ABC's--Apnea, bradycardia, and cyanosis spells-- Episodes when the baby stops breathing for at least 15 seconds, the baby¹s heart rate slows down to less than 100 beats per minute (normal is around 120-160 beats per minute)and the baby's oxygen level drops below 87%.  Premature babies have apnea and bradycardia spells more often than full-term babies, but babies born full-term can also have them. It¹s not clearly understood what causes these spells. Some researchers think the spells are related to centers inside the brain that regulate breathing and that may not be fully developed.. Touching your baby gently or rocking the incubator slightly will almost always get the baby to start breathing again, which increases the heart rate and the oxygen level.  Medications (theophylline or caffeine) are often used to treat these spells in newborn babies. There are two types of apnea (baby stops breathing):central and obstructive. Central apnea occurs when the child seems to 'forget' to breathe. Obstructive apnea occurs when the child makes some effort to breathe, but the voice box or upper airway is closed. The voice box can close in response to food refluxing up from the stomach or just because the infant is small and cannot keep the airway open. Prematurely born babies often have a combination of these two types of apnea. Apnea does not cause sudden infant death syndrome (SIDS). However, prematurely born babies are more likely to get SIDS just because they are prematurely born. No one knows exactly why this is the case.

Amniotic fluid‹Fluid inside the membrane that forms a sac around the embryo and later the fetus. The fetus and the placenta produce the amniotic fluid. This buoyant fluid helps the fetus grow uniformly, helps the bones and muscles develop, and allows the baby to move within the uterus. Babies breathe this fluid in and out of their lungs in the womb helping the lungs to grow as well. It also keeps the amnion (membrane) from sticking to the fetus. Having too little or too much amniotic fluid can signal a problem with the fetus or the mother. A mild decrease in amniotic fluid is common late in pregnancy. Too much amniotic fluid may cause the uterus to enlarge, which may result in premature labor. Excess fluid occurs in maternal diabetes, twins and some other conditions. Fetal problems that may also result in excess fluid are esophageal astresia (blockage of the esophagus that prevents effective swallowing) which prevents the amniotic fluid from passing to the stomach and intestines for absorption.

Apnea‹Literally, this means cessation of breathing. It is common for premature newborn infants to stop breathing for a few seconds. They almost always restart on their own, but occasionally they need stimulation or other drug therapy to maintain regular breathing. The heart rate often slows with apnea. This slowing of the heart rate is called bradycardia. The combination of apnea and bradycardia is often called an A & B spell and refers to slowing of the heart rate in response to apnea. As premature infants mature and grow, apnea gradually becomes less frequent. Unfortunately, it may not disappear before the baby is otherwise ready to go home. In that case, the infant is sent home with an apnea monitor and the parents are instructed in cardiopulmonary resuscitation (CPR). No relationship between apnea and SIDS has ever been proven.

Betamethasone‹Steroid medication that helps the baby¹s lungs mature more quickly. It is most effective if it is given more than 24 hours before delivery. Not only does betamethasone hasten lung development, but it may also help intestines, kidneys and others systems to mature

Bilirubin‹Yellow chemical that is a normal waste product from the breakdown of hemoglobin and other similar body components. The placenta clears bilirubin from the fetus' blood, but after delivery this task belongs to the infant. It usually takes a week or more for the newborn's liver to adjust to its new work load. When bilirubin accumulates, it makes the skin and eyes look yellow, a condition called jaundice. A little jaundice can be expected in all newborns. If the jaundice is higher than usual, it can usually be treated with phototherapy (special lights). If the level of bilirubin gets extremely high, brain injury is a risk. With modern treatment techniques such as phototherapy, such dangers rarely occur. Phototherapy is so effective in helping the liver excrete bilirubin that elevated levels are rarely a problem. Prematurely born infants may have elevated levels of bilirubin for several weeks.

Blood gas‹Test used to determine the oxygen, carbon dioxide, and acid content of the blood. A blood gas is used to evaluate the status of the infant¹s lungs. If the lungs are not working properly, the concentration of oxygen gas in the blood will be low and the concentration of carbon dioxide will be high. The amount of acid in the blood reflects both lung and heart function. Physicians use the blood gas to assist their evaluation of a sick newborn infant. The blood gas can be obtained from three sources: arterial blood, capillary blood or venous blood. Arterial blood (blood taken from an artery) is the most accurate and useful way to measure blood gases because it most closely reflects the lung function. Capillary blood (blood taken by pricking a finger or heel) is often easier to obtain than arterial blood, but does not give as accurate measurements of the oxygen concentration in the blood as does the arterial blood sample. Venous blood (blood taken from a vein) is used the least often and yields values that least closely reflect lung function, but may still be useful.

C-PAP--Supplemental oxygen or room air delivered under pressure through either an endotracheal tube (tube that goes directly into the infant¹s lungs) or small tubes or prongs that sit in the nostrils. Delivering oxygen under pressure helps keep air sacs in the lungs open and also helps to maintain a clear airway to the lungs. Nasal CPAP (NCPAP) is commonly used immediately after removing the endotracheal tube to treat apnea and/or prevent the need for an endotracheal tube and ventilator.

CRIT--Slang for hematocrit, is a test used to determine the percentage of red blood cells compared to total blood volume. It is commonly used to test for anemia.

Developmental Delay-- A term used to describe either failure to develop usual developmental milestones or the development of these milestones later than normal. It is sometimes used as a nicer word for a condition known as mental retardation. However, intelligence may be preserved in developmental delay although muscle function is poorly developed

Extubation-- Removal of the endotracheal (breathing) tube from the infant's lungs. This terminates ventilator-assisted breathing.

Fetal Distress-- Problems with the unborn child during labor. Sometimes during labor and delivery the fetus may not get enough oxygen from the placenta and may become "distressed". When this happens, the fetal heart rate may show patterns consistent with oxygen deprivation. These patterns can been seen on the fetal heart rate monitor. They alert the obstetrician that further investigation or intervention is needed to assure the fetus' well-being.

Full Term Infant-- Baby born between the 38th and 42nd week of pregnancy

GER,  Reflux--Contents in the stomach coming back up into the esophagus. It occurs when the junction between the esophagus and the stomach is not completely developed or is abnormal. Normally, this junction prevents food from rolling out of the stomach and up into the esophagus and sometimes the mouth. GER is very common, especially among prematurely born infants. Reflux of the acid in the stomachcan irritate the lining of the esophagus and cause a form of "heartburn" in some babies with GER. Babies may feel this heartburn and become irritable and uncomfortable. Since mild forms of GER are common, require no treatment, and go away on their own over a period of months, it is first necessary to evaluate how severe the GER is and whether or not it requires treatment. If the GER appears to be a significant medical problem, a barium (harmless substance used to visualize the intestinal tract on X-ray) swallow or nuclear medicine scan of the stomach emptying may be performed. These tests confirm that GER is occurring and look for stomach outlet obstruction or other contributing cause. Endoscopy and pH probe studies may also be done to evaluate this GER. Treatment of GER may include keeping the baby in the upright position,, thickening of the feedings, giving medication to reduce stomach acid, and sometimes giving medication to increase the ability of the stomach to contract. Medical treatment is effective in most cases. Since this is a problem that often improves on its own over time, surgery is reserved for the severe or unusual cases. Most children do very well in spite of GER.

Gavage Feeding-- Feeding an infant through a nasogastric tube. Also called tube feeding. See nasogastric tube.

Gestational Age-- Baby¹s age in weeks from the first day of the mother¹s last menstrual period before delivery. The duration of a pregnancy is measured by gestational age. Gestational age is basically a measure of the length of time that a baby spends in the womb. It is generally calculated as the time from the first day of the last menstrual period to the day of birth. Conception occurs on about day 14 after the first day of the last menstrual period. However, this date is not usually known. The first day of the last menstrual period usually is known. Therefore the beginning date for the pregnancy is the first day of the last menstrual period. A normal gestation lasts 40 weeks or 280 days. If delivery occurs before 37 weeks gestation, the baby is considered prematurely born. By this definition, about 11% of all babies are born prematurely. Irregular menstrual periods or first trimester vaginal bleeding can confuse gestational age estimates. To improve the accuracy of gestational age estimates, many doctors use an ultrasound examination before about 20 weeks gestation. Ultrasound findings help your doctor confirm or correct the gestational age estimate.

Heel Stick-- The procedure of pricking the baby¹s heel to obtain small amounts of blood for laboratory testing.

Hematocrit-- Measure of the number of red blood cells in the blood. This number is actually a percentage of the blood volume that is composed of red blood cells. For example, a hematocrit of 50 percent would mean that within one milliliter of blood, red blood cells take up 50 percent or 0.5 milliliters. The hematocrit measurement is commonly used to identify anemia and determine when an infant needs a blood transfusion. This test may also be used to identify abnormal bleeding in an infant.

High Frequency Ventilation-- Method of respiratory support for the lungs that uses very high frequencies of breaths per minute. There are several types of ventilators that provide high frequency respiratory support.

Incubator-- An enclosed, heated, plastic bassinette used to provide warmth and, sometimes humidity, for prematurely born infants. Incubators are sometimes called isolettes. They are used in the care of premature infants to give them a controlled thermal environment to reduce the infant's heat and water loss.

Indomethacin-- Aspirin-like drug sometimes used to close the patent ductus arteriosus (PDA). It may be given either to treat or prevent a PDA.

Intubation-- Process of placing an endotracheal tube into the trachea (windpipe) through the nose or mouth to allow air to reach the lungs. See ventilator.

Incubator-- Incubator (plastic box that is heated and sometimes humidified). It provides a warm, protected environment for premature babies who are often not able to maintain their own temperature because of their small size and body mass.

Kangaroo Care-- Parent holding the baby skin to skin. During kangaroo care, the baby is placed on the parent¹s chest, dressed in a diaper and sometimes a cap. The baby¹s head is turned to the side so that the baby¹s ear is against the parent¹s heart. Vent tubing and wires are taped to the parent¹s clothing or gown. In this position the baby is able to find comfort in the parent¹s heartbeat and feel the parent¹s warmth. This procedure iseffective, but itis limited to babies whose condition is not critical.

Kilogram-- A unit of weight in the metric system. It is equal to 2.2045 lbs. NICU personnel often use the metric system of weights and measures. It is easier to use than the pound system. A conversion chart from pounds and ounces to kilograms is available.

Lanugo-- The fine, downy hair that often covers the shoulders, back, forehead, and cheeks of a prematurely born newborn infant. Lanugo is replaced by more normal appearing hair toward the end of gestation. Lanugo is a sign of prematurity.

Lead Wires-- Wires that connect the sensors on the baby¹s chest to the vital signs monitor. They pick up the electrical signal of the heart and convey it to the monitor. The wires also measure chest wall movement, although those measurements are not as accurate as the heart tracing.

Magnesium Sulfate-- Mineral salt important in maintaining nerve signaling, healthy bones, and normal muscle contraction. Magnesium sulfate is sometimes used to slow down premature labor and treat pre-eclampsia. It has the ability to reduce contractions.

Meconium-- Dark green, sticky mucus normally found in infants' intestines. It is the first stool passed by the newborn. Meconium is a mixture of amniotic fluid, bile and secretions from the intestinal glands. Passage of meconium within the uterus before birth can be a sign of fetal distress. Meconium is very irritating to the lungs. If there is a possibility that an infant may have thick meconium in the lungs, the doctor inserts a tube into the trachea and suctions out the loose meconium. This tube, called an endotracheal tube, can also be used to help an infant breathe after the meconium has been removed

Monitor-- Machine that displays and often records the heart rate, respiratory rate, blood pressure and blood oxygen saturation of the infant. An alarm may sound if one or a number of these vital signs are abnormal. For example, in a normal infant the heart rate is usually between 120 and 180 beats per minute and oxygen saturation ought to be above 90 percent. False alarms are common, as the baby¹s abrupt movements cause the monitor to register inaccurate readings.

NICU-- Neonatal Intensive Care Unit-- A special care nursery for newborn infants with severe medical complications, who can't get the intense kind of care they need in a normal newborn nursery. They are cared for by doctors (neonatologists) and nurses with specialty training in caring for these infants. Walking into one of these units can seem frightening because the babies are usually very small, in isolettes or warming beds, and there are often machines, monitors, and tubes about the bedside. Many parents feel detached from their infants in this situation; however, parents can help nurses with feedings, baths, and diaper changes. Talking to, holding or just touching the child can help parents stay involved in the care of their child and comfort their baby as well.

Oximeter-- Machine that monitors the amount of oxygen sticking to the hemoglobin in the blood. A BandAid�-style cuff is wrapped around the baby¹s toe, foot, hand, or finger. Light shines through the tissues from one side of the cuff to the other. As the light passes through the finger, the light waves are altered. How much the light waves are altered depends on the amount of oxygen stuck to the hemoglobin. This machine allows the NICU staff to monitor the amount of oxygen in the baby's blood without having to obtain blood for laboratory testing

Oxygen-- Gas normally found in the atmosphere that is essential for our bodies' metabolism. The lungs take oxygen from the atmosphere and allow it to bind to the hemoglobin in the blood. The blood then transports the oxygen to the body tissues. When babies¹ lungs are sick or immature, they must breathe in extra oxygen so they can get enough oxygen into the blood. Babies with very poorly functioning lungs require ventilators to help their lungs work properly.

PDA-- Patent Ductus-- The ductus arteriosus is the fetal vessel that connects the pulmonary artery (artery to the lung) to the aorta (main artery to the body's organs, such as liver, kidney, etc.). PDA occurs when the ductus arteriosus does not close shortly after birth as it should. When the ductus arteriosus does not properly close after birth, it allows too much blood to flow into the lungs and makes it harder for the heart to pump blood into the kidneys, intestine and other organs. If left untreated, the PDA often causes heart and lung failure. Additionally, the other organs do not get the blood flow that they need. A PDA may be treated either with medication or surgery

Pneumogram-- Recording of heart rate, breathing rate, blood oxygen saturation, and air movement in and out of the lungs. The study is used to identify abnormal breathing patterns and its consequences. Almost all premature infants and some term infants have breathing patterns that are less regular than those seen in older infants.

Premature Infant-- Baby born three or more weeks before the due date. The length of a pregnancy is measured by gestational age. Gestational age equals the amount of time that has elapsed since the first day of the last menstrual period. A normal gestation lasts 40 weeks or 280 days. If delivery occurs before 37 weeks gestation, the baby is considered prematurely born. About 11% of all babies born in 1997 were born prematurely by this definition. Irregular menstrual periods or first trimester vaginal bleeding can confuse gestational age estimates. To improve the accuracy of gestational age estimates, some doctors use an ultrasound examination before about 20 weeks gestation. Ultrasound findings help your doctor to confirm or correct the gestational age estimate. Birth weight is lower when a baby is born prematurely. Babies born with a weight of less than 2500 grams (about 5 lbs. 8 oz) are considered low birth weight babies. Generally, infants with a birth weight less than 2500 grams are premature; however, babies can be premature and still weigh more than 2500 grams at birth. They can also be born at term and weigh less than 2500 grams. There is no perfect system for categorizing infants; both measurements, birth weight and gestational age, are used. Many premature deliveries occur close to term and these infants generally do well. For example, only 1.9 percent of all infants born in 1997 were born at less than 32 weeks gestation. These infants routinely require lengthy stays in a special care nursery. These infants are also at risk for long-term problems. The risk of complications accelerates as gestational age decreases.

Premature Labor-- Onset of labor before 37 completed weeks of pregnancy. Tocolytic agents (medications used to inhibit labor) are widely used today to treat premature labor and permit pregnancy to proceed so that the fetus can gain in size and maturity before delivery.

Premature Rupture of Membranes or PROM-- Rupture of the amniotic sac before labor begins. Bursting of the amniotic sac causes a woman to lose her amniotic fluid (bag of water). Labor usually starts soon after rupture of the amniotic membranes, even if the rupture occurs before term.

Pyloric Stenosis-- Narrowing of the pylorus (outlet) from the stomach to the small intestine. It occurs when the pyloric muscle thickens and constricts the outlet. The reason for this muscle thickening is unknown. About 1 in 4,000 infants are affected.

Small For Gestational Age  or SGA-- Small for gestational age (SGA)‹Children whose birth weights are below the 10th percentile (smaller in weight than 90 percent of other infants born at the same gestational age) are considered small for gestational age (SGA). Being small for gestational age has several other names. Some of these follow: Intrauterine growth retardation Small for dates Dysmature Light for dates. SGA has many causes. If your baby is SGA, your baby's doctor should search for an explanation. This is important because some problems cause reduced growth in childhood as well. The following is a partial list of factors that can contribute to an infant being SGA: Maternal high blood pressure Cigarette smoking Maternal street drug use Maternal malnutrition Antiphospholipid Antibody Syndrome Low maternal weight gain (less than 20 pounds) Mother was also SGA at birth Maternal chronic disease (advanced diabetes, anemia, etc.) Frequent, heavy, physical work during pregnancy Mother younger than 20 years of age Racial and ethnic background Multiple fetuses (twins, triplets) Rubella, cytomegalovirus, and other infections during pregnancy Placental abruption (separation of the placenta from the uterine wall) Fetal chromosome problems (Children with abnormal chromosomes seem genetically programmed to remain small and not gain weight appropriately.) SGA babies have more problems in the newborn period than infants who are appropriately grown. Examples of these problems are low blood sugar and too many red blood cells in the blood. These problems are all treatable, but may require NICU care. SGA babies are also more likely than AGA (appropriate for gestational age) infants to be small throughout life and have delayed development. Babies whose growth slowed down later in pregnancy are more likely to catch up with their peers than those whose growth was slow throughout pregnancy.

Surfactant-- Medication used to help infants who have or are at high risk for having respiratory distress syndrome. Surfactant is a soapy material found inside the lungs of adults and mature infants. It helps the lungs to function. Without surfactant, the air sacs tend to collapse when the child breathes out. The production of surfactant in the lungs often does not mature until 34-36 weeks of gestation. Premature infants often don¹t produce enough surfactant, which causes them to have significant breathing problems. Surfactant taken from calves, pigs or human amniotic fluid has been shown to be safe and effective in treating respiratory distress. Several different preparations are available throughout the world. Surfactant taken from calf lungs is the most commonly used preparation in the US. The use of surfactant to treat respiratory problems in newborn infants is one of the most important medical advances in pediatrics in the past decade.

Ultrasound-- Imaging of body parts using sound waves. Ultrasound uses sound waves that are above the range of human hearing to create an image of organs within the body. Sound waves are reflected off internal body structures and back to the ultrasound machine. The reflected sound waves are analyzed by computer and turned into pictures. This method of imaging results in less clear pictures than X-rays, CAT scans or MRI. However, there is no radiation risk with ultrasound and no confirmed adverse effects on the fetus or mother from diagnostic ultrasound examinations in pregnancy. There are different types of ultrasound exams. They are differentiated by the purpose for which they are done and the level of detail obtained. Limited exams are focused studies used to answer specific questions about the fetus, mother, or both. This exam is often used when you go to your doctor or the hospital with an urgent problem related to your pregnancy. Basic exams are performed to survey for obvious malformations of the fetus and to estimate fetal age, the amount of amniotic fluid present, location of the placenta, and for other concerns. These are the kind of exams that you would likely receive in your doctor's office or in the hospital as a routine evaluation. They are typically performed at 18-20 weeks of pregnancy. Comprehensive exams are a more in-depth look at the fetus when there is reason to suspect something is wrong with the fetus or mother. They include a detailed examination that is often done as a response to an abnormal screening test such as the alpha-fetoprotein screen. In some areas of the country this is called a Level II or Level III ultrasound. Technical difficulties and the need to image many different areas of the fetus may extend the length of this exam to 30 or more minutes. Ultrasound can measure fetal size, the amount of amniotic fluid, estimate fetal gestational age, identify multiple fetuses, some fetal abnormalities such as microcephaly or Down Syndrome, and locate the location of the placenta. Although an ultrasound can usually determine gender of your baby, many families do not want to know this information before delivery and some ultrasound centers have a policy of not revealing the gender.

Umbilical Arterial Catheter-- Catheter (small tube) that is placed in a belly button artery. It is used to check blood pressure, draw blood samples and give fluids.

Ventilator-- A machine that assists adults or children to breathe. This most often refers to newborn infants who sometimes have breathing problems so severe that they need help from a breathing machine. If your baby was born with lung problems or didn't breathe on his own he may be connected to a ventilator. Lung immaturity in prematurely born infants is the most common reason for a newborn to require a ventilator.

Very Low Birth Weight or VLBW-- A birthweight of less than 1500 grams. Babies with such a low birth weight are almost always very prematurely born. About 1.3% of all births result in babies with a birth weight of less than 1500 grams.

Vital Signs Monitor-- Machine that measures and displays an infant¹s heart rate, respiration and blood pressure on a computer screen. If these vital signs become abnormal, an alarm usually sounds.

Warmer-- Table on which the baby lies--usually undressed except for a diaper. Radiant heaters above the table keep the baby warm. A warmer allows maximum access to a sick baby.