Just as the environment in the Neonatal Intensive Care Unit can seem foreign, so can the language. It sounds foreign to the untrained ear. With time and a little practice, you will be fluent. Be patient. Keep a small notebook in your pocket and write down every new word or phrase that you may hear, especially in report.
Report may sound something like, “Baby Smith is a 24 3/7 weeker born to a 37-year-old G3P2 with PIH. He has a Grade I right sided IVH. He also has a small PDA. He is on HFO requiring an FIO2 of about 35%. He has had no desats. He has a UAC and double lumen UVC. The plan is to try to wean him from the vent today. He’s getting 15 ml NG every 3 hours and has had no residuals….”
Short and sweet, let’s break this down a bit.
G refers to gravida or how many pregnancies a woman has had. P refers to parity or how many live births after 20 weeks of gestation a woman has had. In other words, a G3P2 means that a woman has been pregnant 3 times and given birth to 2 live babies.
Pregnancy Induced Hypertension or Preeclampsia is a common cause of premature birth. It is manifested by high blood pressure in the mother and can affect the liver and kidneys. The cause can be attributed to several factors and the only treatment is delivery of the baby.
IVH is an abbreviation for Intraventricular Hemorrhage, a bleed in one or both ventricles in the brain. It is an unfortunate result of prematurity that affects some premature babies. The most at risk are those weighing less than 1500 grams. IVH is grade on a scale of I-IV with IV being the most severe that can lead to brain damage.
UAC is short for umbilical arterial catheter, a catheter placed in one of the baby’s two umbilical arteries. A baby’s umbilical cord should have two arteries and one vein. A UAC is a central line frequently used in the NICU. It allows quick, painless access to the baby’s circulation the first week of life. It is used for frequent blood sampling such as blood gases and blood work as well as for continuous monitoring of the baby’s blood pressure.
A UVC is another central line that is accessed through the baby’s umbilical vein. Access here allows for intravenous infusions the first week of life. Typically, both the UAC and UVC are removed after the first week of life as there is a higher risk of infection if they sit longer.
HFO of high frequency oscillation is a ventilator frequently used for the tiniest and sickest babies. One of the biggest problems a premature baby faces is being born with fragile, immature lungs. Most require some form of respiratory support in the beginning of life. High frequency oscillation is gentler on a tiny baby’s lungs.
Desats is an abbreviated way of saying desaturation or a decrease in the oxygen concentration in the blood. It is common for a premature baby to have trouble maintaining their own oxygen levels independently in the beginning of life due to the immaturity of the lungs.
As & Bs
As & Bs is short for apnea and bradycardia. Apnea is the cessation of breathing for more than 20 seconds and bradycardia is defined as a heartbeat of less than 100 beats per minute. Premature infants can have episodes of apnea and bradycardia due to the immaturity of the brain and lungs. Most are treated with a dose of caffeine a day. If a nurse says the infant has had no As & Bs, it is quick way of saying the baby had a fairly stable night. A sudden increase in the number of As & Bs might indicate the baby is getting sick or have some other problem.
Weaning refers to the process by which a baby is slowly weaned from ventilator support. As blood gases begin to normalize and the baby requires less and less oxygen, the doctor may decide to start the weaning process for eventual extubation.
PDA means Patent Ductus Arteriosus. It is common in the extremely premature infant population. Simplified, the ductus is a necessary opening between the aorta and the pulmonary artery of the fetus. The ductus normally closes after the first few days of life. This may not happen for the extremely premature infant and can affect both the circulatory and respiratory status of the baby. Some babies require medication or surgery to close the ductus.
Gavage or NG Feed
Premature babies under 34 weeks are fed via a nasogastric or oral feeding tube. Before 34 weeks, premature infants have a difficult time coordinating sucking, swallowing, and breathing during a feed. When giving report the nurse may refer to the route the baby feeds by saying, “baby Smith gets 25 ml NG or gavage every 3 hours.”
Prior to each feeding, a baby’s feeding tube is always checked for both placement and residuals. Residuals refer to any food left over in the baby’s stomach from the previous feeding. This is an important tool in assessing how well the baby is tolerating feedings and digesting.
There are many more words and phrases you will encounter on your journey. This is just a glimpse. It can be overwhelming at first, but in no time you will catch on. Take each day and learning experience in stride.
Lori is an American nurse and yogini living in Gothenburg, Sweden. She contributes regularly to Mighty Nurse, AWHONN, American Nurse Today, and has been featured in The Huffington Post. Follow her adventures through her blog, Neonurse, or on Instagram.