is placed in a
car seat for a period of time to see whether apnea
or bradycardia develop when
in the car seat posture.
Catheter - A thin tube
placed within a blood vessel for the purpose of
administering fluids and/or obtaining blood samples.
(See: intravenous line, central
venous line, peripheral venous
line, PICC, umbilical
catheters). A urinary catheter is a thin tube
placed within the bladder for the purpose of draining
urine.
CBC (Complete Blood Count)
- A blood test analyzing the number and type of
white blood cells, the concentration of hemoglobin,
the percentage of blood volume consisting of red
blood cells (hematocrit), and
the number of platelets.
Central Venous Line
- An intravenous catheter
that is inserted either through the skin (see:
PICC) or through the umbilical
cord vessels (see: umbilical catheters)
and advanced so that the tip rests in a major
vein within the abdomen or chest. Such catheters
provide more secure and longer-lasting access
than peripheral intravenous lines,
and may be used for the administration of more
concentrated hyperalimentation
solution.
Chromosome Analysis - To assess for the
presence of a genetic disorder, a sample of blood
may be drawn and the chromosomes examined. All
of a person's genetic material (DNA) is contained
in the chromosomes. Any variation from normal
in the structure of the chromosomes can cause
alterations in body structure or development.
Chronic Lung Disease (CLD)
- Persistent inflammation, injury, and scarring
of lung tissue that occurs as a result of underdevelopment
of the preterm lung, as well as the treatments
needed to support the immature lungs. (Also known
as Bronchopulmonary Dysplasia (BPD)).
Congenital Defect -
An external or internal defect (anomaly) that
an infant is born with.
Corrected Age - Gestational age at birth,
plus the number of weeks following delivery. Thus,
an infant born at 30 weeks who is now 10 weeks
old, has a corrected age of 40 weeks, equivalent
to full term.
CPAP (Continuous Positive
Airway Pressure) - Used for the treatment
of lung disease or breathing difficulty that is
not severe enough to require an endotracheal
tube and ventilator. CPAP
is the application of continuously pressurized
air and oxygen to the airways and lungs via small
tubes placed in the nostrils or a soft mask placed
over the nose. These tubes fit tighter to the
nostrils than those of a nasal
cannula. CPAP keeps lungs partially inflated
between breaths, which makes breathing easier.
CRP (C-Reactive Protein)
- A blood protein which becomes elevated when
infection is present. CRP is used as a test to
help determine the presence of infection.
CT (CAT) Scanning (Computed Tomography)
- A patient is placed within a scanner which uses
X-rays to generate cross-sectional images of the
head or body.
Curosurf™ - A preparation of surfactant
derived from the lungs of pigs.
Cyanosis - Blue coloration of the skin
caused by a low level of oxygen in the blood.
Desaturation
- A drop in the blood oxygen level, generally
detected by a pulse oximeter.
Often associated with apnea
and bradycardia.
Directed Donor - A person donating blood
for a specific patient.
Diuretic - A drug which
increases urine output. Infants with edema
or chronic lung disease may
be treated with diuretics, and a diuretic may
be given following a blood transfusion.
Lasix and Diuril are the most common diuretics
used in the ICN.
ECG (electrocardiogram)
- A noninvasive and painless study, in which electrodes
placed on the chest record the electrical activity
of the heart.
Echocardiogram - The use of ultrasound
to view the structure and function of the heart.
Edema - Swelling of
a tissue due to excessive accumulation of fluid.
Skin edema is common. Edema in the lung is called
pulmonary edema and may interfere with lung function.
Edema is treated with diuretics
and restriction of the amounts of fluids administered.
EEG (electroencephalogram) - A noninvasive
and painless study, in which electrodes placed
on the scalp record the electrical activity of
the brain. May be used to diagnose seizures.
Electrode (also Probe, Sensor) - An adhesive
patch placed anywhere on the body, and connected
by a wire to a monitor, used to detect heart rate,
respirations, or blood oxygen levels. (See also:
pulse oximeter)
Electrolytes ("Lytes") - Minerals
dissolved in the blood. Electrolytes analyzed
routinely by blood tests include sodium, potassium,
chloride, bicarbonate, calcium, phosphorus, and
magnesium.
Endotracheal Tube (ETT)
- A tube placed into the mouth and into the trachea
(windpipe) and connected to a ventilator
for the purpose of assisting breathing. The endotracheal
tube is taped in place to the skin around the
mouth. A special flashlight (laryngoscope) is
used to see the vocal cords when inserting the
endotracheal tube. Because the endotracheal tube
is placed between the vocal cords, an infant with
an endotracheal tube in place cannot make vocal
sounds or cry.
Enteral Nutrition
- Use of the gastrointestinal tract for nutrition,
using either breast milk or formula fed by mouth
and/or tube.
Exchange Transfusion
- As a treatment for extreme hyperbilirubinemia
for which phototherapy is
insufficient treatment, an infant's blood is replaced
with blood from the blood bank. This is done in
a slow and controlled manner, and is very effective
at lowering bilirubin levels.
Extremely Low Birth Weight
(ELBW) - Birth weight less than 1000 grams
(2 lbs, 3 oz). (See also: Low Birth
Weight (LBW), and Very Low
Birth Weight (VLBW))
Full Term
Infant - An infant born between 37 and 42
weeks gestation.
Gestational
Age - Duration of time that a fetus has spent
developing in the uterus. Estimated using the
date of the mother's last menstrual period (LMP),
or by ultrasound of the unborn
fetus. The gestational age of a newborn infant
can be estimated by careful physical examination
and scoring of certain criteria (Dubowitz or Ballard
exam).
Hearing
Screen - A test performed on all infants prior
to discharge, in which a machine monitors brain
waves in response to clicking sounds played through
headphones. If the brainwaves are normal, this
indicates normal hearing pathways in the brain.
Also known as a BAER (Brainstem Auditory Evoked
Response).
Heelstick - A sample
of blood taken from an infant's heel. This is
the most common means of obtaining blood specimens
from infants, and is often preceded by placing
a heel warmer on the foot to increase the flow
of blood to the skin.
Hematocrit (HCT) - The
fraction of blood volume consisting of red blood
cells. (Example: a hematocrit of 40 means that
red blood cells account for 40 percent of the
total blood volume.)
Hydrocephalus - An enlargement of the
fluid filled spaces (ventricles) of the brain.
Hyperalimentation
- An intravenous (parenteral)
solution containing all the nutrients necessary
for growth, including amino acids, glucose, vitamins,
minerals, and fats.
Hyperbilirubinemia
- Elevation in blood bilirubin
level, causing jaundice.
Most newborns have a rise in bilirubin in the
first days following birth. At very high blood
levels bilirubin can be toxic to the nervous system;
therefore, blood bilirubin levels are followed
on babies with jaundice so that treatment can
be started before levels become excessive. High
bilirubin levels can be treated with light therapy
(see: phototherapy). Uncommonly,
extreme bilirubin levels unresponsive to phototherapy
may require an exchange transfusion
to drop the bilirubin level.
Hyaline Membrane Disease
(HMD) - The lung disease characteristic of
premature infants. HMD is caused by a deficiency
of surfactant in the lungs.
Also known as respiratory distress syndrome (RDS).
Incubator
- Often referred to as an Isolette™, an enclosed
clear plastic housing that provides a heated and
sheltered environment for the care of infants
that are too small or sick to maintain their own
body temperature. The heat adjusts automatically
to keep an infant's body temperature constant.
(See also: radiant warmer)
Infasurf™ - A preparation of surfactant
derived from the lungs of cows.
Intrauterine Growth Retardation (IUGR)
- An infant, of any gestational
age, whose intrauterine growth was less than
expected. There are numerous causes, including
infection and placental dysfunction.
Intraventricular Hemorrhage
(IVH) - Bleeding into the internal fluid-filled
spaces of the brain (ventricles), or into the
brain tissue adjacent to those spaces. There are
four grades of IVH, indicating degree of severity.
IVH is diagnosed by ultrasound
examination of the brain.
Intravenous Line (I.V.)
- A thin tube (catheter) placed
into a vein for the purpose of administering fluids
and medications. (See also: peripheral
intravenous line, central
venous line, umbilical lines,
PICC line)
Isolette™ - See incubator.
I.V. - See intravenous line.
Jaundice
- Yellow coloration of the skin and eyes due to
an elevation of bilirubin.
(See: Hyperbilirubinemia)
Large for Gestational Age
(LGA) - Weight above the 90th percentile for
gestational age.
Liver Function Tests (LFT's) - Laboratory
analysis of blood levels of substances produced
by the liver. High levels may indicate liver dysfunction.
Low Birth Weight (LBW)
- Birth weight between 1500 grams (3 lbs, 5 oz)
and 2500 grams (5 lbs, 8 oz). (See also: Very
Low Birth Weight (VLBW), and Extremely
Low Birth Weight (ELBW))
Lumbar Puncture (spinal
tap) - A procedure in which a fine needle
is inserted between two vertebrae at the base
of the spine for the purpose of obtaining a sample
of spinal fluid. The most common reason for performing
a lumbar puncture is to look for signs of meningitis.
The fluid is sent to the lab for culture and an
assessment of the number of white and red cells
present. (See: Sepsis workup)
Macrosomia - Birth weight
greater than 4000 grams (8 lbs, 13 oz).
Magnetic Resonance Imaging
(MRI) - A patient is placed within a scanner
which uses magnetic fields to generate cross-sectional
images of the head or body. No X-rays are used.
Meconium - An infant's
first stools, dark green or black in color, consisting
of residue from intestinal development. Meconium
is replaced by actual stool (consisting of digested
milk) once the infant begins feeding.
Meconium Aspiration - Meconium
passed by the infant prior to delivery may mix
with the amniotic fluid and be inhaled by the
infant before birth. Meconium is not normally
passed before delivery, but this may occur if
the unborn infant is stressed. Such stress may
have a variety of causes. If meconium is inhaled,
it can cause pneumonia. This
situation is termed meconium aspiration syndrome.
Meningitis - An infection
of the central nervous system. May be diagnosed
by doing a lumbar puncture.
Metabolic Screen - See Newborn
Metabolic Screen.
MRI - See Magnetic Resonance
Imaging
Nasal
Cannula - Short, thin tubes placed into the
nostrils, through which oxygen is administered.
Used in cases of mild or chronic
lung disease which are not severe enough to
require use of CPAP or a ventilator.
Nasogastric Tube (NG Tube) - See Orogastric
Tube.
Necrotizing Enterocolitis
(NEC) - An infection of the intestine, sometimes
occurring in premature infants who have begun
to feed. NEC is usually treated successfully by
withholding feedings and administering antibiotics.
If severe, surgery may be required.
Neogen Screen - See Newborn
Metabolic Screen.
Neonate - Any infant (premature or term)
in the first 28 days of life.
Neonatologist - A physician who has completed
training programs in both general pediatrics and
neonatology (the care of critically ill newborns).
Newborn Metabolic Screen
- A sample of blood from every newborn is sent
on a filter paper to the State and to a private
laboratory (Neogen™) and tested for a large
variety of rare congenital metabolic disorders.
NPO - An infant who is NPO is not receiving
feedings by mouth or orogastric
tube. Infants who are NPO are typically given
intravenous nutrition (See: hyperalimentation).
Nurse Practitioner - A registered nurse
who has completed a Master's degree program in
the medical care of critically ill newborns.
Orogastric
Tube (OG Tube) - A tube placed from the mouth
down to the stomach for the purpose of draining
air and secretions from the stomach and/or for
feeding infants who are not ready to breast or
bottle feed. Alternately, the tube may be passed
from the nose to the stomach (nasogastric (NG)
tube).
Oscillator - See ventilator.
Oxygen Hood (Oxyhood) - A tent placed
over the head of an infant for the purpose of
delivering supplemental oxygen.
Parenteral
- Administration of fluids intravenously. (See
also: hyperalimentation
and enteral nutrition.
Peripheral Arterial Line
- A short catheter placed into an artery at the
wrist or foot for the purpose of drawing frequent
blood samples and monitoring blood pressure continuously.
An arterial line may also be placed through the
umbilical cord (See: umbilical
lines).
Peripheral Intravenous
Line - A short catheter
placed into a vein for the administration of fluids
and medications. These catheters are often placed
in the hands, feet or scalp, and are intended
for short-term (up to several days) use. If longer-lasting
intravenous access is needed, a centrally placed
catheter may be needed (See also: central
venous line, umbilical lines,
PICC line).
Phototherapy - The
use of light therapy to lower blood bilirubin
levels. Infants are exposed to bright lights over
hours or days. Phototherapy may be administered
using a combination of halogen spot lights, blue
fluorescent lights, or an illuminated fiberoptic
mat (Biliblanket™, or Wallaby™) placed
under the infant. Blood in the skin is exposed
to the light, and the bilirubin is converted to
a nontoxic form. Infants receiving phototherapy
have their eyes covered.
PICC Line (Percutaneously
Inserted Central Catheter)
- A long, very thin catheter inserted through
the skin (i.e. percutaneously) into a vein for
the long-term administration of fluids and/or
medications.
Plasma - The clear
liquid (noncellular) portion of blood. Contains
proteins and clotting factors. Dispensed by the
blood bank, fresh frozen plasma (FFP) may be administered
as a transfusion to sick infants who have blood
clotting problems, or who need an increase in
blood volume.
Platelets - Microscopic
cellular elements in the blood required for blood
clotting. Dispensed by the blood bank, platelets
may be administered as a transfusion
to infants who have low platelet counts or are
at particular risk for bleeding.
Pneumogram - Monitoring
of an infant over a period of 12 to 24 hours to
determine the presence or absence of apnea
or bradycardia. May be done
prior to being discharged home in infants with
a history of apnea, reflux,
or seizures. A more sophisticated
version of a pneumogram (thermistor,
pH probe) may be used to diagnose the presence
of reflux.
Pneumonia - An inflammation
of the lung caused by infection or meconium
aspiration.
Post-Dates Infant - An infant born at
or beyond 42 weeks gestation.
Premature (Preterm) Infant
- An infant born before 37 weeks gestation.
Pulse Oximeter - A
monitor that shines a red light through a hand
or foot to determine the amount of oxygen in the
blood.
Radiant
Warmer - A bed with an overhead heater used
for the care of newborns. The heat adjusts automatically
to keep an infant's body temperature constant.
(See also: incubator)
Red Blood Cells - Blood
cells that carry oxygen from the lungs to the
tissues of the body. The cells are red due to
hemoglobin (the oxygen carrying protein) within
them.
(see also: blood transfusion,
transfusion)
Reflux - The movement
of stomach contents up into the esophagus. Nearly
universal among infants. If excessive, reflux
can cause apnea, bradycardia,
pneumonia. May be treated with
medications, including Reglan
and Zantac.
Reglan™ - A drug
used to assist movement of food from the stomach
into the intestines. Used for the treatment of
reflux.
Respirator - See ventilator.
Respiratory Distress Syndrome
(RDS) - Same as hyaline membrane
disease.
Rounds - Conducted each morning in the
ICN, all aspects of care for all of the ICN patients
are discussed in detail between the attending
neonatologist, the nurse practitioners, residents
and nurses, and plans of care are decided upon.
Seizure
- An episode of abnormal, disorganized brain electrical
activity. Diagnosed using an EEG.
Sepsis Workup - A
set of tests done to evaluate for the presence
of infection. A sepsis workup always includes
a CBC, CRP,
and a blood culture, and
may also include a lumbar puncture,
urine culture, and sample of secretions suctioned
from the endotracheal tube
if an infant is on a ventilator.
Infants will often be started on antibiotics at
the time a sepsis workup is done.
Sleep Study - See pneumogram.
Small for Gestational Age (SGA) - Weight
below the 10th percentile for gestational
age.
Spinal Tap - See Lumbar
Puncture.
Surfactant - A substance
that coats and lubricates the microscopic air
spaces (alveoli) of the lungs and prevents the
lungs from collapsing between breaths. Premature
infants often have a deficiency of surfactant
(hyaline membrane disease)
which makes it difficult for them to breathe without
CPAP or a ventilator.
If an infant requires a ventilator, surfactant
can be administered as a medication through the
endotracheal tube.
Survanta™ - A preparation of surfactant
derived from the lungs of calves.
Tachycardia - Rapid heart
rate. Opposite of bradycardia.
Tachypnea - Rapid breathing.
Thermistor Study -
Specialized monitoring of an infant for 12 to
24 hours to determine the presence and type of
apnea. Often incorporates
a pH probe as part of the study to monitor acidity
in the esophagus, as acid in the esophagus indicates
reflux which may be associated
with apnea, bradycardia,
and desaturation.
Total Parenteral Nutrition (TPN) - Same
as Hyperalimentation.
Transfusion - See:
Blood Transfusion.
Ultrasound
- The use of extremely high frequency inaudible
sound waves to create an image of internal body
structures. Any part of the body may be examined.
No X-rays are used.
Umbilical Lines - In
premature or sick newborns, long, thin catheters
may be inserted into the blood vessels in the
umbilical cord. A catheter inserted into an artery
in the umbilical cord (umbilical arterial catheter
[UAC]) can be advanced into a major artery (the
aorta) in the infants abdomen, and may be used
for drawing blood samples and monitoring blood
pressure continuously. A catheter may be inserted
through the umbilical vein (umbilical venous catheter
[UVC]) and advanced into a major vein in the chest.
This can be used to administer fluids and medications,
and can be used also for drawing blood samples,
but not for monitoring blood pressure. Umbilical
catheters provide more secure access than peripheral
intravenous lines or peripheral
arterial lines. There is no sensation in the
umbilical cord, so the insertion of umbilical
lines is not painful at all. An alternative to
an umbilical venous line is
a PICC line.
Ventilator
- A machine used to assist breathing via an endotracheal
tube inserted into the trachea (windpipe).
Required by infants who cannot breathe on their
own due to lungs that are too immature or sick.
There are two types of ventilators: 1) Conventional
- delivers breaths to an infant that mimic the
type of breaths the infant would take on his/her
own; 2) High Frequency - uses very small
rapid breaths to breathe for an infant in a very
efficient manner. The "Oscillator" is
a type of high frequency ventilator used in the
ICN. An infant on an oscillator will appear to
be vibrating from the very frequent breaths.
Ventolin™ - Brand name of albuterol.
Very Low Birth Weight (VLBW)
- Birth weight between 1000 grams (2 lbs, 3 oz)
and 1500 grams (3 lbs, 5 oz). (See also: Low
Birth Weight (LBW), and Extremely
Low Birth Weight (ELBW))
Zantac™
- A medication which reduces the production of
acid in the stomach. May be used in the treatment
of reflux.
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