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COCOON

Hospital words

  • You will hear lots of medical jargon on the ward. This can be hard to understand so we have put together a list of common conditions, tests, equipment, medicines and more in our COCOON Medical Dictionary to help you understand what all of the words mean in simple English.

    The COCOON Medical Dictionary

    Respiratory

    Low flow oxygen Oxygen delivered through soft plastic tubes under your babies nose.
    CPAP Continuous Positive Airway Pressure delivered through either a mask, prongs or plastic tube into your babies nose, is used when your baby needs help with their work of breathing but they do are able to do some of the work themselves.
    High flow nasal cannula oxygen Oxygen delivered through soft plastic tubes under your babies nose. More flow (pressure) is used to support your baby's breathing.
    Mechanical ventilation Your baby may need a breathing machine (ventilator) to do their breathing for them. They will have a breathing tube (endotracheal tube, ETT) passed through their voicebox (larynx) into their windpipe (trachea) which will be connected to the ventilator. There are different types of ventilation: conventional, high-frequency oscillation and high-frequency jet ventilation used for different breathing problems. Please ask us if you would like to know more information about the type your baby is receiving.
    Nitric Oxide This is a gas that is delivered through the ventilator tubing when babies have tight blood vessels in their lungs that affect their oxygen levels. The nitric oxide relaxes the blood vessels and improves the blood flow allowing more oxygen to be moved around.
    ETT An endo-tracheal tube is used to connect your baby to mechanical ventilation. It is placed into the trachea (windpipe) after medicines are given to ensure they don't feel distress or discomfort when the tube is passed. Putting the ETT in is called 'Intubation' and taking it out is called 'extubation'.
    NPT/NPA A nasopharyngeal tube (NPT) or airway(NPA) is commonly used to help overcome problems in the upper airway, such as the tongue partly blocking air flow into the windpipe. It moves the tongue out of the way and makes it easier for babies to breathe.
    Chest drain These are plastic tubes that are placed through the skin, between the ribs into the space between the inside of the chest wall and the lungs, if the lungs have "collapsed" because there is air in that space that is squashing the lung. This can happen if the lungs are sick or when babies are working really hard to breathe. The drain allows the air to be released and the lung to re-inflate.
    Tracheostomy This is a breathing tube that is placed through the front of the neck directly into the trachea (windpipe) by a surgeon. Some babies need these tubes because they have problems with how their upper airway has formed or because they have been on a ventilator for a long-time.
    Neopuff or T-piece device This is a machine that we use to help babies breathe for a short-time, e.g. if they are moving from Butterfly to the operating theatre and need help with breathing or if we are preparing to take over their breathing for them.

    Common tests

    ECG Electrocardiogram. This test looks at the electrical activity of your baby's heart. Small stickers will be placed on your baby's chest and attached to wires that pick up the electrical activity with each heart beat and produce a line graph that we ask the heart doctors to look at.
    EEG/Brainz Electroencephalogram, also called a 'Brainz' monitor. This test looks at electrical activity in your baby's brain using small metal discs known as electrodes attached to your baby's scalp. The brain is active all the time, even when asleep and this shows up as wavy lines on the monitor. If the brain is sick then we'll see different patterns of wavy lines and this can help us treat babies.
    Echo Echocardiogram. This is an ultrasound scan, using sound waves to create moving pictures of your baby's heart so that we can look at the structure of the heart and how well it is working.
    Eye check This is a test done by the eye doctors (ophthalmologists) to look at the back of your baby's eyes. We do these tests for babies that are very premature we know they are more likely to have problems with the way the back of the eye (known as the retina) develops from being born very early – this is called retinopathy of prematurity or ROP. Eye drops are used to make the pupils bigger so that the eye specialist can use a special lens to look at the back of the eye (the retina). The check only takes a few minutes.
    Hearing check/ABR ABR stands for auditory brainstem response. This is a hearing test that uses a special computer to measure the way your baby's hearing nerve responds to different sounds. Headphones are placed over the ears and small sensor stickers are placed near the ears and on the forehead. Clicking sounds and tones go through the headphones and the sensors then measure how your baby's hearing nerve and brain respond to the sounds.
    Blood gas A blood gas is a very quick blood test that only needs a small amount of blood and can be run on a machine on the unit to get a rapid result. It can tell us how well a baby's lungs are working by looking at the carbon dioxide and oxygen levels in the blood. It also measures the pH level of the blood which can be a good indicator of how sick a baby is as the blood will be more acidic in very unwell babies.
    Other bloods

    Full blood examination: Also called FBE or FBC, measures the numbers and size of the important cells types in the blood as well as the blood haemoglobin level. Haemoglobin is the protein in red blood cells that gives blood its red colour.

    LFTs: Is liver function tests and they tell us how well the liver is working. Bilirubin is one of the liver function tests and it is also the substance that makes your baby's skin look yellow if they are jaundiced.

    UECs: Stands for urea, electrolytes and creatinine. This test tells us how well your baby's kidneys are working.
    X-ray: Chest, abdo, skeletal survey X-rays are a type of radiation called electromagnetic waves. X-ray imaging creates snapshot pictures of the inside of the body in different shades of black and white. This is because different tissues absorb different amounts of radiation. We mostly use it to look at your baby's lungs and heart (chest x-ray) their tummy (abdominal x-ray) or the bones in the body (skeletal survey – looking for any bone breaks that we might not otherwise notice).
    Ultrasound This is an imaging method that uses high-frequency sound waves to produce moving images of structures in the body. For babies we often use it to look at the brain (cranial ultrasound) and the kidneys or abdomen (renal or abdominal ultrasound).
    MRI MRI stands for magnetic resonance imaging. The MRI scan uses radio waves and a powerful magnet linked to a computer to create very detailed pictures of areas inside the body. It gives us more accurate pictures of the soft tissues and inside organs than other imaging methods but takes longer and the baby needs to stay very still so may need some medication to make them sleepy.
    CT CT stands for computed tomography. The CT scan combines lots of X-ray images taken from different angles around the body and uses computer processing to create cross-sectional images (slices) of the bones, blood vessels and soft tissues inside. It's quicker and easier to use than an MRI scan though the pictures aren't as detailed.
    Septic/infection screen This is the name we give to tests that look for infection. It includes blood tests, often urine tests and a chest x-ray and may include a lumbar puncture (taking a small amount of fluid from the spine). We do these tests on babies that are unwell or at risk of infection to help us treat them with the right antibiotics.
    Midline screen Babies who are born with one obvious abnormality can often have other differences inside their body. This is due to the way babies develop in the womb so that problems can cluster in the centre (or midline) of the body as we go from head to toe. A midline screen therefore looks out for these other potential problems and usually includes looking at the head (cranial ultrasound), the eyes (eye check) the heart (echocardiogram), the lungs (chest x-ray), the kidneys (abdominal ultrasound) and the spine (spinal ultrasound).
    Microarray A microarray is a detailed genetic test that looks for extra or missing segments of DNA in the chromosomes that might be causing a baby's condition. It usually takes 10-14 days to get a result and can carried using blood or saliva.
    Genome A genome is the full set of DNA that your baby has. DNA is the building block of all the proteins in our cells. A gene has enough DNA to code for one protein and the genome is simply the total of all the DNA in one person.
    Metabolic work-up A metabolic work up is a series of blood and urine tests that helps us look for rare genetic (inherited) conditions called inborn errors of metabolism. These are disorders where the body cannot properly turn food into energy and babies can get very sick. Our special metabolic team help us know which tests to do and what treatments are needed.
    Newborn screen This is a simple blood test for all newborn babies that helps identify certain rare conditions. If these conditions are picked up early then treatment can start early too. Only a few drops of blood are needed and it is usually taken by pricking your baby's heel.
    PN bloods PN stands for parenteral nutrition which means intravenous feeding, where your baby is given their nutrition directly into their veins instead of via their stomach. The PN bloods are weekly blood tests that help us monitor key nutrients that your baby is getting and make sure that they are getting enough/ not too much of the salts, sugars and fats that make up the special intravenous solution.
    Airway assessments

    Bronchoscopy: A procedure whereby a thin tube with a camera is passed down your baby's throat and into their lungs while they are asleep in order to look closely at the airways.

    Bronchogram: Is similar to a bronchoscopy but instead of looking with a camera, a radio-opaque substance is injected through the tube into the lungs at the same time as x-ray pictures are taken. It helps us look at the overall structure of the airway passages.

    FNE: Stands for fibreoptic nasoendoscopy. This is where the specialist ENT (ear nose and throat) doctor uses a very small flexible tube with a camera on the end to look down your baby's nasal passages and into their throat to look specifically at their voice box (larynx). It helps us look for any blockages or structural differences that could be causing problems for your baby's breathing.

    Sleep study: A sleep study is an overnight test that measures and records what your baby's body does when it’s asleep. It measures the electrical activity of the brain, some specific muscles in the face and legs, heart rate, breathing and oxygen levels.
    GMs The General Movements is an assessment that can be used in infants from birth to 4 months of age. If your baby meets the criteria ( <28 weeks gestation) the physiotherapist or occupational therapist will take a video of your baby moving freely. From this we may be able to identify early signs of motor delay and infants at risk of neurological impairment, specifically infants at risk of cerebral palsy.

    Common medications and treatments

    Dialysis/PD The kidneys play a very special role in the body to filter the blood to rid the body of excess fluid and waste products that are excreted in urine. Peritoneal Dialysis (PD) is a type of dialysis which is done when a babies kidneys are not working properly. A tube called a Tenchoff catheter is inserted by the surgeons into the baby's tummy and sits in the space between the intestines and other organs. A special fluid is put through the catheter to fill the belly and it sits in there for some time. Excess fluid and waste products from lots of the blood vessels in the tummy cross over into this fluid which is then drained out and the cycle continues throughout the day and night.
    Anticonvulsants/antiseizure meds Are medications usually given into a vein that aim to stop or prevent seizures in babies. These medications include phenobarbitone, midazolam and levetiracetam (keppra).
    Bolus Means to give a substance quite quickly rather than infuse slowly. Saline is a fluid that is commonly given as a bolus and certain pain medications are often given as a bolus.
    Fluid resuscitation Is giving fluid into the veins (usually normal saline but sometimes blood products including albumin may be used) if a patient's blood pressure is low or it is felt that they have a low blood volume.
    Inotropes Medications that help to increase your babies blood pressure and usually given continuously into the blood stream. Examples included dobutamine, noradrenaline, adrenaline and many others. They work by improving the strength of the heart beat and some can cause constriction (narrowing) of the blood vessels in the body which helps to increase the blood pressure.
    Prem supplements

    This group of mediations are supplements routinely given to premature babies. Many of these vitamins and minerals are usually passed across the placenta from mother to baby during the third trimester of pregnancy, so if a baby is born early their stores will be lower than that babies born at term.

    Iron: Is routinely given to all babies born at less than 32 weeks of age or for smaller babies less than 2kg at birth once they are 28 days old and managing full feeds into their stomach and is usually continued until about 6 months of age. Iron is important for red blood cell formation and low levels can cause anaemia.

    Vitamin D: Given to babies who are born at less than 32 weeks of age or for smaller babies less than 2kg or if Mum had low Vitamin D levels during pregnancy and is continued for 12 months. It is usually started about 5 days after full feeds are established. It can be given alone as a medication called cholecalciferol or as part of a multivitamin called pentavite. Vitamin D is very important for the health of bones and teeth.

    Phosphate: Is important for bone health. This can be an issue for premature babies. It is usually commenced for all babies who are born at less than 32 weeks gestation and if blood tests reveal low levels of phosphate in the blood. It is continued until the phosphate levels are adequate and stable.

    Sodium Chloride: Given as a medication called 'hypersal' Sodium or salt is important for weight gain so it is given to babies who have slow weight gain or for those who are losing excess salt from their body eg/ due to a stoma or requiring frequent suctioning. We check the urinary sodium levels (usually weekly on a Monday) which helps guide whether we need to increase the dose or cease hypersal.
    Antis/antibiotics Are medications given either via a drip but some are also given via the mouth/tube into the stomach to treat bacterial infections or where there is a suspicion that a baby may have an infection. Different antibiotics are used depending on where we believe the infection may be coming from. Often we will start broad spectrum antibiotics (effective against lots of different bacteria) after taking samples to check for infection (eg/ collecting blood, urine +/- fluid around the brain and spinal cord) and then we may change antibiotics to target an infection once we know what it is.
    Immunisations

    Vaccine: Is a product that stimulates a person’s immune system to produce immunity to a specific disease, protecting the person from that disease. Vaccines are usually administered through needle injections, but can also be administered by mouth or sprayed into the nose.

    Palivizumab: Vaccine is used to prevent severe disease caused by respiratory syncytial virus (RSV) infections. Often offered to babies that were born very prematurely.
    Phototherapy/biliblanket Is the use of a special visible blue light that is used to treat high levels of jaundice in babies. Jaundice is very common, particularly in premature babies and causes a yellow colouring of the skin and eyes due to high levels of bilirubin in the blood. Jaundice can make babies lethargic and therefore impacts on their feeding. Very high levels can cause brain damage which is why we monitor levels very closely and treat if they are too high.
    Anti-reflux/PPI Medications such as omeprazole or esomeprazole that reduce the acid levels in your babies stomach. These medications are sometimes given to babies with severe reflux and are also used in babies who are on other medications which may irritate the stomach and in babies with oesophageal atresia.
    Sedatives/analgesics/opiates/benzos Medications given either into a vein or into the stomach to treat pain or keep babies comfortable and settled for example if they are intubated and have a tube in to help with breathing. Examples of medications used include morphine, fentanyl, midazolam, clonidine, paracetamol.
    Steroids Are a type of drug that can be used to treat many different conditions. Examples of steroids include hydrocortisone and dexamethasone. Some indications for use are to reduce inflammation, improve blood pressure along with inotropes, essential if your babies adrenal glands are not functioning properly and sometimes used in the treatment of lung disease in premature babies.
    Betablockers Are medications that slow down the heart rate. They can be used to treat abnormal rhythms of the heart (arrhythmias) and sometimes for high blood pressure. They are also very useful in treating haemangiomas which are a type of birthmark in babies. This group includes medications such as propranolol, sotalol and esmolol.
    Blood products: blood/packed cell transfusion, plts We often give babies blood products which come from volunteer donations, processed through the Australian Red Cross. Blood which is donated is separated into different components which we can give. These include 'Red Blood Cells' or 'packed cells' which carry oxygen around the body and are given if your babies haemoglobin is low. Sometimes we need to give products that help with the normal blood clotting process such as 'Platelets' 'FFP or fresh frozen plasma' or 'Cryoprecipitate'. Your doctors will discuss the various blood products that your baby may need and provide you with more information and answer any questions. We will ask you to sign a consent form prior to giving these products unless it is an emergency situation.
    Dextrose gel Used to treat low blood sugar levels in babies. This gel is applied to the inside of a babies cheek. Alternatively, dextrose fluid may be given via a drip into a vein. Very low sugar levels for an extended period of time in babies can be harmful so we monitor this closely and treat if the levels are too low.
    Nystatin Is a medication given as drops into the mouth which helps to prevent fungal infections and to treat thrush. Nystatin or nilstat is given to babies who are felt to be at risk of these types of infections and to all babies who weigh <1500grams.
    Caffeine Helps babies with the drive to breath and prevents apnoeas which are pauses in breathing. Caffeine is routinely given to premature babies born at less than 32 weeks and usually supplemented until about 34 weeks gestation or longer if there are ongoing issues with apnoeas.
    Probiotics Are the healthy 'good' bacteria and yeasts that have been shown to reduce the incidence of a condition called 'NEC' (necrotising enterocolitis) which affects the gut of premature babies. Probiotics are recommended for all babies who are born at less than 32 weeks gestation or weigh <1,500grams at birth and are continued until 34 weeks of gestation Probiotics are started once a baby is tolerating some feed into the stomach. In the NICU at the moment we use probiotics called 'infloran'.
    Avastin is an injection to prevent thegrowthof new blood vessels, used in treatment of retinopathy of prematurity.
    Nebulised adrenaline allows your baby to breath in adrenaline via a soft mask placed over their mouth and nose. This is a medication used to treat swelling of their airway.
    Pavlik Harness is used to treat hip dysplasia. It is one of the types of specialised braces that holds the legs in the optimal position to encourage development of the hip joint.

    Lines and tubes

    Art line Is the placement of a thin plastic tube (cannula) into one of the arteries, usually near the wrist or ankle. This allows continuous and accurate measurement of blood pressure (seen as the red waveform on the monitor) and can also be used as a way of collecting blood tests. The cannula is taped down and often a small splint is used to keep the wrist or ankle still to try prevent the cannula from becoming dislodged. A tiny amount of a drug called heparin is continuously infused through an arterial line to keep the line open and prevent any blood clot from forming on the plastic tube.
    Drip/cannula/line Is the placement of a thin plastic tube into one of the veins, usually in the hand or foot. The cannula is taped down and often a small splint is used to keep the wrist or ankle still to try prevent the cannula from being dislodged. Fluids and medications are given directly into the blood stream via this tube.
    Central lines

    PICC/longline: Stands for a 'peripherally inserted central catheter'. This is a long very thin tube/line that is usually inserted into a vein in the arm or leg but sometimes the scalp. Insertion is similar to how a cannula is placed and then the line is threaded along the vein until the tip is close to the heart. The benefits of a PICC line over a cannula is that they last for much longer (can be many weeks instead of days) and it is preferable to give certain medications or fluids (like inotropes or parenteral nutrition) into bigger central blood vessels rather than small veins where drips normally go.

    UVC/UAC/umbi lines: Stands for 'umbilical venous or arterial catheter'. We sometimes insert lines (small long thin tubes) into the vein or one of the two arteries of the umbilical cord of newborn babies. These can stay in for about a week.

    Neck/IJ line: This is a type of line that is usually inserted by the anaesthetics team into one of the big veins in the neck (the internal jugular vein) and the tip sits close to the heart.

    Femoral line: This is a type of line that is usually inserted by the anaesthetics team into one of the big veins in the groin.
    Urinary catheter A small flexible tube that is inserted through the urethra (bladder opening) into the bladder and is used to drain urine. This may be needed for a variety of reasons such as the need to accurately measure the amount of urine being produced, to prevent build up of urine if there is a physical blockage (eg/ posterior urethral valves in boys) or if a baby is receiving medications that make it difficult to pass urine.
    Subcut/insuflon A tiny needle or plastic tube that is inserted just under the skin to deliver medications.

    Gastrointestinal tubes

    TAT Trans-Anastomtic Tube – an NGT that is placed at time of surgical repair in babies with a oesophageal atresia +/- tracheo-oesophageal fistula.
    NGT Naso-Gastric Tube – A small flexible tube that goes through the nose into the tummy, to give milk directly into the tummy, and allow air to vent from the tummy. Babies who are premature and not yet learned to suck feeds, babies on CPAP, and babies with surgical tummy problems will have an NGT.
    Jejunal tube Similar to an NGT, but passes through the stomach to the upper part of the small bowel (the Jejunum).
    Gastrostomy A tube that goes directly into the tummy through the skin to put milk/formula directly into the tummy in children who can not swallow.
    Replogle A special type of NGT that can also suck out secretions from the upper pouch of an oesophageal atresia prior to repair.
    Stoma/bag A bag that is attached to a stoma to collect the stomal output.
    Losses Fluids that are lost from the body – such as gastric juices that are not absorbed due to either stoma formation or a problem with the intestines. If 'losses' are high then this can lead to dehydration and need to be replaced via the IV.
    Bilious vomit A green vomit that can mean there is an obstruction in the gut, bilious vomits can also occur due to infection so your baby will be placed on antibiotics while investigations are done to check if there is an obstruction that may require surgery.
    mls per kilo per day Used to calculate how much fluid (either by IV or milk feeds) to give your baby. For example if your baby is on 120mL/kg/day and they are 3kg, and having milk feeds every 3hrs they will take 45mL every 3hrs.
    Growth chart/centiles A growth chart is used to plot and follow your baby's growth. Centiles are used to compare your baby's weight to other babies the same age and gender – for example if your baby is on the 25th centile that means if there were 100 babies the same age and gender, 75 would be bigger than your baby and 25 would be smaller. A baby's growth is adequate if they are following their centile line.
    Empty breast contact When a baby is learning to breast feed after having had tummy problems, we will start with teaching baby to suck on a breast after you have expressed to ensure it does not get a large volume of milk at once.
    Suck/oral feed Taking a feed via breast or bottle, rather than down the NGT.
    TPN Total Parenteral Nutrition – fluid containing all the nutritional requirements that can be given via an IV for babies who can not feed.

    Surgeries

    Laser Eye surgery sometimes required by babies with severe ROP.
    Laparotomy An operation in the abdomen via a cut in the tummy.
    Sternotomy An operation in the chest via a cut through the ribs.
    Silo A surgical procedure used for gastroschisis repair, when the defect is large a plastic dressing is placed over the abdominal organs that are outside the body and gently squeezes them back into the abdomen over a few days to a week.
    Stoma formation/reversal A surgical procedure used when there is a blockage in the bowel, where the part of the bowel before the blockage is brought out to the skin and the bowel contents collected in a bag. After a period of time (for the bowel beyond the blockage to either grow or heal) the stoma can often be "reversed" where the 2 ends of the bowel are sewn back together. Stomas have different names depending on what part of the bowel is involved – a colostomy is from the colon, ileostomy from the ileum, and jejunostomy from the jejunum.
    Stents Little plastic tubes used to hold things open – such as nasal stents used in choanal atresia (a condition where the connection between the back of the nose and the airway is closed).
    Jaw (mandibular) distraction A surgical procedure for babies with a small or recessed jaw that is causing breathing +/- feeding difficulties, which lengthens the jaw bone over a period of weeks. At the time of surgery a device is inserted that can be used to slowly stretch the jaw bone allowing it to lengthen, moving the tongue forward to improve breathing problems.
    Repair A surgical procedure to fix something.
    Oesophageal atresia repair (stay sutures) Surgery to connect both ends of the oesophagus, when there is a long gap between the two ends multiple surgeries are needed where stitches are used to stretch the ends to encourage growth so they can be connected.
    CDH repair Surgery to put the bowel contents back into the abdomen and fix the hole in the diaphragm to separate the abdomen and thorax.
    Inguinal hernia repair Surgery to put the bowel contents back into the abdomen and fix the hole in the inguinal canal to prevent bowel re-entering the scrotum.
    Abdominal wall repair Surgery to fix a hole in the abdominal wall (such as exomphalos or gastroschisis).
    Palate repair Surgery to fix a cleft palate.
    PDA ligation Surgery to place clips over the patent ductus arteriosus to stop blood flow through it.
    VP shunt Small plastic tube which is placed to help drain extra spinal fluid from the brain to prevent it from building up and causing high pressure, the tube drains the fluid into the abdomen.
    Rickham’s reservoir A soft plastic dome shaped device, placed under the skin with a piece of plastic connected to the fluid-filled system in the brain, which allows extra fluid to easily be accessed and drained when required.
    Supraglottoplasty Small surgical procedure performed by the ear, nose and throat team to shave tissue around the larynx to making breathing easier.
    Valve ablation Surgical procedure which trims down excessive tissue that causes an obstruction in the urinary system.
    Pull-through A surgical operation which brings a colostomy down through to the rectum to reverse the colostomy and bring the bowel all together, usually after a colostomy had been performed after hirschprungs disease.
    Clip and drop A piece of bowel which, usually after the adjoining piece has been resected or removed, is placed back into the abdomen by itself, not in continuity with the rest of the bowel.

    Areas/services

    ICU High level of medical, nursing and allied health care or support, usually requiring breathing support, sometimes in the form of a breathing machine and sometimes medications to support the heart and blood pressure and usually frequent monitoring in the form of observations and blood sampling.
    HDU May still require some breathing support, but not a breathing machine, and doesn't require as frequent monitoring. Provides a higher level of care than a normal ward, but not as much as intensive care.
    SCN Lower level of monitoring and respiratory support, usually a place to work on feeding, maybe even suck feeding, and growing, but not quite ready for home yet.
    HEN Program which enables babies who require gastric tube feeding assistance at home to be provided with the required equipment and formula.
    HITH/Joey Allows for your baby to receive there required ongoing care by RCH medical, nursing and allied health staff at home, if their level of care can be provided in this capacity.
    PAC Post-acute care: short-term increase in level of support if this has increased as a result of an admission to hospital – and this includes a short term need for nursing intervention, allied health, community-based suports and these needs must be linked to their recent hospital presentation in order to help a safe and effecient discharge.
    EDC allows for the hire or sale of equipment that may be required at home for your child.

    Common conditions

    Head and neck

    Seizures is abnormal electrical activity in the brain which can manifest with changes in movements (stiffening, shaking, twitching), muscle tone, behaviours, sensations and sates of awareness and can be caused by man different reasons and has various medications that can be used to treat them.
    Bleeding/stroke bleeding – an area in the brain where blood has come from a burst artery causing localised bleeding into surrounding tissue, which can be a type of stroke. Another type of stroke is where blood flow to a specific area of the brain is interrupted, slowed or stopped, usually by a blood clot.
    Hydrocephalus this is caused by an accumulation of spinal fluid on the brain, and can result in increased pressure inside the skull and on the brain.
    Retinopathy of Prematurity Retinopathy of Prematurity is a complication of prematurity whereby the blood vessels in the back of the eye do not grow properly. Babies born before 32 weeks gestation, or are born weighing less than 1500g, will have regular eye checks by the opthalmology team during their NICU admission to monitor for ROP.
    Upper airway obstruction: PRS

    obstruction to the flow of air in the windpipe which can make breathing difficult.

    PRS – group of findings including a small lower jaw, tongue which is further back thank normal and a cleft palate. The combination together, especially the tongue, can lead to difficulty in keeping the airway open, especially in particular postions.

    Cardiovascular system (heart and blood vessels)

    Blood pressure problems blood pressure is the pressure of blood in the arteries as it is pumped around your body, there can be problems as a result of this pressure either being too low or too high. Which may require investigation and treatment. Blood pressure in young babies, unlike adults, is quite tricky to understand – from know what the right numbers are to why the numbers aren't within this range and which treatments to use, but we do have various tests and treatments for both pressure which is too low or too high.
    PDA a hole between two vessels which is designed to close in the first few days after birth, however sometimes this doesn't happen and the ductus arteriosus remains open, creating a flow of blood into the lungs where it is not meant to be, and can cause problems.
    VSD/ASD the left and right side of the heart are separated by the 'septum' a muscle down the middle of the heart, and this septum can have small holes, or gaps, in it which can occur in-between the two top chambers the atrium, or the two bottom chambers the ventricles.
    Problems with the aorta the aorta is the major artery supplying blood to the body, it can have issues, including areas which are narrowed to the point where the blood can't flow through properly.
    TOF condition which affects how the heart was put together while the baby was growing and developing, can affect the way the blood flows through the heart, including mixing an obstruction of blood through to the lungs.
    TGA condition which affects how the heart was put together while the baby was growing and developing, where major arteries have been switched over not allowing blood to flow through the heart correctly.
    Coarctation condition which affects how the heart was put together while the baby was growing and developing, where there can be a narrowing in the aorta affecting the flow of blood out of the major artery supplying blood to the lower body.

    Respiratory system (lungs and breathing)

    Preterm lung disease Is a general term describing long term breathing problems in premature babies born with underdeveloped lungs. The condition happens when the underdeveloped and immature lungs are exposed to breathing machines and oxygen levels which are needed when they are born to help the babies breath when the lungs are very fragile and are easily damaged.
    Congenital diaphragmatic hernia The diaphragm is the sheet of muscle that lies between the chest and abdomen (belly). It plays a very important role in breathing. Occasionallyit does not form properly when the fetus is developing and the bowels (guts) move into the chest instead of staying in the abdomen. This means that the lungs may not grow properly and sadly,asmall number of babies die for this reason.
    Meconium Aspiration Syndrome Is a condition to describe breathing difficulties requiring breathing support when a baby inhales the meconium (first stool passed by the baby after being born). If the baby is stressed prior to being born, they can pass their first stool in the womb and then can breathe this into their lungs. When they are born, the meconium acts like mud within the lungs making them sticky and very hard for the baby to move air in and out. Babies with MAS often require very high levels of oxygen and some type of breathing support including a breathing tube to help move the air in and out of the lungs properly. Sometimes the babies heart also struggles to pump and supply enough blood to the lungs, so they may need drugs to help the heart pump more effectively. Babies with MAS can be critically unwell needing a lot of support for their hearts and lungs.
    Air leaks Describes the leakage of air out of the normal spaces in the lung. This happens when part of the lung pops and air escapes out of the lung. Most of the time the little hole seals back over very quickly. Sometimes the hole takes a little longer to seal so a larger amount of air builds up in this space. A pneumothorax is when air leaks out of the lung and sits between the lung and the chest wall. Sometimes this air can build up and stop the lung being able to inflate properly and the air needs to be removed via a needle or a drain. A pneumomediastinum is when the air escapes the lung and sits in the centre of the chest, on the outside of the lungs and outside the heart. If there is only a small amount of air in these spaces and it is not impacting the babies ability to breathe, the air does not need to be removed. The air will be reabsorbed by the body with no ongoing issues.
    Sleep-disordered breathing Is a general term describing breathing difficulties during sleep. It is related to breathing being obstructed or blocked for short periods of time during sleep. This can lead to low oxygen levels during sleep which can affect the babies growth and development. These obstructions are often due to structural causes such as a large tongue or small chin that narrows the airway when the baby is on their back and asleep.

    Gastrointestinal system (bowels and abdominal organs)

    Oesophageal Atresia +/- Tracheo-oesophageal Fistula The oesophagus is the food pipe that connects your mouth to your stomach. Sometimes this does not form properly or make a full connection, instead creating a blind pouch referred to as atresia. This means that food and saliva are unable to move from the mouth to the stomach. Often babies born with OA are found on antenatal scans with lots of surrounding fluid in the womb and absence of a stomach seen on USS. This can only be corrected by surgery, connecting up the two pipes. Sometimes there is an abnormal connection (fistula) incorrectly joining the oesophagus (food pipe) to the trachea (breathing pipe). Because of this connection, anything swallowed could end up in the lungs and cause infections and breathing difficulties. If this connection occurs, air can also end up in the stomach from the wind pipe. This connection needs to be closed.
    Abdominal wall defects

    Abdominal wall defect is when the tummy wall (abdomen) does not form properly and some of the abdominal organs (bowel, liver, spleen, stomach) protrude to the outside of the body. There are 2 types, Gastroschisis and omphalocele,Both defects need to be surgically corrected.

    Gastroschisis: Cccurs when the organs are not covered or protected by a sac and the organs and bowel are free floating.

    Omphalocele/exomphalos: When the organs protruding from the tummy and are covered in a thin sac.

    ARM: imp anus Anorectal malformations are birth defects that happen during development in pregnancy. There are a range of defects where the rectum (the bottom of the large intestines) and anus do not form properly, making it difficult or sometimes impossible to pass stool. An example of this is imperforate anus which is where the actual opening has not formed and the baby will need to have surgery to correct this.
    HD Hirschprung disease is a congenital (born with) condition that occurs when the nerve cells in the lower part of the bowel do not form properly. These nerve cells are important at creating a wave like movement within the bowel moving food down from the stomach to the rectum and passed out of the body as stool. When these cells are missing, the body struggles or is unable to move the food down to the rectum and the baby will not be able to stool, causing blockages in the bowel and can make the baby very unwell.
    NEC/stomas/SIP

    NEC: Necrotising Enterocolitis is an infection within the bowel wall causing inflammation and sometimes death of the bowel. It mostly affects premature infants and can make the baby very sick, sadly sometimes babies do not survive from this infection. It is treated with resting the bowel (not feeding the baby any milk), antibiotics and sometimes surgery. If the infection is very severe, sometimes large amounts of bowel can be affected and unfortunately does not survive, becoming necrotic (black). These portions need to be surgically removed. If surgery is required, the majority of the time the baby will have the affected parts of the bowel cut out and a stoma formed.

    Stoma: When healthy bowel is brought up to the tummy (abdominal) wall and this is where the bodies waste/ stool exists the body. This allows the bowel beyond this skin connection time to heal. Then weeks- months later the baby undergoes another surgery and the bowel is connected and the stool is redirected through the bowel and exists the body as stool out of the anus.

    SIP: Spontaneous intestinal perforations is a hole (perforation) that has formed within the bowel (intestinal) wall without a known cause occurring in newborn babies. The perforation allows air and bowel contents (stool) to move outside of the bowel into the tummy which causes inflammation and infection. This can make the baby sick. The baby will require surgery to find and fix the perforation.
    Bowel obstruction

    Bowel obstruction: Means that there is a blockage in the bowel (intestines) not letting food and stool through to the rectum and anus to pass as stool. As a result, the air and stool builds up and the tummy becomes distended and the baby will vomit. Sometimes if the blockage has been present for a while and the bowel becomes very distended, it may perforate (have ahole formed0. There are many causes to bowel obstructions.

    Atresia: A blind pouch, this is a congenital (born with) issue where the tubing of the intestine does not connect the whole way. This prevents food and air moving from the stomach to the anus. The bowel proximal (before the) blind pouch becomes distended and can perforate/rupture.

    Stenosis: Refers to an area of the bowel that is narrow. This may be caused by something on the outside of the bowel cause the bowel to be narrow at a point or the bowel has had an injury resulting in scar tissue to form. This narrow portion of bowel may only allow a partial amount of food and air through and babies can present unwell with tummy distention and vomiting.

    Malrotation/volvulus: An abnormality in which the intestine does not form in the correct way in the abdomen. It occurs early in pregnancy and develops when the bowel fails to coil in the correct position. This causes a twist in the intestine which causes a blockage, and the twist can cut off blood supply to that part of the intestine, causing damage. Babies often present with bilious vomiting- green bile and can become very unwell. This needs to be corrected with surgery.

    Bilious vomiting (BV): When the baby vomits green bile, indicating that there may be a blockage in the bowel.
    Inguinal Hernia occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles near the groin of babies. It presents as a bulge that can be pushed back into the abdomen. This bulge will slide in and out of the groin and back into the abdomen. Sometimes this portion of bowel can get trapped in the groin and it causes a blockage in the bowel. Inguinal hernias need to be surgically corrected to lower the risk of the bowels becoming stuck and baby becoming unwell.
    Feed intolerance

    CMPI: Cows Milk Protein Intolerance is common, found in 2-3% of babies and occurs when the babies immune system reacts to the protein found in cow's milk and the bowel becomes inflamed and angry. CMPI presents with a variety of symptoms and range of severity, from irritability with an upset tummy, loose stools and vomiting to bloody mucousy stools and failure to gain weight. Treatment involves removing cows milk and sometimes soy from milk, either by changing formula or dairy and soy free diets in breastfeeding mothers.

    GORD: Gastro-oesphageal reflux is the passage of gastric contents into the oesophagus, often with effortless vomiting, or 'possets'. It is a physiological process that occurs several times a day in healthy infants. It occurs in at least 40% of babies, usually beginning before 8 weeks of age, peaks at four months and resolves often by 12 months. It rarely requires investigation nor does it cause crying or irritability. GORD – Gastro-oesophageal reflux disease is when GOR causes vomiting with refusal to feed, pronounced irritability with feeding, aspiration, chronic cough, wheeze, poor growth or bloody vomits.

    Genitourinary System (kidneys and bladder)

    PUVs/VUR/hydronephrosis

    Posterior urethral valve (PUV): A disorder in which an abnormal leaflet of tissue (valve) exists in the urethra (the tube that allows urine to flow from the bladder to the outside of the body), causing an obstruction (blockage) to urine flow. It is a developmental anomaly, present before birth and only affects boys. Because the flow of the urine is blocked early on in development, this can cause the organs of the urniary tract- the kidneys and bladder, to be swollen and enlarged, and this ongoing enlargement can result in damage, varying in severity. The lungs may also be affected in baby boys with PUV as the fluid surrounding the baby in the womb, which they need to develop their lungs, is mostly produced by the baby in the form of urine from about 18wks gestation. If the baby can not pass urine, he has little fluid around him in the womb and the lungs do not develop properly. This can lead to breathing difficulties at birth.

    Vesicoureteral Reflux (VUR): A condition where urine from the bladder is able to flow backwards up the tubes connecting the kidneys to the bladder (ureters). This exposes the kidneys to potential infections, if there is an infeciton in the bladder, and the excessive flow backwards can cause the kidneys to swell, both of which can result in permenant kidney damage.

    Hydronephrosis: Is the swelling of the kidney due to a build-up of urine. It happens when the urine can not drain out from the kidney to the bladder from a blockage or obstruction. It can occur in one or both kidneys.
    Kidney anomalies

    Cystic kidney Disease: A group of diseases that cause abnormal pockets of fluid (cysts) to form in the kidneys and the kidneys may not function properly. Examples of cystic kidneys include polycystic kidney disease, medullary cystic disease and medullary sponge kidney. There is no cure for cystic kidney disease, but management is aimed at managing symptoms and reducing the risk of complications.

    Dysplastic kidneys: Or renal dysplasia is a condition in which the internal structures of one or both of a babies kidneys do not develop normally in the womb. This can affect the kidneys ability to make urine and clear waste.
    Renal failure is when the kidneys don't work as well as they should. Kidney failure can be acute, often short lived but requires treatment until kidney function returns. Sadly however the kidneys may not always recover and the body is unable to function without kidneys, so the babies may not survive. Chronic kidney failure develops over time, is a slow process and is related to a number of risk factors such as diabetes and high blood pressure.

    Infectious diseases

    Sepsis

    Sepsis is an extreme immune response to an infection. In babies with sepsis, it can be life threatening as the immune system can injure many different body tissues and organs including the heart, lungs, brain and kidneys. Sepsis may be a response to an infection that develops in the skin, lungs, urinary tract or another part of the body. This response can be caused by a virus or bacteria.

    Virus: An infectious organism that replicates and grows within living cells over our body. Unfortunately antibiotics do not treat viral infections such as RSV or HSV – herpes simplx virus.

    Bacteria: Found almost everywhere on earth and can live outside of our cells. We have many bacteria on our skin and in our bodies which are apart of our normal body flora and keep us healthy. Sometimes however, there are bad bacteria which enter our body and grow very quickly and can make us very sick. Bacterial infections are treated with antibiotics.
    Meningitis is an inflammation of the meninges which are the three membranes that cover and protect our brains and spinal cord. Meningitis can occur when the fluid surrounding the brain and the meninges becomes infected. This infection is often caused by a virus or bacteria and can make the baby very unwell, sometimes leading to seizures and if not treated promptly, death.
    Blood stream infection is an infection within the blood and are often caused by bacteria. These infections can be very serious and can cause a large immune response by the body. There can also be referred to as sepsis. Sepsis is an extreme immune response to an infection. In babies with sepsis it can be life threatening as the immune system can injure many different body tissues and organs including the heart, lungs, brain and kidneys. Sepsis may be a response to an infection that develops in the skin, lungs, urinary tract or another part of the body. This response can be caused by a virus or bacteria.
    Pneumonia is an infection in one or both lungs. It can be caused by bacteria, viruses or fungi. The infection results in inflammation of the air sacs in the lungs (alveoli). As a result, the air sacs fill with fluid or pus, making it difficult to breathe. Babies with this type of infection will often need more breathing support, including a breathing tube and medications to fight the infection.
    Bronchiolitis is a common viral chest infection in children under 1 yr of age. The infection causes inflammation and mucus to build up in the airways making it difficult to breathe. Babies often start with a runny nose then find it difficult to feed and get tired easily. If their breathing is difficult we can provide some breathing support. There are no medications that will help fight the infection, we can only support the symptoms until the infection and inflammation settles, often after a few days.
    UTI urinary tract infection – is an infection within the bladder caused by bacteria. This often presents with a a combination of fever, vomiting or lethargy in babies and in older children burning sensation on passing urine and needing to pass urine more frequently. A UTI requires antibiotics to clear the infection.