Tiptoe Through the NICU: Common NICU Terminology and Typical Vital Signs
Author: Heather Bolan, MA, CCC-SLP
Edited by: Ainsley Martin, MS, CCC-SLP
Neonatal therapists provide direct patient care and services for premature and/or medically complex infants in the Neonatal Intensive Care Unit. Our goal as neonatal therapists is to support the infant's brain/mental health, maximize developmental milestones, and support family interaction with the neonate. To be successful in neonatal therapy, healthcare professionals must be committed to understanding scientific knowledge and continue their development in comprehension of this area. We've compiled a list of common NICU terminology to get you started on your journey into the NICU.
Common NICU Terminology
A
Ankyloglossia: (Tongue tie) A congenital oral anomaly that may decrease mobility of the tongue tip and cause a unusually short, thick lingual frenulum. This is very common and may lead to a frenulectomy. Ankyloglossia can result in difficulty latching effectively at the breast, painful breastfeeding (i.e. blisters, nipple trauma, mastitis), poor extraction of fluids from a bottle (i.e. poor latch, tongue clicking).
Apnea: Defined as cessation of breathing for >20 seconds or >10 seconds with oxygen desaturation or bradycardia.
B
Bottle Feeding: A complex task requiring constant communication and adjusting during a feed based on the infant-driven feeding model. Bottle feeding should be safe, nurturing, and developmentally appropriate in nature.
Brachycephaly: A type of cephalic disorder leading to symmetrical flattening of the occipital area. This may happen in really sick infants that are lying on their backs. It's important to look into any minor adjustments in order to help prevent against developmental delay.
Bradycardia: Reduced heart rate (HR)
Breastfeeding: The preferred route of providing nutrition utilizing infant's feeding readiness cues and assessing quality of feeding to insure breastfeeding is safe, nurturing, and developmentally appropriate. Breastfeeding is a multi-disciplinary approach in education involving; pumping, milk storage, readiness cues, how to utilize equipment, recognition of stress cues with PO feeds, and when to end a feed.
Bronchopulmonary dysplasia (BPD): A form of chronic lung disease that impacts mostly premature infants. This is caused by damage to the lungs from mechanical ventilation and long-term use of oxygen. Most infants recover from BPD, however some may demonstrate chronic issues. These neonates are often at high risk of swallowing difficulties and impaired airway protection during PO feedings.
C
Chronological Age: Time elapsed since birth. This is measured in days, weeks, months, or years.
Congenital Heart Disease (CHD): One or more abnormalities in the heart's structure at birth. Difficulties with oral feeds are common in infants with CHD following surgical procedures to correct heart defects secondary to pre-op/prolonged intubation, injury of the recurrent laryngeal nerve, and increased rate of oral motor abnormalities. These infants should be considered at high risk for swallowing difficulties and impaired airway protection during oral feeds.
Corrected age: Chronological age reduced by the number of weeks born before 40 weeks of gestation. This is measured in weeks and months.
Cyanosis: Blue tinge to skin/mucous membranes associated with hypoxemia.
E
Early-Parenting Perception and Performance Scale (EPPS): Assessment designed to gain an accurate measurement of the parent's self-efficacy to help support a greater level of independence in caring for their infant upon discharge and to assist NICU professionals in developing an individualized progressive care giving treatment plan for families during their time in the hospital.
External Pacing: A strategy that may be helpful when an infant is having difficulty self-coordinating sucking, swallowing, and breathing. Tipping the bottle down to slow milk flow and/or removing the bottle from the infant's mouth in order to impose a break in sucking.
F
Fetal Acidosis: Interruptions along the exchange of oxygen and carbon dioxide with the infant and mother, leading to a potentially dangerous drops in oxygen supply to the infant's tissues. This is often caused by a mix of respiratory and metabolic factors leading to abnormally acidic blood values. Fetuses experiencing hypoxia and acidosis often require emergency C-section. If acidosis is very severe or chronic, it can lead to HIE, Cerebral Palsy, brain damage, developmental delays, seizures, or intraventricular hemorrhages.
Fremitus: Vibration caused by partial airway obstruction (often secretions) that can be felt from outside the body.
G
Gavage Feeding: The infant is fed breast milk or formula through a nasogastric (NG) tube. Gavage feedings are for infants that cannot get enough nutrition by bottle or breast feedings alone. This is seen typically in premature infants who have too weak of a suck, difficulty coordinating the suck-swallow-breathe, babies who have digestive issues, or infants who have lung and heart problems causing their breathing to be too labored to support PO intake.
Gestational Age: A common term to describe how far along the pregnancy is. It is measured in weeks, from the first day of the woman's last menstrual cycle to the current date.
H
Hand Swaddling: Provides an infant with flexion, containment, alignment and comfort as a means of facilitating self-regulation in the infant.
High Flow Nasal Cannula (HFNC): Oxygen therapy capable of delivering up to 100% humidified and heated oxygen at a flow rate of up to 60 liters per minute. Major indications for HFNC in the neonatal population are essentially the same for the nasal CPAP: postextubation, respiratory distress syndrome, and apnea of prematurity. Infants should not be fed on CPAP or HFNC.
Horizontal Milk Flow: Bottle is horizontal and parallel to the floor.
Hypoxemia: Reduced oxygen in the blood (Normally defined as <95%)
Hypoxic-Ischemic Encephalopathy (HIE): Permanent brain damage caused by insufficient oxygenated blood flow during or near the time of birth. High risk pregnancy conditions and complications during labor and delivery may cause HIE. In a severe case of HIE, this may be referred to as anoxic brain injury.
I
Increased Work of Breathing (WOB): Physically observed respiratory distress. Infant may show signs such as: nasal flaring, neck extensions, head bobbing, tracheal tug, utilization of accessory chest muscles, and grunting.
Infant Driven Feeding: An approach to feeding developed by Ludwig and Waitzman in 2007 that places the infant at the center of care. Constant assessment before, during, and after feeding is completed on: infant's readiness cues, any micro- or macro- environmental changes needed, understanding the suck-swallow-breathe sequencing, utilization of the appropriate nipple size for bottle feeds, identifying appropriate compensatory strategies, stress signs, and knowing when to disengage a feed.
Intrauterine Growth Restriction (IUGR): A condition when the unborn baby's growth is too slow. This may be caused by an underlying maternal or fetal health issues, or problems with the placenta or uterus. Infants with IUGR need to be delivered early secondary to difficulty tolerating contractions or labor well.
Intra-Ventricular Hemorrhage (IVH): Bleeding inside or around the ventricles in the brain. Severe damage can lead to brain injury. There are four grades of IVH depending on the amount of bleeding. It is unclear why IVH occurs. Infants that are premature or have low birth weight, breathing problems, labor and delivery complications, genetic background, head injury, or shaken baby syndrome have a higher risk of having IVH. Currently, there is no specific treatment for IVH except to treat any other health problems that may worsen the condition. Infants should be considered at high risk for swallowing difficulties and impaired airway protection during PO feeds.
L
Laryngeal Cleft: Occurs when the esophagus and larynx do not develop normally in embryo, causing an opening between the larynx and the esophagus. There are four types of laryngeal clefts, classified based on their location. This allows food and liquid that is swallowed to pass through the opening to the larynx and into the lungs. This may lead to feeding problems, failure to thrive, reflux, coughing, wheezing, stridor, respiratory distress, and recurrent lung infections. Minor clefts may be treated with medication while others may require endoscopic procedures or surgery. Infants should be considered at high risk for swallowing difficulties and impaired airway protection during PO feeds.
Laryngomalacia: Congenital softening of the tissues of the larynx. The structure is malformed and weak which causing tissues to fall over the airway, partially blocking it. In most cases this resolves without surgical intervention, however there are some infants who struggle with PO intake and require prompt attention. Infants should be considered at high risk for swallowing difficulties and impaired airway protection during PO feeds.
M
Macro-Environment: Everything in the infant's room (ex. cabinets, ventilators, human voices, windows, overhead lights, IV pumps, beds, chairs, respiratory equipment).
Micro-Environment: Anything surrounding the infant directly (ex. incubator doors, placing objects on incubators, opening packages near infant, procedural lights, tubes, pacifiers, respiratory equipment, positioning equipment).
Micrognathia: A genetic mutation in which the jaw is undersized. This may interfere with the infant's ability to feed and breathe. This presents at birth with a variety of other syndromes such as clef lip, cleft palate, Pierre Robin sequence/syndrome, Treacher Collins syndrome, and others. The symptoms may include apneic spells, inability/prolonged feeds, poor weight gain, poor sleep. There are non-surgical and surgical treatments for micrognathia. Infants should be considered at high risk for swallowing difficulties and impaired airway protection during PO feeds.
N
Nasal Continuous Positive Airway Pressure (CPAP): A noninvasive form of respiratory assistance that is utilized to support infants with lung disease. it is utilized to maintain a continuous positive pressure in the inspiratory and expiratory phases of spontaneous breath. Infants should not be fed on CPAP or HFNC.
Neonatal Abstinence Syndrome (NAS): A condition caused when a baby withdraws from certain drugs that he/she was exposed to in the womb before birth. This is often caused when a woman takes opioids during pregnancy. Signs of NAS may include: tremors, overactive reflexes, high-pitched cry, breathing problems, poor feeding, slow weight gain.
Non-Nutritive Suck (NNS): Considered to be practice for nutritive suck, the goal of comfort. NNS during tube feedings have shown great benefits for infants such as better PO feeding performance and transition from tube feedings to PO feedings. NNS on a fully pumped breast may also be an option for some infants while they are on tube feeds.
Nutritive Suck: Sucking with the goal of gaining milk. this may be accomplished via breast or bottle.
P
Plagiocephaly: A type of cephalic disorder that causes unilateral flattening, malalignment of ears, and an asymmetrical forehead by repeated pressure on one part of the head.
Post Menstrual Age (PMA): The age of the infant in weeks at discharge home. Gestational Age + Chronological age. This is measured in weeks.
S
Scaphocephaly: A type of cephalic disorder that occurs when the bones of the head fuse together before they should, involving the suture that runs from the front to back at the top of the head. When this happens, the elongation and flattening of the skill impacts development. This in turn may impact the shaping of muscles and impact swallowing.
Semi-Upright Position: A supported, upright position with the infant's head above their chest and hips, and the infant's neck supported (such as by the inside of the caregiver's elbow).
Side-Lying Position: Infant is on their side with their ear, shoulder, and hip in line and facing up towards the ceiling.
Skin-to-Skin Care (Kangaroo care): Consists of placing an infant (wearing a diaper only) directly onto the parent’s bare chest. This lasts for at least one hour in order to allow the infant to enter at least once cycle of deep sleep.
Slow Flow: A compensatory strategy offered to help the infant coordinate the suck-swallow-breathe with reduced milk flow. Rationale and considerations when recommending a bottle nipple with a slower flow rate may include; physiological changes, anterior milk spillage, a change to weaker or slower sucking patterns (or a NNS pattern), frequent self-imposed rest breaks, and requiring external pacing to impose rest breaks.
Stertor: Coarse sound from the pharynx by a narrow or obstructed airway.
Stridor: High-pitched sound originating in the larynx, trachea, or bronchi caused by narrowing or obstructed airway.
Swaddling: Wrapping a blanket around an infant in order to provide neutral warmth, boundaries, and proprioceptive input. This also provides therapeutic positioning. The shoulders are supported and slightly rounded forwards while the elbows remain flexed. Hands should be placed close to midline so the infant can attempt to self-regulate through NNS. The lower extremities are in a flexed position with enough room to move lower extremities.
T
Tachycardia: Increased heart rate
Tachypnea: Increased respiratory rate (RR) (>60BPM)
Therapeutic Diapering: Changing the infant's diaper in a way to support neurodevelopment and neurobehaviors. Time-outs may be utilized in combination with NNS and hand swaddling in order to support organization throughout the activity.
Therapeutic Handling: A slow, gentle, and supportive touch while providing the infant a tucked/flexed posture with movements that help facilitate self-regulation. This is always initiated with a preparatory touch and a gentle, soothing voice.
Therapeutic Holding: Slow, gentle movements with appropriate postural alignments in order to avoid any stressful events. This may be utilized in the infant's bed space, in the arms of a caregiver, or any other place the infant may be placed in their current environment. This technique may be utilized during gavage feeds in order to promote positive and safe feeding experiences.
Therapeutic Positioning: Positioning of the neonate should be age-appropriate in nature and support homeostasis. In general, therapeutic positioning may include: head and hands at midline, neck in a neutral of soft flexion, shoulders and trunk rounded, arms/legs/hips flexed. this positioning should also allow the infant to have dynamic movement to allow for self-regulation (i.e. sucking, grasping, bracing).
Therapeutic Touching: Providing a gentle approach when touch is initiated in order to prepare the infant’s neurobehavioral systems. This touch uses the whole palm of the hand, with full contact.
Tone: The infant's continuous and passive partial contraction of the muscle. Can also be the muscle's resistance to passive stretching during a resting state.
Typical Vital Signs in Neonates and Young Infants:
RR: 30-50 breaths per minute (High 60+, Low 20)
HR: 110-160 beats per minute (High 200+, Low < 80)
O2 Saturation: 88% or 92% (High 99-100, Low below parameter depending on age of infant)
We hope this post provided you with a foundation of knowledge of common terms you will enocunter in the NICU. Be sure to stay tuned for our upcoming posts in our Tiptoe Through the NICU series!
References
Ludwig, S. (2019, September). Traning Module 4: The Neurobehavioral System. NANT Ignite Core Training and Mentoring Program for Neonatal Therapists.
