Conditions and Treatments

Anemia

Anemia is when the baby’s blood has fewer red blood cells than usual. Red blood cells carry oxygen in the blood to support organ health and function. Many healthy newborns develop anemia in the first few months and do not need medical treatment. Usually, the baby is just growing a little too quickly for the body to keep up with the baby’s growth. Other causes of anemia include jaundice, blood loss, and infection. Prematurity, genetics, and chronic conditions may also play a role.

Our team will monitor the red blood cell count, hemoglobin (the protein in red blood cells that carries the oxygen), and iron levels during your baby’s stay in the Abess NICU. Our nurses will also watch for physical and behavioral changes that indicate anemia, like appearing pale, acting lethargic, and having high heart and breathing rates. If your baby is anemic and requires intervention, our neonatologists will choose the best treatment based on the type, severity, and cause of the anemia. The team may arrange for a blood transfusion or give medications or iron supplements to boost red blood cell production.

Apnea and Other Breathing Problems

In adults, apnea is considered a sleep-related breathing disorder. Apnea occurs in newborns and premature babies because the brain and respiratory system are underdeveloped. The brain doesn’t send consistent signals to the lungs to keep breathing, and the muscles are weak and get tired. Preemies often switch between a few deep breaths and shallow breathing with pauses. Apnea can occur while a baby is awake or asleep and even while feeding. Most preemies have some degree of apnea and will require respiratory support during their stay in the NICU. Infections and heart or lung problems may make apnea worse.

Our Mount Sinai Medical Center NICU team is trained to watch your baby closely for pauses in breathing, low oxygen levels, and decreased heart rate. Our NICU nurses will monitor your baby for other signs of apnea, like turning blue, feeding difficulties, or temperature changes. Intervention depends on the frequency and severity of episodes. For mild cases, our nurses will gently stimulate the baby with light rubbing or tapping. This will trigger the baby to take a breath. Our neonatologists commonly use caffeine therapy to stimulate the lungs and heart in moderate to severe apnea cases. Caffeine is a common and successful medication for apnea in the NICU.

Babies with infections or heart and lung problems may need respiratory support, even if they don’t have apnea. The Abess NICU has respiratory therapists on staff if babies need supplemental oxygen or mechanical support to help them breathe. Our neonatologists and respiratory therapists will determine the level of support your baby needs. A small face mask or prongs in the nose can deliver extra oxygen. If more support is needed, a ventilator will help your baby breathe deeply and stimulate the lungs to inhale and exhale. As babies grow, their ability to regulate their breathing will mature until they can do it on their own. Our medical experts will gradually wean your baby from respiratory support and supplemental oxygen as your baby’s lungs get stronger.

Bacterial Meningitis

Bacterial meningitis is a rare infection that can cause severe illness in babies. Premature babies with bacterial meningitis can become critically ill very quickly. It is often associated with sepsis. This condition begins as a bacterial infection that spreads through the blood and enters the brain. The infection causes inflammation in the tissue layers surrounding and protecting the brain and spinal cord.

Common symptoms our nurses and physicians at Mount Sinai Medical Center will look for include fever, lethargy, fussiness, poor feeding, and jaundice. If our neonatologists suspect meningitis, they will order a test called a lumbar puncture or “spinal tap.” A small needle will be carefully inserted into the baby’s back to take a sample of the fluid around the spine. The spinal fluid will be tested for signs of infection and can also tell us if the cause is viral or bacterial. Our team of specialists in the Abess NICU will then treat the underlying infection with antibiotics and manage any symptoms like fever, blood pressure changes, or breathing problems with medications and respiratory support.

Bacterial meningitis can cause serious long-term health problems. Babies who recover from the infection are at high risk for developing neurological problems, vision and hearing changes, seizures, and other disabilities. These babies need to check in regularly with our Developmental Follow-Up program after discharge so our specialists can monitor for any concerns or health issues.

Birth Asphyxia

Birth asphyxia is when the baby’s brain and organs do not get enough oxygen during labor or delivery. Causes include issues with the placenta or umbilical cord, problems with the baby’s airway, or severe anemia. The damage caused by asphyxia depends on how low the oxygen level was, for how long, and how quickly treatment was provided. Most babies with mild to moderate asphyxia may recover fully without lasting health problems. Severe cases may have permanent injury to their brain or organs.

The specialists at Mount Sinai Medical Center’s Abess NICU are experts in providing respiratory support and supplemental oxygen to newborns in distress. The medical team will use a mask, nasal prongs, or a ventilator to improve a baby’s oxygen level. If a baby is full- or near-term, “body cooling” may be an option to enhance recovery. Body cooling is when our neonatologists use a water-filled cooling blanket to lower the baby’s body temperature. This treatment can reduce the severity of brain damage but is not an option for babies born more than five weeks early. The medical team will also use medications to treat any other issues caused by asphyxia, like blood pressure changes, apnea, heart problems, kidney injury, or seizures.

Bradycardia

Bradycardia is another common condition in premature babies due to the underdeveloped central nervous system. The brain cannot consistently control a baby’s heart rate, causing the heart rate to slow the average number of beats per minute (bpm). Bradycardia is often associated with apnea but can occur in babies without apnea.

Our specially trained NICU team at Mount Sinai Medical Center will watch your baby closely for signs like lethargy or color changes and use monitors to measure heart rate, breathing rate, and oxygen levels. For most babies in our NICU, we consider bradycardia anytime the heart rate drops below 100 bpm. If the baby cannot resolve the bradycardia on its own or if the episode lasts longer than approximately 20 seconds, our NICU nurses will use light tapping or rubbing to stimulate the baby. This will trigger an increase in heart and breathing rates and bring up the baby’s oxygen level. Our neonatologists will likely prescribe caffeine therapy and additional respiratory support if episodes are severe or frequent. Caffeine is a largely successful method of stimulating the heart and lungs. Respiratory support may include using a mask or small prongs in the baby’s nose to deliver extra oxygen in mild to moderate cases. A ventilator may be used in more severe cases. Our respiratory therapists will work alongside the rest of the NICU team to ensure your baby gets enough oxygen.

As babies grow stronger and their central nervous systems mature, the Mount Sinai Medical Center specialists will carefully and gradually wean them from the additional medicinal or respiratory supports and watch closely for any signs of distress. Like apnea, most babies grow out of bradycardia as they grow.

Bronchopulmonary Dysplasia (BPD)

BPD is a lung disease that develops when babies have spent a long time on supplemental oxygen or a mechanical breathing machine. The extended time on respiratory support causes inflammation, lung scarring, and changes in how the lungs develop. This often results in long-term breathing issues. BPD does not have a cure, but it is treatable. It is most common in extremely premature babies. Many babies in the NICU do not need supplemental oxygen for long enough to cause permanent damage. Babies with defects affecting the lungs, heart disease, or infections like pneumonia are at an increased risk for developing BPD because they usually need intensive respiratory support for extended periods.

Our specialists at Mount Sinai Medical Center will carefully balance your baby’s individual respiratory needs while considering the risk of developing BPD. Many infants improve and can be weaned from respiratory support, while others require continual intensive care. Our respiratory therapists will gradually wean the babies while the neonatologists provide additional support with a few medications to enhance recovery from BPD. Bronchodilators will help keep the airways open. Diuretics will reduce the buildup of fluids in the lungs. Steroids will reduce inflammation, and antibiotics will treat any underlying infections. Any babies with breathing problems at discharge will continue to be seen by our specialists in the Developmental Follow-Up program.

Feeding Problems

A baby’s main jobs are to eat and grow. Feeding difficulty and coordination of breathing and swallowing are very common in premature newborns. Babies with feeding problems often cannot eat enough to meet their nutritional needs. Our team of specialists will watch for indicators of feeding problems, including gagging, coughing, choking, vomiting, and milk leaking from the nose or mouth. Babies with feeding difficulty are at risk for slow weight gain, weight loss, aspiration, pneumonia, and failure to thrive. Prematurity and heart and lung problems often contribute to a baby’s difficulty with feeding.

The comprehensive NICU team at Mount Sinai includes speech-language pathologists (SLPs) — specialists in treating feeding and swallowing problems. They work with babies who have difficulty sucking and swallowing or don’t have enough stamina to drink by bottle or breast. The team may recommend an “upper GI” and/or a “swallow study,” the gold standard for examining swallowing or feeding problems. During a swallow study and upper GI, your baby will be placed under an X-ray and fed a liquid that is highly visible under an X-ray. This will allow our SLPs to see a baby’s swallow in real time and follow the trajectory of the contrast to identify anatomical problems and sucking problems. They will also see if liquid enters the lungs, known as aspiration, or if the liquid returns to the upper esophagus (reflux). Aspiration can lead to infections like pneumonia or sepsis.

If your baby is having trouble feeding, our specialists in the Abess NICU will also examine your baby’s mouth for “lip ties” or “tongue ties,” which occur when the tissues in the mouth are too tight. This prevents the baby from moving the tongue or lips well enough to latch correctly. Our SLPs will use advanced techniques and gentle stretching in the mouth for babies with mild lip or tongue ties. More severe cases may require surgical correction by a pediatric ear, nose, and throat (ENT) specialist.

SLPs in the Abess NICU will work with parents and their babies to improve their latch and suck strength. They will also recommend the best way to hold the baby during feeding and what bottle nipple is best. While you are feeding your baby, our NICU nurses or an SLP will monitor them for apnea, bradycardia, fatigue, or other signs of distress. As babies grow, their ability and stamina to suck and swallow improve, and the suck-swallow-breathe reflex matures. When babies cannot eat enough, our physicians will insert a tiny feeding tube through the nose or mouth into the stomach. When hooked up to a pump, a precise amount of breastmilk or formula is slowly pushed through the tube directly into the baby’s stomach. This ensures that all babies in our NICU get enough nutrition to grow and gain weight. Some babies may go home with a feeding tube and a plan to continue care with our Developmental Follow-Up program.

We recognize the importance of building a bond with your baby during feeding, so our team of specialists will provide the support and resources you need. Parents will have access to our knowledgeable SLPs, nurses, and lactation consultants, to learn about bottle-feeding, breastfeeding, and tube-feeding in preparation for discharge.

Hypoglycemia

Hypoglycemia occurs when the blood glucose level is lower than normal, also known as “low blood sugar.” It is extremely common in the NICU. Glucose is vital to bodily function and a baby’s health and development. Premature babies are especially vulnerable to hypoglycemia because their underdeveloped systems cannot regulate glucose production. Babies with hypoglycemia are not necessarily diabetic.

Hypoglycemia can exacerbate other health issues, including apnea, seizures, and brain damage. Many infants may not show signs at all, making frequent blood tests a vital tool. Our medical team in the Abess NICU regularly checks the blood sugar levels. Our nurses will monitor for symptoms, such as weakness, lethargy, low body temperature, and a blueish tint to the skin. Treatment options for hypoglycemia depend on the severity, frequency, and duration of episodes. Our neonatologists will choose the most appropriate treatment for each baby and may prescribe small doses of glucose as needed. The most common treatment method is to put the baby on a strict, regular feeding schedule to stabilize natural glucose production and frequently check the blood sugar level.

Intraventricular Hemorrhage (IVH)

IVH occurs when the fragile blood vessels in the brain rupture and cause brain damage. Respiratory problems, high blood pressure, and prematurity are common risk factors. The earlier a baby is born, the greater the risk of IVH. Babies are at the highest risk during the first few days of life, and the odds generally fall as they approach 1 month old. Grades 1 and 2 are the most common types of IVH and the least severe.

Levels of Severity for Intraventricular Hemorrhage (IVH)

There is no cure or treatment for IVH. The specialists in the Abess NICU will use repeated imaging like ultrasound to monitor the size and location of the bleed and will treat the symptoms that develop due to the IVH. Each baby will experience different symptoms, so our skilled neonatologists will tailor their approach to manage symptoms and keep the baby medically stable. Some common symptoms include apnea, bradycardia, changes in coloring, feeding difficulties, seizures, weakness, and lethargy. Most Grade 1 and many Grade 2 bleeds will resolve over time with few or no lasting complications. Grades 3 and 4 bleeds are more severe and often result in long-term health problems that require ongoing medical management in the NICU. These babies would benefit from monitoring by our skilled physicians in the Developmental Follow-Up program.

Jaundice

Jaundice is a common condition in newborns and affects about 3 in 5 babies. Jaundice is easily recognized by the yellowish tint it gives the skin and eyes. Bilirubin, a side product of the body breaking down red blood cells, builds up in the baby’s blood, causing this color change. In healthy, full-term newborns, it typically develops in the first few days after birth and will go away without treatment over a few weeks. Some conditions like blood disorders, internal bleeding, liver problems, or infection may cause or exacerbate jaundice. Moderate to severe cases of jaundice will require intervention from our neonatology team at Mount Sinai Medical Center. Premature babies are more likely to need medical intervention for jaundice than full-term babies.

In addition to changes in skin color, our specialists in the Abess NICU will look for lethargy, extreme fussiness, signs of pain, and a reduction in how often a baby’s diaper needs to be changed. The team will take a blood sample to measure how much bilirubin is in the blood. In most cases, we can treat jaundice using “light therapy.” Phototherapy is a treatment in which the baby is placed under special lights that help the body break down and remove the bilirubin. Your baby will wear small goggles to protect the eyes. The lights are not ultraviolet (UV) and will not hurt or burn your baby. The duration of therapy varies based on the severity of jaundice. Some healthier babies may only need a day or so of light exposure, while some very premature babies may need multiple days under the lights. In rare and extreme cases, our neonatologists may decide that a blood transfusion is necessary. Our medical team in the Abess NICU will routinely check the bilirubin levels in your baby’s blood as they progress through treatment. Most babies recover fully from jaundice and have no long-term health problems.

Maternal Transmitted Diseases

Mothers are often tested for sexually transmitted diseases (STDs) during pregnancy by their doctors. This is because STDs can lead to complications in labor and delivery, such as prematurity and low birth weight, and can have severe and devastating effects on the health and development of newborns. Babies born to mothers with STDs are at high risk for infection during pregnancy and delivery.

Congenital STDs most commonly passed from mother to baby include the following:

• Chlamydia
• Gonorrhea
• Herpes
• Hepatitis B
• Human immunodeficiency virus (HIV)
• Human papillomavirus (HPV)
• Syphilis

The gold standard is to prevent transmission from mother to baby by treating the mother during pregnancy. If you have an STD, it is essential to let your baby’s doctor know so we can quickly treat your baby. Some mothers don’t know they have an STD, so our expert medical team is trained to recognize the signs. Fever, skin rashes, seizures, respiratory distress, and abnormal blood tests may indicate a congenital STD. If the medical team suspects STD transmission, our physicians will order a panel of blood tests and swabs from the skin, nose, or throat to identify the infection. Once identified, our neonatologists will prescribe antibiotics or antivirals to fight the infection. Viral STDs can only be treated and managed, not cured. Our expert medical team at Mount Sinai Medical Center will closely monitor your baby during and after the treatment process for any new or long-term health problems that may develop, such as anemia, jaundice, vision and hearing loss, rashes, and brain damage. These babies would also benefit from participating in our Developmental Follow-Up program for frequent check-ins with our medical experts during their first year.

Necrotizing Enterocolitis (NEC)

NEC is the most common and dangerous gut infection that affects newborns. Premature babies are at exceptionally high risk. The causes of NEC are unknown, but it is often caused by an inflammatory process in the intestines. This results in belly pain, gas buildup, vomiting, diarrhea, and bloody stools. If not treated with urgency, NEC infections can cause severe tissue damage and puncture through the intestines, which requires surgery to close the hole. Severe infections can cause sepsis or even death.

Our comprehensive neonatal team at Mount Sinai Medical Center is trained to recognize the early signs of NEC infections. By identifying NEC early, our physicians can treat the infection with IV antibiotics and support the baby as needed. Babies with NEC cannot eat while their gut is healing, so the medical team will give liquid nutrition through an IV to prevent weight loss. Our NICU nurses will measure your baby’s belly for gas buildup. The team may also need to place a thin tube through your baby’s mouth or nose into the stomach to drain gasses and other fluids from the infection. In cases of severe infection and tissue damage, surgical specialists will place a tube through the abdomen into the intestines to remove stool. We will take regular X-rays of your baby’s gut during the treatment process to monitor the infection and watch for tissue damage.

Patent Ductus Arteriosus (PDA)

PDA is a heart defect found in newborns, often preemies, shortly after birth. Babies in the womb do not need to use their lungs because the placenta provides oxygen from the mother’s blood. A baby’s normal anatomy before birth includes an extra blood vessel that allows the blood to skip going to the lungs to pick up oxygen. When babies begin to use their lungs after being born, the extra artery is no longer needed. It typically closes on its own shortly after birth. When the artery fails to close, this is called PDA.

At Mount Sinai Medical Center, our neonatologists will check your baby for signs of PDA, including listening to the heart for a murmur (an irregular heartbeat rhythm), lethargy, fatigue when eating, trouble breathing, poor weight gain, and a bluish tint to the skin. Our specialists will use a few different noninvasive methods to take pictures of your baby’s heart and blood flow as it moves through the heart and lungs.

Treatment for PDA depends on the size of the hole and the severity of the symptoms. Smaller holes may close on their own over time as a baby grows. Our neonatologists and their team will monitor and treat any symptoms your baby experiences. Treatments typically include medications for the heart and lungs and respiratory support. Our team may also work with a pediatric cardiologist if a baby requires surgery to close the PDA.

Persistent Pulmonary Hypertension of the Newborn (PPHN)

PPHN is a severe respiratory condition that generally affects full-term or near-term babies. Before a baby is born, the mother provides blood and oxygen to the baby through the umbilical cord. After a baby takes its first breaths, the blood vessels in the lungs open, allowing blood to circulate to the lungs and pick up oxygen. In PPHN, these vessels stay closed or only partially open, limiting the amount of oxygen getting to the baby’s brain and body. The exact cause of PPHN is unknown, but our attentive neonatologists in the Abess NICU will watch for risk factors and symptoms that may indicate PPHN. Risk factors include inhalation of fecal matter (meconium aspiration) or other fluids during labor and delivery, bacterial infections, and other conditions that affect how well the baby can breathe. Our team at Mount Sinai Medical Center will monitor for symptoms such as a blueish tint to the skin, grunting or gasping, cold hands and feet, low blood pressure, and a low oxygen level. Our specialists will also use noninvasive imaging like X-rays or echocardiograms to take pictures of your baby’s heart and lungs.

It can take weeks or months to recover from PPHN. During that time, our comprehensive team in the Abess NICU will use medications to control your baby’s heart rate and blood pressure, open the blood vessels to the lungs, and treat any infections. Our respiratory therapists will use supplemental oxygen and breathing machines like a mask, nose prongs, or a ventilator to help your baby get enough oxygen.

Pneumonia

Pneumonia is a lung infection caused by bacteria or a virus that creates fluid buildup in the lungs. This makes it hard for a baby to breathe and get enough oxygen. The infection typically enters the lungs during delivery or shortly after birth, and symptoms start within a week. The neonatologists at the Abess NICU will examine an X-ray of your baby’s chest to check for fluid in the lungs if they suspect an infection. Our team will also look for signs of the infection, including fever, difficulty breathing, poor feeding, lethargy, and increased heart rate. We may also take blood samples to check for a high number of white blood cells, indicating an infection.

Our neonatologists at Mount Sinai Medical Center treat pneumonia using antibiotics and work closely with respiratory therapists who provide supplemental oxygen and respiratory support. Oxygen delivered through a mask, nose prongs, or a ventilator will help the baby breathe and keep the airways open. The physicians may also prescribe additional medications or treatments like blood transfusions or blood pressure medications if a baby is very sick.

Respiratory Distress Syndrome (RDS)

Babies born before the 28th week of pregnancy are at the highest risk for RDS, a common respiratory condition in the NICU. The lungs are not fully developed and do not have enough of a substance called surfactant, which keeps the airways open and inflated. These babies must work harder to breathe, and their airways may collapse, causing lung damage.

Our neonatologists and their team in the Abess NICU will monitor babies for common signs of RDS, like changes in their breathing, low oxygen, grunting or gasping breaths, and a blueish tint to their skin. We will order imaging of your baby’s chest and blood tests to confirm if we suspect RDS. Babies with RDS are at a higher risk for developing other complications. Our neonatologists will closely watch for changes, such as developing a brain bleed, infections, bronchopulmonary dysplasia (BPD), and other breathing or heart issues.

Our priority for babies with RDS is to help them breathe easier while they recover. Our neonatologists and respiratory therapists in the Abess NICU will give a baby supplemental oxygen through a mask or small prongs into the nose. If a baby needs more assistance, we may use a ventilator to help with breathing. Our NICU also has CPAP machines, which deliver high air pressure through a mask to keep the airways open. Our neonatologists will also give artificial surfactants and medications to manage heart rate, blood pressure, and infections for sicker babies. As babies grow and their lungs get stronger, our specialized NICU team will gradually wean them from respiratory support until they can breathe independently.

Sepsis

Sepsis is a severe blood infection that can impact the entire body and all organ systems, causing severe illness. In babies, it is usually caused by a bacterial infection obtained during labor or shortly after birth. Premature babies and babies born to mothers with an active infection at the time of delivery are at the highest risk. Most babies recover fully after treatment.

The signs of sepsis vary, so our skilled neonatologists and their team in the Abess NICU will consider risk factors like extended labor, preterm birth, and maternal health while watching for symptoms like fever, lethargy, feeding problems, changes in heart or breathing rates, vomiting, and jaundice. If sepsis is suspected, we will run blood tests, urine tests, and X-rays to check for signs of infection. Our physicians use antibiotics to treat the underlying infection and additional medications to manage the other symptoms during recovery.

Withdrawal From Alcohol or Narcotics

Withdrawal from drugs or alcohol starts in the first hours after the baby is born and no longer exposed to the substance through the mother’s blood. It can last weeks to months, and your baby will need constant monitoring by our neonatologists and their team. The signs of withdrawal present differently based on the drug type, frequency, and duration of maternal drug use. Our specialists in the Abess NICU are trained to identify symptoms of withdrawal, which may include shaking, twitching, seizures, extreme fussiness, breathing and heart problems, fever, vomiting, and difficulty with feeding and gaining weight. Our neonatologists will prescribe medications based on the type and severity of withdrawal symptoms to keep your baby safe, stable, and comfortable.

Neonatal drug withdrawal, also known as neonatal abstinence syndrome (NAS), is the result of chronic maternal drug use during pregnancy and can result in premature birth and lifelong health and developmental problems for the baby. If the team suspects NAS or exposure to any illicit substance, they will run a blood panel test to identify the drug. Babies with NAS are at high risk for low birth weight, jaundice, and sudden infant death syndrome (SIDS).

Fetal alcohol spectrum disorders (FASDs) are a group of conditions caused by exposure to alcohol during pregnancy. Alcohol passes from mother to baby through the bloodstream. Research consistently tells us that no amount of alcohol at any point during pregnancy is considered safe. Like NAS, babies with FASDs are at high risk for additional medical complications like SIDS, breathing problems, and low birth weight.

Babies with NAS or FASDs may have lifelong health problems that require complex medical care. Lifelong health issues may include developmental delays, hearing or vision problems, learning disabilities, cognitive delays, and changes to their overall physical development. These babies would benefit significantly from the attentive and compassionate care our expert medical team will provide at the Developmental Follow-Up program. Support is also available for mothers through our social workers. They can provide resources for addiction and substance abuse support and referrals to rehabilitation programs.