Diagnostic Studies

Pre-term Infants

Laboratory Studies
Blood Gas Analysis: Blood gas is a blood test that looks at the acid and base balance and
oxygenation level in a newborn's blood. Blood gasses are some of the most common blood tests
used in the NICU, as they pack a ton of information about your baby's health into just a few
drops of blood. A blood gas test can be called an ABG, for arterial blood gas; a CBG, for capillary
blood gas; or just a gas.

NICU staff collects blood for a blood gas in different ways. If your baby has an umbilical artery
catheter (UAC), blood can be drawn from the UAC without having to prick your baby. Blood
gasses can also be collected with a heel prick or by inserting a needle into one of your baby's
arteries or veins.

Results might include:

 pH: The infant’s acid and base balance are measured by the pH. A low pH means that
the infant’s blood is acidotic, whereas a high pH means their blood is alkaline. Both
conditions can be dangerous.
 Carbon Dioxide: Carbon dioxide can build up in the infant’s blood when it’s not
breathing well, which can cause acidosis. Doctors can lower carbon dioxide levels by
making sure your baby's airway is open or by increasing respiratory support. For
example, a baby with a high carbon dioxide may need to be placed on CPAP or have
their ventilator settings changed.
 Bicarbonate: Bicarbonate, or bicarb for short, is a measure of the infant’s metabolic
functioning. A high or low bicarb can be caused by sepsis; prolonged lack of oxygen;
or problems with the heart, kidneys, or gut.
 Oxygen saturation: An arterial blood gas measures how much oxygen is in the
infant’s blood. Blood gasses drawn from a vein or from a heel prick are not good
measures of oxygenation.

Blood Tests
CBC: Complete blood cell counts may reveal anemia or polycythemia that is not clinically
apparent. A high or low white blood cell (WBC) count and numerous immature neutrophil
types may also be found. An abnormal WBC count may suggest subtle infection.

Blood Typing and Antibody Testing (Coombs test): performed to detect blood-group
incompatibilities between the mother and infant and to identify antibodies against fetal red
blood cells (RBCs). Such incompatibilities increase the infant's risk for jaundice and
kernicterus.

Serum Electrolytes Analysis: At birth, most serum electrolyte levels reflect those of the
mother. For example, if the mother received magnesium sulfate to inhibit labor, the baby's
respiratory effort may be compromised, and the serum magnesium value in the infant may be
elevated.

The serum calcium may be low shortly after birth in small preterm babies.
Immature renal function, as well as limited bone and tissue reserves, result in the need for
intravenous replacement of calcium, sodium, potassium, phosphate, and trace minerals in those
infants who are taking nothing by mouth. Infants who can tolerate enteric nutrition receive
adequate electrolytes and minerals from appropriate preterm formulas and fortified human
milk.

Frequent laboratory determinations of serum sodium, potassium, calcium, and glucose levels in
conjunction with monitoring of daily weight and urine output in extremely low birth weight
(ELBW) infants assists the clinician in managing fluid and electrolytes.
Serum Glucose Concentrations: Serum glucose levels must be closely monitored because
of the risk of hypoglycemia and hyperglycemia in preterm infants. The infant’s gestational age
and other medical conditions dictate the frequency of testing.
Metabolic Screening: programs include testing of newborn blood spots for a minimum
of phenylketonuria, hypothyroidism, and galactosemia. The timing of obtaining the sample
varies and a few samples may be required at different intervals.

Imaging Studies
Echocardiogram: an ultrasound of the heart to check for problems with the infant’s heart
function. Much like a fetal ultrasound, an electrocardiogram uses sound waves to produce
moving images on a display monitor.

Ultrasound scan: ultrasound scans may be done to check the brain for bleeding or fluid
buildup or to examine the abdominal organs for problems in the gastrointestinal tract, liver or
kidneys.

Chest radiography: performed to assess the lung parenchyma and heart size in newborns
with respiratory distress.

Cranial ultrasonography: is performed to detect occult intracranial hemorrhage in

extremely low birth weight (ELBW) premature newborns.

Eye exams: ophthalmologist may examine your baby's eyes and vision to check for problems
with the retina (retinopathy of prematurity).
Diagnostic Studies
Post-term Infants

In-utero Studies
Cardiotocograph: Electronic fetal monitoring to check the infant’s heartbeat and is typically
monitored over a 30-minute period. If the heartbeat proves to be normal, the doctor will not
usually suggest induced labor.

Ultrasound scan: ultrasound scan evaluates the amount of amniotic fluid around the baby.
If the placenta is deteriorating, then the amount of fluid will be low, and induced labor is highly
recommended. However, ultra sounds are not always accurate since they also monitor the
fetus's development, and if the fetus is smaller than normal, the doctor's guess at the age can be
quite off. The actual placenta won't start to deteriorate until about 46 weeks. Because of the
risks, doctors favour induction by 42 weeks.

Biophysical profile: a biophysical profile checks for the baby's heart rate, muscle tone,
movement, breathing, and the amount of amniotic fluid surrounding the baby.

Doppler flow study: Doppler flow study is a type of ultrasound that measures the amount
of blood flowing in and out of the placenta.

Imaging Studies
Echocardiogram: an ultrasound of the heart to check for problems with the infant’s heart
function. Much like a fetal ultrasound, an electrocardiogram uses sound waves to produce
moving images on a display monitor.

Ultrasound scan: ultrasound scans may be done to check the brain for bleeding or fluid
buildup or to examine the abdominal organs for problems in the gastrointestinal tract, liver or
kidneys.

Chest radiography: performed to assess the lung parenchyma and heart size in newborns
with respiratory distress.