120: NICU Explained: The Real Reasons Newborns Need Extra Care

When parents hear the word NICU, it can feel frightening. But the reality is that many babies who spend time there are simply adjusting to life outside the womb. In this episode, Afif and Anne break down the most common reasons newborns are admitted to the neonatal unit, including breathing difficulties, low blood sugar, infection checks, temperature regulation, and feeding challenges. Afif explains the physiology behind these issues and why most NICU stays are short and part of a baby’s normal transition after birth. If you’re expecting a baby or have ever wondered what really happens in NICU, this episode offers clarity and reassurance. Proudly sponsored by www.happytummy.ie Learn more about your ad choices. Visit megaphone.fm/adchoices

Transcript

SPEAKER_00 0:01

This show is part of the Head Stuff Podcast Network.

SPEAKER_04 0:07

Welcome to the Baby Tribe. I'm your host, Afi Felkafash, Neatologist, Pediatrician, and Lactation Consultant, and my co-host is Anne Deharty, obstetric anesthesiologist. This episode of The Baby Tribe is sponsored by Happytummy.ie and Biogaia Arland. Biogaia contains the probiotic Lactobacillus routeri, the only clinically proven probiotic to help infants with colic. They also have probiotics suitable for the whole family, like Biogaia Prodentis for oral health, one of my favorites. Let's get on with the show.

SPEAKER_03 0:46

Hello and welcome to another episode of the Baby Tribe Podcast with me and Doherty and my co-host, Afif Alkaflash. And today what we're talking about is what sends babies to the NICU. And this has been a topic that's been requested by many listeners. And I'm going to start grilling a fief, so we'll see now if he's worth his salt. So when parents hear the word NICU, something shifts. The room gets a little bit quieter, the air feels a little heavier. It sounds like something has gone very wrong. And sometimes, yeah, babies can be very sick, but most of the time that's not the story. A fief works in the NICU every day. He sees the babies who come through those doors, and what surprises parents is this most admissions are about transition, about adjustment, about physiology. And it's not necessarily a catastrophe. So today we want to walk you through what actually sends babies to the NICU. Not the myths, not the horror stories, just the real everyday reasons. Because when you understand the why, it may feel a little less frightening. So a thief, you're in the hot seat.

SPEAKER_04 1:58

Oh my god, this is the first time Anne does the introduction, and I think you did a great job.

SPEAKER_03 2:03

Oh, stop patronizing me. I'm so this is great.

SPEAKER_04 2:09

I was just sitting here doing nothing, and Anne was doing it. And the introduction is a little bit long-winded.

SPEAKER_03 2:14

Okay.

SPEAKER_04 2:15

You should just try and do it.

SPEAKER_03 2:16

I tried, I wanted to make it shorter, but you wouldn't let me, so yeah, I know. So it's just to make it short and snappy, and a thief can't handle it.

SPEAKER_04 2:24

It's just the two of us today.

SPEAKER_03 2:25

Yeah.

SPEAKER_04 2:26

We don't have a guest. No. Because I'm kind of the guest.

SPEAKER_03 2:29

Yeah, so that's why I'm doing the grillin.

SPEAKER_04 2:31

Yeah, you're doing the grillin'.

SPEAKER_03 2:32

I'm doing the grillin'.

SPEAKER_04 2:33

Exactly.

SPEAKER_03 2:34

Although I'm a little bit shook.

SPEAKER_04 2:35

You are. Why are you shook, Anne?

SPEAKER_03 2:37

Well, because I was out with my sisters last night and I still haven't recovered. Yeah. A thief was doing a comedy gig.

SPEAKER_04 2:45

I'm a comedian now, guys. So um yeah, this this podcast is multiple reasons to laugh at them. Yeah, this podcast is no longer gonna be in the parenting charts. We're gonna move to comedy. We're gonna rival, yeah, we're gonna rival, you know, um podcasts like Ghosted Me and Mark Megan. Sure, sure. Yeah, exactly.

SPEAKER_03 3:04

Yeah, yeah.

SPEAKER_04 3:06

So yeah, I did a gig yesterday.

SPEAKER_03 3:08

Yeah, in Wheelands. In Wheelens in the what's it called again? The Cherry Club, the Cherry. The Cherry Club. The Cherry Club.

SPEAKER_04 3:14

Yeah, exactly. And my sister. I popped my comedy cherry.

SPEAKER_03 3:17

Ew. Um, myself and my sisters went along to offer support, and we were highly supportive, but we also really had a lot of fun amongst the three of us.

SPEAKER_04 3:31

Yes.

SPEAKER_03 3:32

And yes, oh my god, I'm still suffering a little bit today now.

SPEAKER_04 3:36

At some stage, I do believe one of the other comedians asked for you to shush.

SPEAKER_03 3:42

It wasn't me directly that they asked.

SPEAKER_04 3:44

You were being very loud.

SPEAKER_03 3:45

It was one of my rowdy siblings. Yes, it was one of my rowdier siblings. There was only out of the the six siblings, there was three of us there. Um, and uh we usually have a bit of crack when we meet up.

SPEAKER_04 3:58

When Anne meets up with her two sisters, it's um yeah, it's it's a lot of fun. Cyan Arabia. Yeah, but last night wasn't about you and your sisters, it was about me.

SPEAKER_03 4:06

Uh yeah, are you sure?

SPEAKER_04 4:08

Was I funny?

SPEAKER_03 4:09

You were very good, you're actually very funny. I was very funny. You were very good, yeah. I think I think the girls were impressed.

SPEAKER_04 4:14

Yeah, and like I was up there with Martin Angolo, who's a great comedian. Yes, and Eva Dunn, who's a Dunn, yes, yes, and Tarano Sullivan. And Taran O'Sullivan. Yeah, Eva Dunn is a pal of mine, and it was so good to actually be up there with her. I know it was so much fun.

SPEAKER_03 4:30

I know. Well, you're very brave. I just would not have the wherewithal now to stand up and do that. Well, look, I mean it's very good. You did well.

SPEAKER_04 4:39

You and the kids have provided, and the extended family, I must say, have provided so much um material for me.

SPEAKER_03 4:46

A lifetime of things to last to capitalise on.

SPEAKER_04 4:48

So yeah, I can't wait to do it again. It was so much fun.

SPEAKER_03 4:51

Yeah, so listen, well done anyway. But I'm a bit shook, so I'm going to try and hold it together now. Yeah. And uh that's why FIFA's in the hot seat. I don't think I'd cope with the hot seat now today, I have to say.

SPEAKER_04 5:08

Let me put this in context.

SPEAKER_03 5:09

Okay.

SPEAKER_04 5:10

So whenever we talk about NICU admission, yeah, parents can get really, really worried. But what some parents may not realise is that we have multiple levels of NICU.

SPEAKER_03 5:20

Yeah.

SPEAKER_04 5:21

And NICU in itself um comprises three main different levels of care. So we have intensive care, which is the highest level of care. So in that you will have babies that are extremely premature, babies that need ventilation support, so they're on a breathing machine, babies that are growth restricted, and um, you know, term babies that may have heart conditions or surgical conditions.

SPEAKER_03 5:46

Okay. Okay. So they're the babies that have, they're not just there to do a little bit of growing or a little bit of monitoring. Yeah. They're there because they need significant interventions. Yes. Right.

SPEAKER_04 5:58

Then we have the high dependency unit, which is a step down from the intensive care unit. So the high dependency unit is babies mainly that are maybe term babies that will stay for a while but need some sort of support with their breathing. So not invasive ventilation or a tube, but maybe a mask, a bit of oxygen. And these are babies that have graduated from the some babies, uh, another group of babies that end up in the high dependency unit are babies that have graduated from the intensive care unit. And they're stepping down and they're stepping down level of care.

SPEAKER_03 6:31

Um but some babies may be in the high dependency unit with that. So when he says like a little bit of breathing support, it's you know the mask, the the nose mask that you see on TV for people who snore really badly and have sleep apnea. Yes, it's essentially a mini version of that for babies, a little snory mask. So some babies only ever reach that beyond that, yes, right? And a lot of babies nowadays, because care has really progressed so well, so um, they may never go to the ICU formal. That's right. They might stay in the high dependency, and then there are some babies who have been in the ICU who then get better and go to high dependency.

SPEAKER_04 7:09

And of course, there are other um admissions that go into the high dependency unit that may not need the intensive care, but but you know, still some sort of specialized care. Then we have the special care unit, and the special care unit is for babies that are almost ready to go home. Okay. So these are babies that may have been extremely preterm, have gone through ICU, HDU, and now are in special care.

SPEAKER_05 7:32

Yeah.

SPEAKER_04 7:33

It's a lot less intensive, it's a lot quieter, basically, to get babies ready to go home. They may still need a bit of oxygen, they may still need help with the feeding, and sometimes we admit babies to the special care that we know aren't going to stay for an extended period of time and don't need a huge amount of support. And we'll talk through what kind of babies may go to the special care. Some units have something called a transitional care unit, okay, which is kind of like special care, but it's more dedicated for babies that are term that we know are only staying for a day or two. Okay, they may have jaundice, they may need phototherapy, they may have low blood sugars for a variety of reasons that may need some support with that until they go home.

SPEAKER_03 8:11

So they're well babies that just have a very specific but reasonably mild issue that needs to be monitored, really.

SPEAKER_04 8:20

So just to put it in context, in terms of how busy the NICU is, and by NICU I'm meaning all three or four of the categories that we've just described.

SPEAKER_03 8:30

Between 10 and 20% of babies will need some level of care through your department.

SPEAKER_04 8:36

Will end up admitted to our department.

SPEAKER_03 8:38

Yeah.

SPEAKER_04 8:38

So you know, if you think That's a lot. It is a lot. So if you think that we have between eight and nine thousand deliveries a year, yeah, we have around twelve hundred to fourteen hundred admissions. One in four to one in five babies generally. Maybe one in five babies will need to be.

SPEAKER_02 8:54

Yeah, is it's is it partly though because your unit is uh a kind of high-level unit, so it's a tertiary referral centre for sick mums and then potentially for fetuses who have found issues during pregnancy that are likely to need help or intervention postpartum.

SPEAKER_04 9:11

So it's partly that. Um, but the majority of our work, to be honest with you, is less intensive.

SPEAKER_02 9:18

Okay.

SPEAKER_04 9:18

Right? So it's babies that are late preterm and it is babies that we're about to talk about now. Yeah. So this episode is not talking about the extremely premature babies that need neonatal intensive care.

SPEAKER_05 9:28

Yeah.

SPEAKER_04 9:28

Because we've discussed this before. Um, this is to talk about maybe more the why would term babies need to come into the intensive career.

SPEAKER_03 9:38

I think, yeah, and I think that's a really useful um piece of information for people to understand. Yeah. Um, because a lot of a lot of the babies, okay.

SPEAKER_04 9:48

So say that again, because you're just like when when when you tilt your head back.

SPEAKER_03 9:51

So I think it's a really useful important piece of information for people to have. Um because you know, obviously for parents, you if you have a term baby that's well grown, yes, um, and you expect everything to be a-okay like 100% normal, which you know it it can be, yeah. But if then you're told that your baby has to go upstairs for monitoring, it's it's quite scary. So one of the things that you help a lot with in those babies is things like breathing and stuff like that. So, can I ask why is it that some babies do like struggle with that transition to breathing at at the time of delivery?

SPEAKER_04 10:32

Yeah, so excluding preterm babies that often need help with breathing because their lungs are premature, a lot of term babies may need help with breathing as well.

SPEAKER_03 10:42

Yeah.

SPEAKER_04 10:42

And there's a lot of reasons for that. But by far the commonest reason is a condition called transient tachypnea of the newborn.

SPEAKER_03 10:50

Yeah.

SPEAKER_04 10:51

Which is a condition whereby the fluid in the lung that is present while the baby is in the womb, the kind of absorption of it in the lung tissue is delayed. So what happens in and around the time of delivery and as the baby's delivered and shortly after delivery is that there is a slow reabsorption of the fluid in the lung so that the air pockets, the alveoli, are ready to accept air when the baby starts crying. Yes. Okay. And that process is actually a lot of people think that it's due to the squeeze as the baby is a physical squeeze that is squeezed out of the baby when it passes through the vagina. Exactly. That's not strictly true. That plays a small part, but the actual majority of the process is chemically and hormonally driven.

SPEAKER_03 11:39

Okay.

SPEAKER_04 11:39

So labour, onset of labour.

SPEAKER_03 11:42

Yeah. It gives them the heads up.

SPEAKER_04 11:44

Gives them the heads up, and then there's a chemical reaction whereby the cells start absorbing the fluid from the lung tissue, puts it back into the bloodstream.

SPEAKER_03 11:51

Okay. So ideally, then you have drier lungs that are ready to expand and be used. It's mad when you think about it, that they come out and these lungs have never been used, and then in the space of like a minute, they go from like taking their first breath to being pretty well, five minutes, but taking their first breath to being completely independent then.

SPEAKER_04 12:13

Because that transition is actually really fascinating because until the umbilical cord is cut, yeah, the baby gets their oxygen from the placenta.

SPEAKER_03 12:24

Yes.

SPEAKER_04 12:24

And they're not relying on their lungs and their lungs are fluid-filled. So that transition, and you know, I know we sometimes or often now do delayed cord clamping or deferred cord clamping.

SPEAKER_03 12:34

It's a default practice in most places.

SPEAKER_04 12:36

Exactly, it is for both term and preterm babies, by the way. And the babies may start crying during that process.

SPEAKER_03 12:41

Yes.

SPEAKER_04 12:42

What happens is as you cry and the baby takes a breath in, that that mechanical stretch helps expand the lungs but also helps with the absorption. But prior to that, that chemical process would have started as the labour started. Okay. So some babies will have some fluid retained. And yes, they can breathe, and yes, they can exchange you know oxygen and carbon dioxide, but the lungs are still a little bit heavy, and the babies sometimes struggle with the breathing. So they have laboured breathing.

SPEAKER_03 13:16

Yeah, because lungs that are a little bit wet are stiff lungs. Yes. So it takes more energy to try and expand and use them efficiently. Yeah. Um, so yeah, it it's it's just part important.

SPEAKER_04 13:29

And sometimes when babies are born um towards the sort of lower end of what we term term.

SPEAKER_03 13:36

Yeah. Right. So late so early term. Early term.

SPEAKER_04 13:40

Yes, so 37, 38 weeks, there could still be an element of lung prematurity there.

SPEAKER_03 13:45

Okay.

SPEAKER_04 13:46

You know, and things like gestational diabetes in the mother can make lungs less mature. What's interesting is how we identify it when babies are born is they make a grunting noise.

SPEAKER_03 13:57

Yes. Okay, babies.

SPEAKER_04 13:58

And sometimes people think that this is a cry or a weak cry, but it's not, it's a grunt. Right.

SPEAKER_02 14:04

So instead of the baby going, what a great noise.

SPEAKER_04 14:09

They go, uh, sorry if somebody imagine if somebody just clicked in on this, on this, in this moment.

SPEAKER_03 14:19

Like, what okay, stop, stop. So they make a little like grunting noise, okay. Um, when they're breathing out.

SPEAKER_04 14:27

Why does that happen?

SPEAKER_03 14:29

So they do it because did you you know when you're if you if you go running and then you're a bit pooped um and you start breathing through pursed lips, yeah, and it increases your end expiratory pressure. Yeah. And what it does is it helps keep your airways open. Yeah. Um, and it's a very efficient way to try and help you exchange oxygen in a better way. So essentially, that's what grunting is for the babies. They've got stiff lungs, yeah, and it's a mechanical support for them. And essentially, they're trying to create what the snoring machine will do for them if they need it.

SPEAKER_04 15:04

They're very clever. So, what they do is they partially close their vocal cords as they're expiring air.

SPEAKER_02 15:08

Yeah.

SPEAKER_04 15:09

And the grunt is that sound of air flowing through the partially closed vocal cords. And what that does is that it increases the pressure in the lungs and keeps the prep the lungs open and stops them from collapsing. Yeah. And that helps with gas exchange. But obviously, they can only maintain that for a while before they get knackered themselves.

SPEAKER_03 15:24

Yeah, and wet lungs again are stiff lungs, so therefore there's more effort with that breathing.

SPEAKER_04 15:28

Yeah.

SPEAKER_02 15:29

Okay, so then that so then let's talk it just very briefly about that kind of no like the snoring machine. I'm just gonna keep calling it the snoring machine.

SPEAKER_04 15:36

Before we talk about the CPAP, um, we need to talk about why that happens. Why TTN happens.

SPEAKER_02 15:42

Okay, yeah, tell me about that.

SPEAKER_04 15:44

So, and this is very interesting. So we know that labour, yeah, the onset of labour helps.

SPEAKER_03 15:49

Yeah, that's the heads up.

SPEAKER_04 15:50

Yeah, so regardless of the mode of delivery, if you have a vaginal delivery or a cesarean section after onset of labour, the risk of TTN is low.

SPEAKER_03 16:00

That's what I wanted to talk about after the C Pappy. Thank you. So what you can do now. So cesarean section, because that is associated with an increased risk of TTN, but it's only cesarean section if you haven't been in labor. Yes. Is that correct?

SPEAKER_04 16:15

Yeah, elective cesarean section. Okay. Yeah. So in elective cesarean section, the risk of TTN is slightly higher. And the reason for that is the labor part of the process is not there. So the baby's more relying on the mechanical part.

SPEAKER_05 16:30

Yeah.

SPEAKER_04 16:30

And the chemical process only starts after the baby starts crying.

SPEAKER_05 16:34

Yes.

SPEAKER_04 16:34

So it can be delayed. And this is the importance because us as neonatologists don't like elective sections before 38 weeks, before 39 weeks. Yes, as well. Unless unless there is a medical reason. Yeah. Right. If there is a plant cesarin section for maternal reasons that or a maternal request or whatever, that is not that the timing is not.

SPEAKER_03 17:00

Is before 39 weeks gestation.

SPEAKER_04 17:02

Yes. Yeah. Then if that has to be done, fine. But if it doesn't, then it's best to wait after 39 weeks. Yes. Right.

SPEAKER_03 17:08

Because we talked about those lungs um it kind of from 37 weeks up until 39 weeks, still being that little bit young, yes, that little bit immature.

SPEAKER_04 17:16

Yeah. So after elective cesarean section, the risk of breathing issues at 37 weeks is up to 12%.

SPEAKER_03 17:24

Okay.

SPEAKER_04 17:25

It's a big number of babies. At 38 weeks, it's about 5%.

SPEAKER_03 17:29

Okay, there's a huge drop there.

SPEAKER_04 17:31

At 39 weeks, it's about 2%.

SPEAKER_03 17:33

2%.

SPEAKER_04 17:34

And at 40 weeks, it's about 1%.

SPEAKER_03 17:36

Okay.

SPEAKER_04 17:37

Right? So it can still happen, but there's a big drop in the risk after 38 completed weeks.

SPEAKER_03 17:45

Okay.

SPEAKER_04 17:45

So elective section before 39 weeks is not really recommended unless there is a medical indication. Indication for mum or baby.

SPEAKER_03 17:54

Yeah. So the timing of delivery in that situation is usually weighed up by a balance of risk. Yeah. And people get delivered either in late in early term or late preterm or earlier. Yeah. If it's warranted for medical reasons, so like the health of the mother, or there's a fetal issue where the baby's not growing.

SPEAKER_04 18:13

But if it's a scheduling issue, wait till after 39 weeks.

SPEAKER_03 18:18

We understand. Has he laid no pun intended, has he laboured the point enough?

SPEAKER_05 18:23

Yes.

SPEAKER_03 18:23

Um see I should have been on stage. You should have been on stage. Exactly. Okay, so then tell us a little bit about just the snoring machine, the CPU machine.

SPEAKER_04 18:33

So what what cures TTN? It's time.

SPEAKER_03 18:36

Okay.

SPEAKER_04 18:37

Right? So you have to just wait for the baby. It's called TTN. What does TTN stand for? Transient tachypnea of the newborn. Transient means short-lived.

SPEAKER_03 18:46

Yeah.

SPEAKER_04 18:46

Tachipnea is fast breathing. Yeah. Newborn means baby.

SPEAKER_03 18:49

Okay. So, but just give us an idea. What does what's the time meaning?

SPEAKER_04 18:52

Between 24 and 48 hours.

SPEAKER_03 18:54

Okay. So if those babies, for whatever reason, get this TTN and they need to go upstairs for their snoring machine, usually that is weaned. Yes. And the support is weaned within the first 24 to 48 hours.

SPEAKER_04 19:08

Generally, yes.

SPEAKER_03 19:09

For the majority, but not always, but for the majority.

SPEAKER_04 19:11

Why do we use the CPAP machine, which stands for continuous positive airway pressure? Yes. That's exactly what it says on the tin. It provides continuous positive airway pressure. So there's a mask that sits on the baby's nose and it pushes air into the lung at a constant pressure. Yeah. And the babies can breathe through that, but it keeps the lung open. So it does the valsalva or the cord thing that I described for them. So they don't get tired and actually helps. If you leave a baby with TTN without that support, they will get better eventually, but they may tire tire. And we have seen babies that maybe this grunting was missed and that they end up getting really tired that they actually need to be intubated and helped with the breathing.

SPEAKER_03 19:54

Okay.

SPEAKER_04 19:54

And then the recovery is a lot longer.

SPEAKER_03 19:56

Okay.

SPEAKER_04 19:57

Their blood vessels in their lungs may not relax as easily, so they may have a bit of a condition called pulmonary hypertension.

SPEAKER_03 20:02

Okay.

SPEAKER_04 20:03

So that's where the blood vessels in the lungs don't relax as they should after delivery. Yeah. So if it can spiral to a more significant disease, but luckily, the vast majority of babies, it's very mild.

SPEAKER_03 20:16

Yes.

SPEAKER_04 20:16

But it's not without issues. You're separating baby from mother.

SPEAKER_03 20:20

I was gonna get to that, yeah.

SPEAKER_04 20:22

Baby if if you're intending on breastfeeding, babies won't be able to latch and effectively feed until their fast breathing settles down, which can be a couple of days, sometimes three, four days. They will invariably receive antibiotics because we can not rule out infection. Rule out infection as the cause of the fast breathing. So there are implications to this, and that's why, as neontologists, we say avoid delivery. Yes. Do yeah, avoid delivery before 39 weeks, unless you absolutely have to. Okay.

SPEAKER_03 20:51

Now, as I said, there is unless it's indicated. Yes. I don't do absolutely have to, because I think that that's an unfair onus to put on somebody unless it's indicated.

SPEAKER_04 21:02

Yes, ma'am.

SPEAKER_03 21:02

Yeah, good man.

SPEAKER_04 21:04

We're taking a quick break to thank happytummy.ie, the official distributor of Biogaia probiotics, for supporting the baby tribe.

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SPEAKER_04 21:40

Visit happytummy.ie to learn more and give your crew the gift of a happy tummy and a healthy smile. Hey there, Baby Tribe listeners. Did you know that we've got some amazing bonus material just for you? Baby Tribe Shorts is here. Quick evidence based breakdown of all things science when it comes to mum and baby. You can find it as part of the Headstuff Podcast Network. You can subscribe to Headstuff Plus for as little as 5 Euro a month. We'll give you quick evidence-based takes on science behind maternal and infant health.

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SPEAKER_03 22:29

The other reason, another reason that's very common is kind of baby's blood sugars are not being maintained.

SPEAKER_05 22:36

Yes.

SPEAKER_03 22:37

And that's another reason that babies need to go to the unit, but they'd end up in one of those kind of more low intensity areas. So the high dependency or um the special care baby unit. So can we talk about that?

SPEAKER_05 22:49

Yeah.

SPEAKER_03 22:50

So if when a baby is born, um how for a normal term baby, how frequently are blood sugars checked?

SPEAKER_04 22:59

Not.

SPEAKER_03 23:00

They're not.

SPEAKER_04 23:01

And because there's something very interesting. Babies are so clever.

SPEAKER_03 23:04

Look, the physiology is a stuff. Yeah, babies are clever. When they're sitting there looking cute and looking like they're not doing anything, their bodies are working hard.

SPEAKER_04 23:12

Okay, so in a healthy baby with no risk factors for low blood sugar, and we'll talk about those in a second. The brain for the first 24 hours doesn't need a lot of sugar to survive because it survives on ketones.

SPEAKER_03 23:27

Okay. Right.

SPEAKER_04 23:28

What are ketones? You tell us what are ketones.

SPEAKER_03 23:31

They're they're fatty acid metabolites.

SPEAKER_04 23:33

Yes.

SPEAKER_03 23:34

Um, so it actually so babies utilize fat stores um in their bodies and break those down to make ketones, and then ketones cross the blood-brain barrier and um kind of support essentially the the nerve functions in the brain at that point in time.

SPEAKER_04 23:51

Now we're not advocating any kind of diet, but in in have you you probably guys have heard of the keto diet. So what is the keto diet? Yeah, so the keto diet is in order for you to survive on ketones, which is a less efficient way of using energy. Yes, right?

SPEAKER_03 24:06

You must literally have no carbs in your diet at all, hardly.

SPEAKER_04 24:10

And why? Because that switches off insulin production.

SPEAKER_03 24:13

Okay.

SPEAKER_04 24:13

Okay. What does insulin do? Insulin makes glucose go from your blood into your cells so that they can use it for energy, but also it switches off ketone production.

SPEAKER_03 24:25

Insulin switches off ketone production. Okay, that makes sense.

SPEAKER_04 24:28

Yeah, because if you have insulin, it you're using sugar, not the fat. So it switches off ketone production. Yeah. Right? At birth, the baby's insulin levels are very low. Yeah. So the ketone is the primary source of energy for the brain for the first 24 hours because there's only colostrum for the first 24 hours.

SPEAKER_03 24:46

Yeah, which is rocket fuel.

SPEAKER_04 24:48

Which is rocket fuel.

SPEAKER_03 24:49

It's a high lipid, yes, uh very concentrated.

SPEAKER_04 24:54

It's predominantly protein and immunoglobulins, um, less lactose, which is the carbohydrate source. Yeah. But babies survive no problem because they are reliant on their fat stores to put ketones in the body until milk comes in.

SPEAKER_03 25:08

Yes.

SPEAKER_04 25:09

Right? Now, when we say risk factors for hypoglycemia, these are risk factors that disturb this mechanism.

SPEAKER_03 25:16

Yeah, and by hypoglycemia you mean low blood sugar.

SPEAKER_04 25:19

Low blood sugar, okay. So a small for gestational age baby, so a baby that is small for their age, even at turkey.

SPEAKER_03 25:26

And just don't have the same stores.

SPEAKER_04 25:27

They don't have enough fat stores to produce ketones.

SPEAKER_03 25:32

Yes.

SPEAKER_04 25:32

So their blood sugar is much more important to monitor.

SPEAKER_03 25:36

Okay.

SPEAKER_04 25:37

Right? And then babies born to mothers with gestational diabetes.

SPEAKER_03 25:41

Yes.

SPEAKER_04 25:41

Now, go listen to the two gestational diabetes episodes for the full physiology because we talk about that. But in short, if the mother's insulin control is all over the place.

SPEAKER_03 25:53

Yeah.

SPEAKER_04 25:54

Right.

SPEAKER_03 25:54

Or challenged.

SPEAKER_04 25:55

Or challenged, exactly. What happens is the high insulin in the mother goes into the baby.

SPEAKER_03 26:05

Yes.

SPEAKER_04 26:05

Right?

SPEAKER_03 26:06

So the baby's born with higher than normal insulin levels. Yes. And therefore their own ketone stuff doesn't switch on. It's switched off. I can see where you're talking about.

SPEAKER_04 26:15

But also, also their blood sugar is low. So they have no source of energy.

SPEAKER_03 26:19

Yes. So they have no ketosis. Yes. And they also don't have blood sugar. Yes. Okay.

SPEAKER_04 26:24

Now, most mothers with gestational diabetes who are well controlled, this is not a problem. Yes. But in a small subset, yes, that can happen.

SPEAKER_03 26:33

So what we what what you do is you monitor those babies' blood sugars and you monitor the baby clinically.

SPEAKER_04 26:40

So the big three categories is a preterm baby. Yes, we check blood sugars, a small for gestational age baby, and a baby born to a mother with gestational diabetes or diabetes of any kind. Yes, because their blood low blood sugar in the first 24 hours is important because they don't have ketones.

SPEAKER_03 26:56

Yes. Okay.

SPEAKER_04 26:57

Yeah. So if you have a baby that is less than the third percentile, for example, they may still stay on the ward with you.

SPEAKER_03 27:04

Yeah.

SPEAKER_04 27:05

However, we will check their blood sugars.

SPEAKER_03 27:07

Okay.

SPEAKER_04 27:07

And if their blood sugars are low, there is a stepwise thing that we do. We try and optimize feeding first.

SPEAKER_03 27:14

Okay.

SPEAKER_04 27:14

And if that is not working, we either talk about supplementation if mom is breastfeeding, or we do something called glucagel. So it's a little gel that we rub on the baby's cheeks on the inside. And that can sometimes help bring the blood sugar up.

SPEAKER_03 27:28

Yeah, because all you're trying to do is kind of support it until their own body starts figuring this out. Yeah. And they clear the mother's insulin and they produce, they start kind of managing their own biochemistry again.

SPEAKER_04 27:40

Exactly. Yeah. If the glucagel doesn't work and the feeding doesn't work, then babies do need to be admitted to the neonatal unit for an intravenous infusion of dextros.

SPEAKER_03 27:51

Okay. And where would that happen? Would that happen in the HDU or would happen in the in the special care baby unit?

SPEAKER_04 27:56

It's usually the HDU or the transitional unit.

SPEAKER_03 27:58

Okay.

SPEAKER_04 27:59

Yeah.

SPEAKER_03 27:59

Okay. But generally they're well babies who are just going through a temporary challenge.

SPEAKER_04 28:04

Correct.

SPEAKER_03 28:05

And how long is it on average that a baby would need to be there for sugar monitoring?

SPEAKER_04 28:09

That is so variable. Most babies it's 24 to 48 hours. Okay. And the interesting thing is.

SPEAKER_03 28:13

I suppose it depends on the cause, because if it came from a the maternal diabetes, that the their maternal influence on their physiology will start to wane fairly quickly. But if it became because they were had low stores or they were kind of small for their gestational age, or a little bit early preterm, then that's a longer challenge to kind of deal with.

SPEAKER_04 28:33

Yeah, and sometimes managing that can be a challenge because the baby's pancreas, if it's been exposed.

SPEAKER_03 28:39

The pancreas is where the insulin is produced.

SPEAKER_04 28:42

Yes. It can it can take a while for it to kind of reset. It's kind of all over the place. It's like almost menopausal. It shoots hormones up and down like crazy. A menopausal pancreas.

SPEAKER_03 28:54

Really conflating your endocrine organs here, dude. Okay. It's it's okay. I understand.

SPEAKER_04 29:01

Let me explain. Yeah. So what the what the it fluctuates. What some pancreases need in that situation is a slow steady infusion of sugar.

SPEAKER_03 29:11

Yes.

SPEAKER_04 29:12

If sometimes babies feed and take a big gulp of milk, that will cause the pancreas to overproduce insulin.

SPEAKER_03 29:19

It'll overcompensate and then then it'll plummet their sugars again.

SPEAKER_04 29:22

And then it will plummet their sugars again.

SPEAKER_03 29:23

And then it'll go, oh god, oh god, and then it'll start messing around again. Exactly.

SPEAKER_04 29:27

Just like a menopausal woman.

SPEAKER_03 29:30

Oh my god.

SPEAKER_04 29:31

Yeah.

SPEAKER_03 29:31

Really? You okay, stop.

SPEAKER_04 29:34

Sorry. She's a bit menopausal. I'm joking, I'm joking.

SPEAKER_03 29:40

All I'd like to say is he seems to have lost sight of the fact that the majority of our listeners listeners are female.

SPEAKER_04 29:46

Yeah, 95%.

SPEAKER_03 29:48

Yeah. Have you lost sight of that dude?

SPEAKER_04 29:50

I'm sorry.

unknown 29:51

Okay.

SPEAKER_04 29:51

To the 95% of our listeners.

SPEAKER_03 29:53

What about this one? Anyway, go on. Go on.

SPEAKER_04 29:59

Okay. So like we also have to be careful with the feeding and keep a slow, uh uh close eye on the sugars. Okay. Uh most babies recover within 24-48 hours. And what we'd like to see is a baby is able to maintain their blood sugar above a certain number for three consecutive feeds without intravenous fluids before we deal them safe to go back to the ward.

SPEAKER_03 30:24

Okay. The last thing I'm going to ask on this sugary stuff is if somebody's on the ward with their baby, what are the clinical signs of they're looking at their baby and they're wondering, is this a sugar issue? Do they need to call somebody to check it? What does that look like?

SPEAKER_04 30:40

Yeah, so we label the baby as a jittery baby. So a baby that sort of has, I don't know how to display it.

SPEAKER_03 30:47

Um you can just talk us through it.

SPEAKER_04 30:50

So it's kind of these kind of shudders that babies do that are persistent. They get a bit shaky. They get a bit shaky, yes. And sometimes it is a sign of a low blood sugar, sometimes it's just the baby.

SPEAKER_03 31:00

But we're worth checking.

SPEAKER_04 31:01

And in the combination of that with the risk factors, we let we're a lot we check a lot closer, but the baby can be lethargic, not feeding, can be a bit more drowsy. So these are the signs that we watch out for.

SPEAKER_03 31:10

Okay, excellent. Um, okay, so I'm gonna move on now to the third most common reason. Yeah, which is a potential infection. Yes. Okay, so that's the third most common reason why a baby might need to go to these kind of low-level increased monitoring.

SPEAKER_04 31:27

So this is this is one of the this is one of my bugbears about babies and kneon ontology.

SPEAKER_03 31:32

Bugbears about babies.

SPEAKER_04 31:34

I'm gonna complain. I'm gonna complain about the babies. Sorry, we're both getting stiff legs are like adjusting, we're so old.

SPEAKER_03 31:41

Um, like he's I'm menopausal and I'm old. This is amazing. Keep on going there, love.

SPEAKER_04 31:48

Anyway, what were you saying? Infection.

SPEAKER_03 31:50

Infection, yeah.

SPEAKER_04 31:51

Yeah. So we have to be super careful with the potential for infection in babies. Because unlike adults or even older children, not treating a true infection immediately can actually result in the baby being extremely sick, brain damage, or even death. Right? Luckily, infection in the early newborn period is relatively rare. Okay, but our suspicion for it is common because we have to have a low threshold for checking a baby.

SPEAKER_03 32:22

So again, we're looking at kind of the risk assessment. Yes. So because in a newborn baby, significant infection can have disastrous consequences, even though it's extreme, even though it's rare to have that level of infection, we remain very vigilant because of the implications.

SPEAKER_04 32:39

So when you have an older baby that is, you know, six months old and they have a fever.

SPEAKER_03 32:44

Well, they have in their own immune system developed by then.

SPEAKER_04 32:46

Number one, and number two, 90 to 95% of the time it is viral.

SPEAKER_03 32:51

Yeah.

SPEAKER_04 32:51

And yes, you should get them checked if you're worried, but most of the time it's viral.

SPEAKER_03 32:55

Yeah.

SPEAKER_04 32:56

In newborn babies, it is mostly bacterial that needs antibiotics. Okay. Now, thankfully it's rare. The other problem is the symptoms of infection in baby is so vague.

SPEAKER_03 33:06

Yeah, so do need like do neonates go around with like high temperatures and stuff like that?

SPEAKER_04 33:10

In fact, the temperature can be normal or low.

SPEAKER_03 33:12

Okay. And they just get sleepy and lethargic.

SPEAKER_04 33:15

So with an infection, babies are more likely to have a low temperature than a high temperature with a true infection during the early period after delivery. Blood tests are highly unreliable. So we look at white cells.

SPEAKER_03 33:29

So white cells are the cells that they're your immune cells that respond to infections.

SPEAKER_04 33:34

So in in in an adult, for example, if you do um a full blood count and look at the their white cells, a high white cell count is an indication of infection. Infection. But again, in babies it can be normal or even low.

SPEAKER_03 33:46

Okay.

SPEAKER_04 33:47

So low cell count is more of an indication of an infection. Okay. And then we have all these other markers of inflammation, or if your body mounting a reaction, they're notoriously unreliable. They're all high after delivery.

SPEAKER_03 33:59

Yeah, because I'm just thinking, like, you know, labor and delivery itself is actually an inflammatory process that's triggered by the baby.

SPEAKER_04 34:06

Correct.

SPEAKER_03 34:07

Um so then you've got a baby who's come through an inflammatory process. Yeah. Um, and your most reliable signs are what? Like lethargy, sleeping? Yeah. Like, should they do that all the time?

SPEAKER_04 34:18

So because the signs are unreliable, we implement a risk-based system.

SPEAKER_03 34:23

Okay.

SPEAKER_04 34:23

Right? Are there enough factors that make us suspicious of an infection, even if the baby that you're looking at is well, right?

SPEAKER_05 34:30

Okay.

SPEAKER_04 34:31

So we shoot first, ask questions later, basically. So what are the risk factors? The risk factors are prematurity, less than 37 weeks, a prolonged labor, more than 18 to 24 hours.

SPEAKER_03 34:43

Yeah.

SPEAKER_04 34:44

And a mother that has a positive swab for group B streptococcus or GBS.

SPEAKER_03 34:49

Or a mother who's had a temperature in labor. A mother who had temperature in labor, and we talked about how that's not necessarily an indicator of infection in her, but again, now that the her and the baby have come through the same process, we now need to check the baby.

SPEAKER_04 35:03

Exactly. Okay. So we usually have a risk calculator, and if the baby meets a certain threshold, they get what we call as a septic workup. So we take a full blood count, we do a blood culture, and we put the baby on antibiotics.

SPEAKER_03 35:16

Okay. And then are the antibiotics stopped when the cultures come back negative?

SPEAKER_04 35:20

So we wait for 36 hours to see if there's any growth of bacteria on those cultures, and then we stop the antibiotics.

SPEAKER_03 35:27

Okay.

SPEAKER_04 35:28

Now we do about 2,000 to 3,000 septic workups a year.

SPEAKER_03 35:35

And that's out of a delivery of what, eight and a half together.

SPEAKER_04 35:37

Now it has gone down significantly with the introduction of the risk-based system that kind of more intelligently selects babies that are high risk.

SPEAKER_03 35:45

I will talk about that in a second. Yeah. Actually, we can talk about it now. But the risk-based system, okay, so this is um a series uh it assesses a series of triggers.

SPEAKER_04 35:57

Yes, what we spoke about. Yeah. You plug them into a calculator.

SPEAKER_03 36:03

How is it val how many where did it come from? How is it?

SPEAKER_04 36:06

It came from it came from looking at thousands and thousands and thousands of babies and mum combinations.

SPEAKER_03 36:11

Okay.

SPEAKER_04 36:11

Whereas we know now certain factors increase the risk. Now it's a risk, it's not a definite. So that's why we have to do the blood workup. Now, you know, there are implications to this because we know that antibiotics can disrupt the microbiome in babies.

SPEAKER_03 36:24

Yeah, and some people really would try and avoid antibiotics uh exactly as much as possible.

SPEAKER_04 36:31

So whereas before we used to give a longer course of antibiotics before we stop, we have now shortened it to 36 hours.

SPEAKER_03 36:36

To minimize the exposure.

SPEAKER_04 36:37

To minimize the exposure. Yeah. Right. Um, and we know that in 99% or even more of these tests, they're negative.

SPEAKER_03 36:48

Okay.

SPEAKER_04 36:48

Meaning that there is no evidence of infection and we stop the antibiotics. It's very rare that we have a positive culture.

SPEAKER_05 36:53

Okay.

SPEAKER_04 36:54

Generally, babies will be visibly sick. They're lethargic, they're not feeding, they have fast breathing.

SPEAKER_03 37:00

Again, the only thing I'd say is that though, like babies, normal babies can go through periods of fast breathing and then slow their slow their breathing and fast. You know what I mean? And normal babies can be very sleepy on the first day post-delivery, and that's normal. Yes. So it's hard to know exactly.

SPEAKER_04 37:17

Exactly. But it's important to say that most of these babies do not get admitted to the neonatal department.

SPEAKER_03 37:22

Okay.

SPEAKER_04 37:23

They get the work up and they stay with that's really important. Unless they are unwell.

SPEAKER_03 37:28

Okay.

SPEAKER_04 37:29

Meaning they're not feeding or they're fast breathing or there's another reason for them to come in. Okay. So the vast majority of babies that undergo a check for infection remain well and remain with mum. Remain with mum. Okay, good. That's reassuring. Yeah.

SPEAKER_03 37:41

Um, the next thing I want to talk about is babies who cannot maintain their temperature. So we talked about like the temperature being an unreliable marker of infection.

SPEAKER_05 37:51

Yeah.

SPEAKER_03 37:52

But even a well baby who doesn't have an infection or anything like that, sometimes it's very hard for them to maintain their temperature in that it tends to go low.

SPEAKER_04 37:59

Yeah.

SPEAKER_03 38:00

Uh why is that, and what do we do about it?

SPEAKER_04 38:03

So babies cannot regulate their temperature the way adults do, right? So, you know, we can maintain a core body temperature as an adult of 36.5 or 37 degrees in a wide range of environmental temperatures, right? From zero to whatever. Babies can't do that. Babies, if the environment is cold, they will be cold. If the environment is hot, they will be hot. So sometimes if the baby's overwrapped and the room is hot, they can actually spike a fever.

SPEAKER_03 38:34

Okay.

SPEAKER_04 38:34

And often when they are undressed, they'll get freezing cold. No, they're they'll they'll settle down. And and vice versa, if the room is cold, they can get cold. And that's why we always ask parents to maintain their but their temperature, their room temperature at home, roughly between 18-20 degrees, something like that. But because a low temperature can be a sign of infection, yeah. We have to sometimes bring the baby up to the neonatal department and monitor them.

SPEAKER_03 39:02

Yeah.

SPEAKER_04 39:03

Make sure they are no other signs of infection. Okay. Make sure they are feeding well.

SPEAKER_03 39:07

So the baby, the temperature issues itself will not bring the baby to the neonatal unit.

SPEAKER_04 39:13

Yeah. Sometimes if you like if they're if it's a high temperature. So if the baby, if we're called about a baby on the postnatal word that either either has a high or a low temperature, if the baby's otherwise well and is feeding, we generally say it could be environmental.

SPEAKER_03 39:33

Yeah.

SPEAKER_04 39:33

And we sometimes just leave the baby alone and see if there's a persistence. We check it in an hour, see if it settles. If it doesn't settle, we would do a septic work-up.

SPEAKER_03 39:41

So do heat waves drive you to mint it?

SPEAKER_04 39:43

Yeah, sometimes. But I mean, it's not that bad because inside we have like so babies that are small for gestational age, though, that don't have enough fat stores in their body can become very cold, and that can then make them actually hypoglycemic.

SPEAKER_03 40:00

Okay, because it mess starts messing with all of their metabolism.

SPEAKER_04 40:02

And it makes them cold, yeah, and they won't feed well. Yeah. So oftentimes they need to come up to the unit.

SPEAKER_03 40:08

And they go in in a little incubator. Yeah. And then once they're warmed up, they come out and then they're checked to make sure they can still maintain.

SPEAKER_04 40:15

Yeah. The sole purpose of an incubator, people see incubators all the time. The sole purpose of an incubator is to maintain uh uh heat and moisture. Heat and moisture for baby. That's all it does.

SPEAKER_03 40:29

It doesn't cook them?

SPEAKER_04 40:30

Doesn't cook them, doesn't fix them. Sometimes people think, oh, I'll put them in an incubator and it will it will incubate them. Yeah. You know, and fix them. No, it's just a method of maintaining heat and moisture though. So for example, preterm babies that are born at 24 weeks have almost no skin barrier. So they will they will evaporate. But no, they do have skin, yeah, but they cannot maintain they can't yeah, they can't stop themselves from the literally the water will evaporate if they are in um a room temperature environment. Okay, dry air. So we actually have to bump up the humidity to 80% in the incubator. And have the temperature 33 degrees. Wow. So they're like in a tropical island inside. In order for them to stop the to stop losing moisture. To stop losing moisture, yeah.

SPEAKER_03 41:22

Wow.

SPEAKER_04 41:22

Yeah. And generally babies can't maintain their own body temperature until they're closer to maybe 34, 35 weeks.

SPEAKER_03 41:30

Gestation.

SPEAKER_04 41:31

Gestation, yeah. Yeah, exactly.

SPEAKER_03 41:33

So they need to be close to term. Yeah. Okay. Yeah. Okay.

SPEAKER_04 41:36

Um, so that's why babies go in an incubator. So when they are transitioning to a cot.

SPEAKER_03 41:40

That's a huge transition, though. It means that they can maintain their their own body temperature and their own their own moisture balance, their skin barrier. In a normal environment. Yeah, so their skin barrier has matured.

SPEAKER_04 41:51

Some babies are put in an incubator because we can put ambient oxygen in it.

SPEAKER_03 41:56

Oh, so you so it's like breathing oxygen-enriched air, like in the casinos in Las Vegas.

SPEAKER_04 42:02

Yes, it's in the exactly. You know how these oxygen chambers that people are talking about.

SPEAKER_03 42:06

Well, no, in the casinos they pump extra oxygen to keep people alert.

SPEAKER_04 42:09

We've been doing it for babies all along.

SPEAKER_03 42:11

There you go.

SPEAKER_04 42:11

Yeah.

SPEAKER_03 42:12

So they're in some okay, so they're in some subtropical hyper-oxygenated environment. Fucky them.

SPEAKER_04 42:18

Yeah. And another interesting um uh incubator anecdote. Um, everybody's talking about poor punch.

SPEAKER_03 42:27

Oh, stop. Poor punch. No, poor punch is doing better. Poor punch is friends now.

SPEAKER_04 42:33

Yes, poor punch, the monkey that was rejected.

SPEAKER_03 42:36

That was rejected by the IKEA. No, there was a bit where he literally got beaten up and then he got his little IKEA mammy monkey that they gave him, and um he he got the arm and he tucked it around himself and then snugged in like he was being held, and I swear it broke my heart.

SPEAKER_04 42:54

Yeah. So I can't remember if it was in the 70s or the 80s.

SPEAKER_03 42:58

The 80s or the 90s.

SPEAKER_04 43:00

The 80s or the 90s. The same thing happened in Dublin Zoo.

SPEAKER_03 43:03

Now you're gonna tell this story wrong, but go ahead.

SPEAKER_04 43:06

Why?

SPEAKER_03 43:06

You tell the story then I've heard about four different versions of it, you see.

SPEAKER_04 43:10

So the neonatal department in the rotunda had to take care of a some form of a baby bunch of a of a monkey.

SPEAKER_03 43:19

Yes, but uh there's multiple different kinds. Some kind of I don't know if it was gorilla, orangutan, chimp, yeah, and he was in an incubator.

SPEAKER_04 43:28

In the neonatal ward.

SPEAKER_03 43:29

Yeah, for a few hours.

SPEAKER_04 43:30

For a few hours, yeah.

SPEAKER_03 43:32

I know it's a bad dog. Can you imagine? I I'd say the nurses were like going, what in the world?

SPEAKER_05 43:37

Yeah.

SPEAKER_03 43:37

Oh, so cute though.

SPEAKER_05 43:39

I know, yeah.

SPEAKER_03 43:39

Um, okay, so back onto humans. Yes. Okay. Um the other thing, and I would say that this is something that drives new mothers absolutely demented in the first couple of weeks, but definitely in the first couple of days, if there's any feeding difficulties.

SPEAKER_05 43:58

Uh huh.

SPEAKER_03 43:58

Oh my god, is anything more? Stressful, I swear. For for a new mum with a well baby, that is literally your focus, and you're like, Oh my god, yeah, I know it's so hard.

SPEAKER_04 44:08

That is a problem, and obviously feeding difficulties on their own when the baby is term. We do our best not to admit the baby if they're not, yeah.

SPEAKER_03 44:17

Because you want to keep mum and baby together because other than like otherwise, you're kind of nearly underlining or enhancing the difficulties that are there because they're not together as a little die out. And unfortunately, with our infrastructure at the moment, we don't have room in a capacity abilities, room rooming inabilities.

SPEAKER_04 44:34

Rooming inabilities, yeah, exactly. So, you know, breastfeeding is not natural.

SPEAKER_03 44:41

Well, it's all natural, but it's not easy.

SPEAKER_04 44:44

It's not easy.

SPEAKER_03 44:45

Yeah, we are not, it's not like a cow that has a calf and the calf just goes over and suckles, and there you go, it comes out. It is not like that.

SPEAKER_04 44:52

No, there's a learning process for both mum and baby, and mum needs a lot of support, which sometimes can be lacking, unfortunately. There's no point in kind of denying that.

SPEAKER_03 45:01

It's a resource-limited issue.

SPEAKER_04 45:03

Yes, exactly. And oftentimes, if the baby's not feeding well, breastfeeding, and you know, there's issues with formula feeding as well, they can't be admitted to the to the intensive care unit. They tend to be babies that are late preterm.

SPEAKER_03 45:18

Okay.

SPEAKER_04 45:19

So you're talking babies that are 35, 36 weeks. Okay. So technically, um, automatic admission to the intensive care unit is less than 35 weeks.

SPEAKER_03 45:30

Right.

SPEAKER_04 45:31

Right? And less than two kilos.

SPEAKER_03 45:35

Okay.

SPEAKER_04 45:35

Okay. If a baby's over two kilos and they're over 35 weeks, they can go to mum.

SPEAKER_03 45:43

Again, but now we're back to is there suck well developed? All of that kind of stuff.

SPEAKER_04 45:47

So the suck, swallow, breathe doesn't get fully established until term.

SPEAKER_03 45:53

Okay. So some by term you mean 37 weeks onwards.

SPEAKER_04 45:56

Yeah, but sometimes even babies born at 37 weeks can struggle with that.

SPEAKER_03 45:59

Okay. Because I suppose we we never truly know their exact gestation. We estimate it.

SPEAKER_04 46:04

Yeah, so sometimes they may have issues with coordination, and again, you need time. So sometimes they are admitted for nasogastric tube feeding.

SPEAKER_03 46:11

Yeah, it's interesting actually when you think about it, because you know we assume every baby's just gonna know how to suck, swallow, and breathe and get that coordination thing going. But when you think about it, it it it's quite a sequence that they have to master, you know.

SPEAKER_04 46:26

Exactly. So some babies find that difficult.

SPEAKER_03 46:28

And again, if they're vigorous and the more hungry they get, the more upset they get.

SPEAKER_04 46:33

Exactly, yeah. So we sometimes do nasogastric feeding where we pass a tube up the baby's nose, down the back of the throat, all the way to the stomach, okay, and we feed them through that, but also getting them on the breast at the same time and getting them to learn how to suck.

SPEAKER_03 46:50

And can they feed effectively with that tube in place? It doesn't bother them so much.

SPEAKER_04 46:54

No.

SPEAKER_03 46:55

Because having nasogastric tubes in adults dives into vent it, they eat it.

SPEAKER_04 46:59

Exactly. No, but with babies, oftentimes, if mum is intending on breastfeeding, or even if they're formula feeding, we start introducing breast or bottle as the tube is there.

SPEAKER_03 47:09

Yeah.

SPEAKER_04 47:09

And then we have babies that are combination, what we call is um teeth and tube. So these babies that have some feeds via the nasogastric tube, some feeds orally, but the tube stays in. We don't take it in and out.

SPEAKER_03 47:22

So they're still learning how to feed themselves while we're supporting their nutrition with the nasogastric tube for safety.

SPEAKER_04 47:30

Exactly.

SPEAKER_03 47:30

Okay, and how long? I suppose it depends on the gestation of the state.

SPEAKER_04 47:33

It really depends. It's some some babies take some babies, it's just 24 or 48 hours, some babies can be days. It's like 12 hours, some babies can be days. Yeah. Yeah. It's rarely weeks unless they're very premature.

SPEAKER_03 47:44

Yeah, like if you have a kind of growth-restricted 36-week or say, you know, they've got a bigger catch-up to do with their difficulty in feeding because now they have the other issues with her in terms of being small, you know. Exactly. Individualised.

SPEAKER_04 47:59

Very individualized.

SPEAKER_03 48:00

Very individualized. Okay.

SPEAKER_04 48:02

Ann I think you've done a very good job.

SPEAKER_03 48:04

Oh, driving driving the car.

SPEAKER_04 48:06

Driving the car, exactly. It's always very difficult for mums to be separated from their baby, and they often feel that they're missing out on the time with them. And that is, you know, a valid feeling, and that is legitimate. But you know, if you look at the longer-term picture, babies are very resilient, and as long as you care for them once you go home, that initial separation, yes, I know, can be very traumatic for some mums. But overall, babies always do extremely well when they are discharged.

SPEAKER_03 48:41

Like, I suppose the difference is that like if a baby is well, yeah, they're not going to be separated from you.

SPEAKER_05 48:47

Yes.

SPEAKER_03 48:48

Um, and that's fine. But if the baby has a reason to be in the NICU, they are likely not feeling well enough anyway, yeah, to actually be missing anything. And the babies don't remember. Um, so I hope that this episode is actually very reassuring for people. Yes. So that you understand the context potentially, or you've got greater information on the context that a neonatologist might come and have a chat with you about your baby. Yeah. Um, and that all is not lost, it's not a catastrophe. Yeah. And for the most part, for the vast majority of babies, it's just a little blip and they'll be back in your arms in in in a short period of time.

SPEAKER_04 49:28

Exactly. Why did I tell people last night in that I did neonatology?

SPEAKER_03 49:33

So that you could get pity and so that you could get girls when you were younger.

SPEAKER_04 49:37

Yeah, and it worked. I got you. Mind you, you weren't you weren't impressed when I told you I was a pediatrician.

SPEAKER_03 49:43

No, I said I don't go out with doctors.

SPEAKER_04 49:45

Yeah. But you did in the end.

SPEAKER_03 49:48

You are the only medic I've ever gone out with.

SPEAKER_04 49:51

What do you mean? Have you gone out with other people?

SPEAKER_03 49:55

Yeah.

SPEAKER_02 49:57

And they were hot.

SPEAKER_04 50:00

See you next week.

SPEAKER_02 50:02

Bye.

SPEAKER_04 50:03

The Baby Tribe is proudly sponsored by Happytummy.ie, the exclusive distributor of Bayagaya probiotics, providing support for gut and oral health for the whole family.

SPEAKER_00 50:14

This show is part of the Headstuff Podcast Network, a hub for the creative and the curious. Shows are produced in association with Headstuff and the Podcast Studios Dublin. Find out more or become a member at Headstuff Podcasts.com.