Navigating the NICU: A Glossary

Whether you’ve just had your first child, or your fifth, every birth and every baby is different. Even under ideal circumstances, labor and delivery can have its challenges. When your infant arrives very early, or has health complications, this experience can intensify.Navigating the NICU: A Glossary

If your newborn needs acute medical assistance or observation, they are admitted to the hospital’s NICU (Neonatal Intensive Care Unit) where they will be carefully monitored 24 hours a day by a specialized team of nurses and life-saving machines. Parents are released for home, and quickly learn to juggle hospital visiting hours, regular life, work and the many unknowns involved when your baby is in the hospital.

One of my first experiences as a NICU parent was a crash course in medical terminology. My son, Sebastian, was born midway through my training as a doula, and he became my greatest teacher. He arrived 12 weeks early and weighed only 2 pounds 3 ounces. He was a “micro-preemie,” which is a baby born before 26 weeks. He spent 2.5 months in the NICU, and over that time I learned many of the phrases and terminology used in that environment.

For ease of reference to other parents and practitioners, I’ve compiled a list of common NICU related terms below, which was compiled with the assistance of my dear friend Lora Schallert, a neonatal intensive care nurse I had the pleasure of working with during our time at the Cedars Sinai Hospital level 4 NICU in Los Angeles.

NICU GLOSSARY

A’s and B’s (Apnea and Bradycardia)

NICU nurses monitor vital signs and note if breathing pauses (Apnea) or heart rate slows (Bradycardia).

Adjusted Age

10% of babies born in the US are premature. Care providers determine a preemie’s age by their due date, not the day they are born. To factor the adjusted age, begin with the number of weeks since the date of birth and subtract the number of weeks that baby was born early.  It will often be a negative number while a baby is still in NICU. This is the adjusted age. For example a baby who has been in the NICU for two weeks, and was born 8 weeks early would have the “adjusted age” of being 6 weeks early. It is standard for NICU nurses to wait until a baby reaches his or her actual due date before being released for home.

CPAP (Continuous Positive Airway Pressure)

Newborns in the NICU can need breathing assistance, especially if they have been born prior to 36 weeks gestation when most newborns’ lungs are mature. To keep lungs open, a continuous flow of air and oxygen may be provided through a mask or lightweight prongs on the baby’s nose.

CRIT (Hematocrit)

Lab work may be done to measure the percentage of red blood cells that are present to determine how much oxygen a baby is receiving. These blood cells, called hematocrit, carry oxygen throughout the body.

Desatting (Desaturation)

This is when the blood does not have enough oxygen and often occurs alongside an event of bradycardia or apnea. Depending on the strength of each infant, most nurses give them time to recover on their own. If they need additional support, it’s usually a combination of tactile stimulation, physical adjustment and/or oxygen support.

Gavage Feeding

Premature infants often have trouble eating and may be fed with a tube via mouth or nose to the stomach.

GER (Gastroesophageal Reflux)

Reflux is fairly common in newborns and especially in premature infants. GER is when the stomach contents pass back up into the esophagus. Cases can vary from mild to severe, such as when a baby is in pain, refusing to eat or not gaining weight. Treatment can vary and may indicate medication.

GRV (Gastric Residual Volume)

Premature infants have their health evaluated in many ways in the NICU. In order to catch early symptoms of feeding intolerances, or NEC (Necrotizing enterocolitis), food is extracted from a baby’s stomach via a feeding tube. GRV is the shorthand term for the stomach residuals that are then examined.

HMF (Human Milk Fortifier)

This powder can be added to breast milk to increase the calories while providing additional vitamins and minerals.

Intubation

Depending on lung maturity, instead of using an oxygen mask, a tube may be placed via an infant’s nose or mouth to their windpipe to provide O2. The tube is usually connected to a ventilator.

IVH (Intraventricular Hemorrhage)

There are many screenings done in the NICU to determine if babies have any unseen health issues. Cranial ultrasounds are routinely performed to see if a hemorrhage is present.

Kangaroo Care

NICU nurses may place the baby on your bare chest and cover them with warm blankets. This is also called Skin to skin or chest-to-chest contact. Kangaroo Care can help improve oxygen stabilization and breathing patterns in infants while providing a soothing and less stressful environment. It also provides a way for parents to bond and touch their babies. For mothers who are expressing milk, it can help maintain and increase their milk supply.

NPO (Nothing by mouth)

It comes from the Latin phrase “nil per os,” which translates to “nothing by mouth.” If an infant is having medical issues such as showing digestive intolerances or being prepared for a surgery, NICU staff may decide a baby should have NPO.

NG/OG (Nasogastric tube/Orogastric tube)

Tubes may be inserted via the mouth (Orogastric) or nose (Nasogastric), into the stomach for gavage feeding, medication and suctioning. They are also used for evaluations such as the oral gastric residual.

OT (Occupational Therapist)

An occupational therapist who specializes in preterm babies and children may visit your baby in the NICU.  I remember having an OT help us with bottle-feeding and ensuring my son had a good range of motion in his neck muscles. For older children, an OT can work with them to build skills such as tying shoes, holding a pencil and even how to dress themselves.

PDA (Patent ductus arteriosus)

The PDA is a heart issue that occurs when the ductus arteriosus remains open after birth. An open (patent) ductus arteriosus allows oxygenated and deoxygenated blood to mix, which can put a strain on the baby’s heart and increase blood pressure in their lungs arteries.

PICC Line (Central Line/Peripherally inserted central catheter)

The PICC line is often used to provide intravenous medication. It is an IV placed in a vein near a main artery to the heart in order to efficiently transport the fluids.

PPHN (Persistent Pulmonary Hypertension)

A very serious condition when oxygen exchange with the lungs is impaired and an infant’s circulatory system isn’t operating normally.

Pulse Pressure

The difference between the systolic (top) and diastolic (bottom) blood pressure numbers. This diagnostic can be helpful in determining if a baby is exhibiting signs of PDA (patent ductus arteriosus).

RETIC (Reticulocyte Count)

A reticulocyte count is a test that measures how fast red blood cells are being made and released into the blood.

ROP (Retinopathy of Prematurity)

ROP is a disease that can lead to blindness. Babies born prematurely are the number one risk group. Pediatric ophthalmologists assess for this and are usually part of the regular care team in the NICU. You will be provided with information to continue following up after your baby is discharged. One of the most famous cases of ROP is the great musician Stevie Wonder, who was born 6 weeks premature.

RSV (Respiratory Syncytial Virus)

RSV is an infection which most children contract by the age of 2. It resembles a common cold in healthy children. For children born premature, the chance for serious infection is greater and could result in rehospitalization. During RSV season, your pediatrician may suggest Synagis injections, to prevent the virus that could lead to a lung and respiratory tract infection.

RT (Respiratory Therapist)

Respiratory Therapists work with doctors and nurses in the NICU, providing expert support for the ventilators and other equipment that help babies breath.

Speech Therapist

In the NICU, a speech therapist will assess and support an infant’s ability to suck, swallow and breathe. Speech Therapists work very closely with preemies that have feeding difficulties, teaching them how to use a bottle, choosing the proper nipple and giving recommendations for positioning during feedings. Toddlers and children with speech delays, speech impediments and other issues communicating verbally also receive speech therapy.

TPN (Total Parental Nutrition)

If a premature infant is not ready to eat or digest food, this fluid is given intravenously to provide the nutrition they need until their gastrointestinal system is ready. It contains protein, carbohydrates, fat, electrolytes, minerals and other vitamins.