Prematurely born babies often have a combination of these two types of apnea.

Apnea does not cause sudden infant death syndrome (SIDS). However, prematurely born babies are more likely to get SIDS because they are prematurely born. No one knows exactly why this is the case. 

Abortion
Termination of the pregnancy before the fetus is able to survive outside the womb. In the U.S. this age is arbitrarily taken to be 20 weeks gestation, although no infant less than 22 weeks has been reported to survive after delivery. Abortion may be either spontaneous or induced.

Accreditation
Being accredited by someone or something. In the US this usually refers to Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and in (Canada this refers to the Canadian Council on Health Facilities Accreditation (CCHFA)). Through the JCAHO web site you can access summary information on thousands of surveyed hospitals and other organizations. Your hospital should be accredited. This is not to be confused with Board Certification which relates to physicians.

Accu-Check or Chemstrip 
These tests measure the amount of glucose (sugar) in the blood. Premature babies (especially those who are ill or are receiving certain medications) may have high or low glucose levels in their blood. Since a low blood sugar demands prompt attention, having this blood test available at the bedside reduces the time needed to know whether a patient needs treatment. Without these tests it is necessary to send a blood specimen to the lab for analysis, which takes more time and delays treatment. 

Accutane®
Also known as isotretinoin, Accutane® is a retinoid medication used to treat that has not responded to milder forms of treatment. It is one of the most intense forms of acne therapy and has significant side effects. The most common side effect is increased skin sensitivity to sunlight. It is also a powerful teratogen, or cause of birth defects. Under no circumstances should a woman take this medication if there is a chance she is or may become pregnant. Accutane® has been known to cause prematurity, and severe birth defects- often leading to death, even if taken for a short amount of time during the pregnancy. If a woman takes Accutane®, her risk of having an affected child is over 30%. Accutane® is also prohibited for nursing mothers. Women taking Accutane® should work closely with their doctors to regulate their use of this very helpful, but potentially harmful medication. Other trade names used in Canada or Australia are Accure®, Isotrex®, and Roaccutane®.

Acellular
Generally, this is a word that means without cells. In the context of pregnancy and early childhood it usually has reference to acellular pertussis vaccine. The original pertussis vaccine (DTP) included parts of the whole bacterial that causes pertussis. Recent research has shown that only certain parts of the bacterial cell are required to produce immunity; not the whole bacterial cell. The new vaccine is called an since it contains only those proteins that are important for producing immunity and not the whole bacterial cell. The acellular vaccine has fewer side effects than the old, whole-cell vaccine and is the recommended type of vaccine for preventing.

Acetaminophen
This is one of the most commonly used medications to reduce fever in children. It does not cause upset stomach and other side effects that aspirin and ibuprofen have been known to cause. It is commonly known by its commercial name, Tylenol®.

Acne
There are three forms of acne that might be important for women and their newborn children. PREGNANT WOMEN who have had acne in the past sometimes note improvement in their acne. For other women, pregnancy makes acne worse or causes it to develop even if it has not been present in the past. It is not possible to predict the course of acne during pregnancy for most women.

NEWBORNS can develop a skin rash on their face that looks like acne. This acne is thought to be caused by the hormones in the mother's blood. These hormones are transferred to the infant through the placenta and remain in the infant's blood causing increased oil production with resultant acne lesions. The best way to care for this "acne" is to wash is with a gentle soap a couple times a day and pat dry- do not rub- a newborns skin is very sensitive. Occasionally, medications applied to the infant's skin are required, but this is uncommon.

INFANTS may occasionally develop acne at about 3-6 months of life. It is more common in boys and among those infants whose parents have also had problems with acne. This form of acne more commonly requires treatment. It usually resolves by about three years of age and leaves no scars.

Acquired immunodeficiency syndrome (AIDS)
A usually fatal disease in which the immune system is severely damaged following infection with the human immunodeficiency virus (HIV). AIDS can be spread through sharing needles among drug addicts, sexual contact, and from mother to child during pregnancy, labor and delivery. New medicines have markedly reduced the risk of transmission from mother to child and have also improved the survival and quality of life for infected persons.

ADD (Attention Deficit Disorder)
This is sometimes also called hyperactivity or the distractible child syndrome. This is a relatively common disorder occurring in about one in twenty children. It may manifested by the following:

Inability to sit still for more than a few moments at a time

Difficulty following simple instructions

Sudden emotional outbursts

School difficulties, often because they cannot concentrate long enough to get instructions and pursue a task to completion

Difficulty focusing on a specific task especially when there are other events going on around the child.

Persistence disobedience

Tendencies toward talkativeness, disobedience and being demanding

It is common for children under the age of three to manifest many of these behaviors and not have ADD. Even up to the age of five years, some children will manifest many of the signs of ADD. If you think that your child may have ADD, you should check with your child's doctor. The doctor will examine your child and evaluate his development. The only drug approved for treatment of ADD is Dexedrine although other drugs have been used. There are a number of unproved therapies, which are often recommended in the lay press. Check with your child's doctor before trying these. Megavitamin therapy and the use of special vitamin and mineral supplements may be harmful.

Adhesion
The abnormal joining of adjacent tissues following infection or other inflammation. This is often used to refer to fallopian tubes that can develop adhesions and prevent conception.

After-birth
The placenta and associated membranes passed from the uterus after birth of the child. The placenta usually follows shortly after the baby. However, if it does not come on its own the doctor may have to remove it by other means, as complications may arise if it is not expelled. The fetal membranes-the chorion is the outer one and the amnion is the inner one-envelope the embryo and contain the amniotic fluid.

Albumin 
A protein found in the fluid part of the blood. It is a component of plasma given to the infant to help maintain blood volume and good blood circulation. Babies who are ill often have a drop in the amount of blood available to the heart for pumping to the body. Albumin has been used to expand the blood volume and increase the effectiveness of the heart. An example would be a baby who has lost blood for any reason and needs an immediate infusion of fluid before a red blood cell transfusion is available. 

Allopathic
Medicine practiced by those with a doctor of medicine degree, sometimes called Western medicine. Allopathic medical care is the kind of care that the majority of Americans receive. It uses medications and surgery to fight diseases. It stands in contrast to homeopathy which uses natural herbs, diet and vitamins to improve health. Other alternatives to allopathic medicine include chiropractic, acupuncture and meditation. An increasing number of Americans are using alternatives to allopathic medicine as either a substitute for or in conjunction with allopathic medicine.

Alopecia
Hair loss. Most newborns lose some hair in the first six months because the lanugo falls out before the mature or normal hair, emerges. Infant hair loss also occurs when by the baby's scalp rubbing against the mattress. This can be avoided by change your baby's position often, washing the scalp often ,and brushing the scalp with a soft hairbrush daily to stimulate hair growth. If your baby still has not grown hair by 12 months talk to Pediatrician.

Alpha-Fetoprotein (AFP)
A plasma protein normally produced by the fetus' liver. AFP eventually finds its way into the mother's blood and the amniotic fluid. When too much or too little AFP enters the mother's blood stream it can be a sign of fetal problems, such as birth defects. High AFP levels in the mother's blood indicates an increased risk of fetal spina bifida, anencephaly, or other malformations. Low AFP levels are associated with an increased risk of Down syndrome (trisomy 21) and other chromosomal problems. AFP testing is offered to almost all pregnant women in the U.S. Measuring the AFP level is not sufficiently accurate in screening for Downs- AFP testing should be combined with other tests. Don't assume your child has Down syndrome or spina bifida just because you had an abnormal AFP test result. The AFP test assesses risk, it does not diagnose disease. Unfortunately, many abnormal test results are falsely abnormal and do not reflect a problem with the fetus or mother. If the AFP test is abnormal, additional testing should be performed

Amennorhea
The absence of menstruation. Temporary amenorrhea may occur after stopping oral contraceptives. About 90% of all women who have ovulated regularly before taking the pill will have again begun to do so by three months after stopping oral contraceptives.

American Association for Premature Infants (AAPI)
This national advocacy organization is dedicated to improving the quality of health, development and educational services for premature infants, children, and their families. Its Web site is a good entry point to available services.

Amniocentesis
Sometimes called an 'amnio', this is a minor surgical diagnostic test that allows the doctor to obtain a sample of the amniotic fluid. A long, thin, hollow needle is inserted through the mother's abdomen into the uterus and amniotic fluid. The procedure is almost always performed with ultraound imaging to guide placement of the needle. The small amount of fluid removed should not affect the baby. It a common way to obtain material for genetic and other testing of the baby. The risk of complications from the procedure are low, but as with any procedure complications can occur. You should have a thorough consultation with your doctor before the procedure is performed. Amniocenteses is usually done after the thirteenth or fourteenth week of pregnancy.

Amnion
The thin, transparent inner membrane (the chorion is the outer layer) that constitutes the amniotic membranes. These membranes contain the amniotic fluid and form a protective layer for the baby insulating him/her from bacteria in the vagina. Rupture of this sac exposes the child to bacteria in the vagina and increases the risk of infection if the infant is not delivered within about 18 hours. Labor usually starts shortly after of before rupture of the amniotic membranes.

Amniotic fluid
The fluid within the amniotic sac is produced by the fetus and placenta. This buoyant fluid aids symmetrical growth, musculoskeletal development, allows the baby to move within the uterus and prevents the amnion from sticking to the fetus. Either low or high amounts of amniotic fluid can signal a problem with the fetus or mother. Mild decreases in the amniotic fluid levels are common late in pregnancy.

Amniotomy
The artificial rupture of amniotic membranes (AROM). This procedure is commonly performed to hasten or induce labor, check for meconium, or enable the use of an internal fetal monitor. The benefits of this is that it allows doctors to view the amniotic fluid and can speed up labor. The disadvantages are that it may rarely lead to umbilical cord compression and eliminate the barrier protecting the fetus from bacteria in the birth canal. Some doctors frequently perform an amniotomy on all their patients and some do not, find out your doctor's policy.

Analgesic
Refers to any medication that relieves pain while allowing the patient to remain consciousness.

Androgens
Male hormones that regulate male sexual secondary characteristics and sexual function.

Anemia
An abnormally low level of red blood cells in the blood stream. Sufficiency of red blood cells is measured as the quantity of hemoglobin per milliliter of blood or the volume percentage of red blood cells in a milliliter of blood. There are several causes of anemia such as reduced production of red blood cells or increased blood loss. The most common cause is iron deficiency. Both pregnant women and children are at risk for a low level of red blood cells. The frequency of this problem is the reason that the red blood cell level should be measured as a part of routine care both in children and pregnant women.

Anencephaly
One of several neural tube defects. The neural tube is a embryonic structure in the developing fetus that forms the spinal cord and brain. Anencephaly is caused by failure of the upper end of the neural tube (the rostral neuropore) to close in the embryo's fourth week of life. This is a fatal malformation and these children die within a few days of delivery. The risk of anencephaly and other NTD's (neural tube defects) can be reduced by taking appropriate amounts of folic acid before conception and throughout pregnancy.

Anomaly
Something abnormal or out of the ordinary. This usually refers to a congenital anomaly or birth defect. Birth defects may be caused by genetic problems, alcohol, medications, and environmental factors, many of which are not well understood.

Anterior
Means in front of, usually with reference to the front part of the body. Often used in association with the term 'anterior presentation' or 'occiput anterior' (OA). Usually, babies are born with the back of the head or occiput pointed up or slightly to the left or right side. It is as if the child was looking at the floor during emergence from the birth canal. This is the best position in most cases since it allows the child to negotiate more easily the turns required to get through the mother's pelvis and birth canal. If the baby presents in the birth canal with the occiput anterior and to the left it is called an LOA (left occiput anterior) presentation. If the occiput is anterior and to the right, it is called ROA (right occiput anterior).

Apgar score
A numerical summary of a newborn's condition at birth based on the five signs noted in the table. The score is measured at 1 and 5 minutes. Additional measurements are made every five minutes thereafter if the score is <7 at five minutes until the score reaches 7 or greater. Prematurely born infants generally have lower scores than full term infants. The Apgar score does not predict future development with accuracy. The score was developed by Virginia Apgar and represents a rough estimate of the condition of the infant at birth.

Apnea
Literally, this means cessation of breathing. It is common for premature newborn infants to stop breathing for a few seconds. They almost always restart on their own, but occasionally they need stimulation or other drug therapy to maintain regular breathing. The heart rate often slows with apnea. This slowing is called bradycardia. The combination of apnea and bradycardia is often called an A & B spell and refers to the slowing of the heart rate in response to apnea.

Apnea gradually becomes less frequent as premature infants mature and grow. Unfortunately, it may not disappear before the baby is otherwise ready to go home. In this case, the infant is sent home with an apnea monitor and the parents are instructed in cardiopulmonary resuscitation (CPR). No relationship between apnea and sudden infant death syndrome (SIDS) has ever been proven.

Areola
Any circular area of a different color than the surrounding skin. This often is used in reference to the dark ring of skin around the nipple of the breast. The areola often becomes more prominent during pregnancy.

Artificial insemination
A medical procedure to place sperm inside the reproductive tract.

Asymptomatic
Without symptoms.

Autism
A rare condition (2:10,000 births) manifested by difficulty in establishing relationships and responding to the environment. The child is often very self-absorbed and may not develop speech normally. These children may ignore external stimuli and others, even their parents. Autism is usually diagnosed when a child is about 1 or 2 years old due to speech and developmental delays. If you have a question that your child may have autism or has been diagnosed with autism, you should consult with your pediatrician and possibly other specialists regarding prognosis and therapy.

Azoospermia
The absence of sperm. This rarely occurs except in men who have had chemotherapy or radiation therapy for malignancy.

Baby Blues (Post partum depression)
During the first few weeks after delivery up to 15% of new mothers experience postpartum depression. This is characterized by mood swings, lethargy, feelings of inadequacy, and anxiety. Women at greater trisk of postpartum depression are those with depression following a previous pregnancy (about 70% risk), adolescent mothers (30% risk) and women with a history of depression in the past not associated with pregnancy (30%). For most women, this depression is transient, resolving within six months. However, for some mothers a more lasting type of baby blues occurs. These women may have more severe depression that interferes with their ability to function.

Lack of sleep with caring for the new baby, medical complications of childbirth, and other pressures associated with a new baby can worsen the depression. Fathers can also suffer from baby blues. For them it is usually a much milder condition. It should be discussed with a doctor if it interferes with daily activity or lasts more than a few weeks. Most likely postpartum depression is triggered by changes in levels of progesterone and estrogen after delivery although the exact cause is not known.

Back labor
Some women have labor pains that are concentrated in their back. This is more common when the baby is presenting in the birth canal with the occiput posterior (OP) with the baby looking up rather than down as in the occiput anterior (OA) position.

Bag and mask
Two items available during delivery and in the Newborn Intensive Care Unit (NICU) to help a baby breathe in an emergency. The mask fits over the infant's nose and mouth and is attached to a plastic or rubber bag with a supply of oxygen. A nurse or physician uses the equipment to push oxygen into the infant's lungs when the infant is having trouble breathing.

Bag of Waters
Refers to the amniotic membranes which contain the amniotic fluid. See amniotic fluid.

Basal body temperature
Just before ovulation, a woman's basal (resting) temperature increases. The temperature should be taken early in the morning, which is usually the lowest temperature of the day. The basal body temperature has been used to time intercourse to increase the likelihood of conception and also as part of the rhythm method or preventing conception.

Basal body temperature
Just before ovulation, a woman's basal (resting) temperature increases. The temperature should be taken early in the morning, which is usually the lowest temperature of the day. The basal body temperature has been used to time intercourse to increase the likelihood of conception and also as part of the rhythm method or preventing conception.

Bethamethasone
Steroid medication helping the baby's lungs to mature more quickly. It is most effective if it is given more than 24 hours before delivery. Betamethasone hastens lung development and also helps intestines, kidneys and other systems to mature.

Bilirubin
Yellow chemical that is a normal waste product from the breakdown of hemoglobin and other similar body components. The placenta clears bilirubin from the fetus's blood, but after delivery this task belongs to the infant. It usually takes a week or more for the newborn's liver to adjust to its new workload. When bilirubin accumulates, it makes the skin and eyes look yellow, a condition called jaundice.

A little jaundice can be expected in all newborns. If the jaundice is higher than usual, it can usually be treated with phototherapy (special lights). If the level of bilirubin gets extremely high, brain injury is a risk. With modern treatment techniques such as phototherapy, such dangers rarely occur. Phototherapy is so effective in helping the liver excrete bilirubin that elevated levels are rarely a problem. Prematurely born infants may have elevated bilirubin levels for several weeks.

Biophysical profile
A series of measurements made to evaluate the fetus' condition before delivery. The biophysical profile is similar to the Apgar system, but performed before delivery. Ultrasound observations are made for at least 30 minutes. The score is based on the findings in the table below.

VariableScore 2Score 0Fetal breathing movementsThe presence of at least 30 sec of sustained fetal breathing movements in 30 min of observation.Less than 30 sec of fetal breathing movements in 30 min. Fetal movements Three or more gross body movements in 30 min of observation; simultaneous limb and trunk movements.Two or less gross body movements in 30 min of observation.Fetal toneAt least one episode of motion of a limb from position of flexion to extension and rapid return to flexion.Fetus in position of semi- or full-limb extension with no return or slow return to flexion with movement; absence of fetal movement counted as absent tone. Fetal reactivity Two or more fetal heart rate accelerations of at least 15 beats/min and lasting at least 15 sec and associated with fetal movement in 20 min.No acceleration or less than two accretions of fetal heart rate in 20 min of observation.Qualitative Amniotic fluid volumePocket of amniotic fluid that measures at least 1 cm in two perpendicular planes.Largest pocket of amniotic fluid measures < 1 cm in two perpendicular planes.

Biopsy
Obtaining a fragment of tissue for examination. This is done with many body tissues to look for abnormalities such as malignancy or infection.

Birth canal
The tunnel comprised of the vagina and cervix, through which the infant must pass from the uterus during birth.

Blastocyst
A very early stage of embryonic development. About 4-5 days after conception the embryo consists of a ring of cells with fluid in the center and a clump of cells at one end with a thinner layer of cells at the other end.

Blood gas
Test used to determine the oxygen, carbon dioxide, and acid content of the blood. A blood gas is used to evaluate the status of the infant's lungs. If the lungs are not working properly, the concentration of oxygen gas in the blood will be low and the concentration of carbon dioxide will be high. The amount of acid in the blood reflects both lung and heart function. Physicians use the blood gas to help them evaluate a sick newborn infant.

Blood gas can be obtained from three sources: arterial blood, capillary blood or venous blood. Arterial blood (blood taken from an artery) is the most accurate and useful way to measure blood gases because it most closely reflects the lung function. Capillary blood (blood taken by pricking a finger or heel) is often easier to obtain than arterial blood, but does not give as accurate a measure of oxygen concentration in the blood as the arterial blood sample does. Venous blood (blood taken from a vein) is used the least often and yields values that least closely reflect lung function, but may still be useful.

Bloody show
As the cervix dilates, blood and the cervical mucous plug (from the cervical canal) pass from the vagina. The bloody show is a classic indicator of beginning or progressing labor.

Bordetella pertussis
Pertussis is a highly contagious infection of the respiratory tract and lungs caused by Bordetella pertussis. It produces a cough that is characteristic of the infection. Violent, repeated coughing is punctuated by a rapid gasp (whoop) of inspiration. People with this infection take a rapid breath in, which causes a whooping sound and then go into another bout of coughing. This pattern of coughing and whooping inspirations has led to the nickname 'whooping cough'.

Although pertussis is an uncommon infection, it is very serious. This is especially so in infants or toddlers. In them the infection can be severe enough to require a respirator and also affect the brain, leading to life-long impairment. Pertussis is still around; 5,137 pertussis cases were reported in 1995. An outbreak of 32 confirmed and probable cases recently occurred among students in a private, Minnesota school.

The acellular DTP vaccine protects most recipients (up to 90%) against this infection and has few side effects.

Bradycardia
An abnormally low heart rate. When referring to the fetal heart rate (FHR) tracing in labor, abnormally low heart rates can signal problems with the fetus before delivery. The FHR is often monitored for abnormalities of the heart rate. Fetal bradycardia episodes are sometimes called FHR decelerations. Some types of FHR decelerations are common during labor. Others suggest fetal stress and demand further evaluation or intervention. Sometimes the FHR not only dips down, it stays down and does not return to its usual level. This is an ominous situation that demands immediate delivery. FHR decelerations or bradycardia episodes come in three types.

1. Early decelerations are normal and common. These decelerations are called early because they occur early during a uterine contraction. These FHR decelrations usually occur after labor is well established (4-7 cm of cervical dilatation). The FHR rarely goes below 100 beats per minute. The cause of these decelerations is head compression during uterine contractions.

2. Late decelerations cause more concern. They are called late because they first appear at or after the peak of the uterine contraction. The FHR improves only after the contraction has stopped. These FHR decelerations may be mild or severe based on how low the FHR goes and how long it takes for the FHR to recover. It is thought to be caused by reduced blood flow to the uterus and placenta during a during a contraction.

3. Variable decelerations are a common type of FHR deceleration in labor and are caused by umbilical cord compression. Up to 80% of fetuses will have variable decelerations during labor. the significance of the these decelerations depends on how low the heart rate drops and how long the episode lasts.

When referring to a newborn baby bradycardia is usually associated with apnea or cessation of breathing. Apnea and bradycardia spells are most common in prematurely born infants. During these spells the infant will stop breathing for at least 15 seconds and the heart rate will start to slow. Gentle touching or other stimulation almost always restarts the breathing and increases the heart rate. Medications (theophylline or caffeine) are often used to treat these spells in newborn babies. Apnea of prematurity does not cause sudden infant death syndrome (SIDS). However, prematurely born babies are at greater risk for SIDS, just not because of apnea of prematurity. The exact reasons why premature babies have a higher risk of SIDS is not known.

Braxton-Hicks contractions
Periodic contractions of the uterus that do not represent true labor. These contractions may begin as early as the first trimester, are irregular, usually painless, and of low intensity. They can be confused with labor. Toward the end of the third trimester, the contractions become more frequent and intense.

Breast pump
A mechanical device that pumps breast milk from the breast so that it can be stored for later consumption by the baby. Some babies are not able to feed at the breast immediately after birth due to illness. These infants can still receive breast milk that has been pumped from the breast. There are both manually operated and electrically operated pumps. the electric pump is far easier and more likely to maintain the flow of milk.

Breastfeeding
Simply, the best way to provide nutrition for an infant. The American Academy of Pediatrics recommends that women breastfeed their children at least 12 months. During pregnancy the mother's body prepares to produce milk for the unborn baby. Breast milk contains important nutrients essential to the health of the infant and enzymes that assist the infant's digestion. Breast milk also provides factors that bolster immunity and help babies resist infections. Research has shown that breastfed babies tend to have fewer childhood infections, less diabetes later in life, better tooth and jaw development, and greater intelligence. It is the best food for your baby.

Breech presentation
When babies are aligned in the uterus to come out buttocks first, as opposed to head first--the way most babies come out of the uterus--it is called a breech presentation. The head is the largest part of a full term baby's body. Therefore, delivery of the buttocks first may not adequately open up the birth canal enough for the head to pass through. The head may then get stuck in the birth canal, leaving the infant and mother in a precarious situation. Most babies with a breech presentation are delivered by cesarean section. On occasion the infant can be turned around so that he is lined up to come out head first.

Bromocryptine
A drug that stimulates production of prolactin inhibitory factor and suppresses lactation. Many years ago, bromocryptine (Parlodel) was given to postpartum women who did not want to breastfeed their babies to inhibit milk production. It is now known that such medication is not only not necessary, but may actually be dangerous to women. It is no longer approved by the FDA for this purpose.

Bronchospasm
The air passageways within the lungs have small strands of smooth (involuntary) muscle encircling them. In chronic lung disease(CLD), these tiny bands of muscle often get bigger, and when they contract, they can narrow the bronchial tubes. This narrowing is called bronchospasm. Bronchospasm, the narrowing of the airways from smooth muscle contraction, interferes with lung function because it narrows the space through which the air must flow in and out of the lungs.

Bronchospasm can be brought on by too much fluid in the lungs, infection, and irritants such as tobacco smoke.

Broviac catheter
Type of intravenous tube used to give fluids and medications to infants or children. The catheter is placed in a major vein of the body during surgery. The Broviac catheter is designed to stay in place over many months, if needed. There are other types of catheters with different names, all of which serve the same function.

Caffeine
There are some conflicting reports on whether or not caffeine consumption during pregnancy is safe or not, but consuming 800mg of caffeine, or about 4 cups of coffee, a day is associated with decreased birth weight, smaller head size, miscarriage, and premature labor. The more caffeine you consume the greater your risks. Caffeine crosses the placenta and can affect calcium metabolism and increase the risk of breathing problems in your newborn. Caffeine is also passed to your baby through breast milk, which causes irritability and sleeplessness in infants, so in 1980 the FDA advised pregnant women to limit their caffeine intake.

Cannula
A hollow tube used to infuse liquid into a body space or vein. Examples are the cannulas are used to infuse intravenous fluids and to perform artificial insemination.

Caput succedaneum (caput)
A spongy swelling and accumulation of fluid in scalp tissues of infants born vaginally. This occurs because the baby's head, in normal presentation, is under much pressure in the birth canal, This pressure on the skin of the scalp causes accumulation of soft tissue fluid. Although it may look serious, it usually disappears within a few days.

Carpal tunnel syndrome
A tender wrist caused by an irritation of the median nerve. The median nerve, the main nerve going into the hand, passes through the carpal tunnel on the inside of the wrist. During pregnancy the tunnel through which the median nerve passes can become narrower, probably due to the influence of hormones produced during pregnancy. the narrowing of the tunnel compresses the median nerve producing numbness, burning sensation and tingling in the hand . This is a common problem of pregnancy (2-25% of women) that usually resolves without surgery after pregnancy. Women with diabetes, arthritis, obesity, and those who perform repetitive movements of the wrist at work (e.g. typing, assembly jobs) are most likely to suffer from this condition.

Cauterize
Destruction of tissue with heat or caustic chemicals to seal off blood vessels and or stop bleeding. Cauterization is often used in surgical procedures where only a very small amount of tissue is cauterized to quickly reduce bleeding during the procedure.

Cells 
Slang for packed red blood cells or PRBCs. A transfusion of PRBCs is often used to treat anemia.

Central venous line
The central venous line (CVL) also called the central venous catheter (CVD) is a type of intravenous tube used to give fluids and medications to infants or children. The catheter is placed in a major vein of the body during surgery or by insertion through a vein in the arm, leg or head.

Cephalopelvic disproportion
The most common reason for doing a cesarean section. Sometimes the infant's head is larger than the mother's pelvis, through which the head must pass in a vaginal delivery. Therefore, the safest way to deliver the infant is to do so by cesarean section. There are several ways to estimate fetal size and pelvic size. Physical exam and ultrasound are very useful in evaluating cephalopelvic disproportion.

Cerebral palsy
This is an abnormality of muscle control that occurs because of a brain injury. It affects muscle strength, coordination, and may cause spasticity of muscles. It may or may not be associated with mental disability. Children with cerebral palsy may have difficulty with walking, speech, hearing and arm/hand coordination. The amount and type of involvement of these functions is variable and hard to predict at birth. It is an uncommon problem occurring in about 2 per 1000 infants. Cerebral palsy is associated with very premature delivery, problems that result in a loss of oxygen to the unborn infant and illness in the immediate post-delivery period.

Certified nurse-midwife
Midwives help women with all stages of pregnancy and delivery. They provide prenatal care, attend and help with the birth process, provide postpartum care, and some provide routine gynecological services. Nurse midwives emphasize prenatal education, answer questions, address concerns, and explain different birth options. There are about 120 certified nurse midwives registered in the state of Minnesota and about 4,500 in the United States. The World Health Organization has endorsed midwifery as an approach to improving the health of women worldwide. Types of Midwives

There are three types of midwives and they are distinguished on the basis of their educational background and certification.

Certified nurse midwives (CNM) have the most formal education. They complete their education to become a registered nurse and then pursue extra schooling in one of more than 40 advanced educational programs accredited by the American College of Nurse-Midwives. After completing their education, they must pass a certifying exam. Most CNM's work in hospitals or birthing centers.

Certified Midwives may be nurses or have other educational backgrounds. They receive their preparation through various means including correspondence courses, formal schooling, and apprenticeships. Some states license this type of midwives. They must pass a certifying examination.

Lay midwives are neither licensed nor certified. Their background is quite variable. If there are serious medical complications with mother or baby, their ability to deal appropriately with the situation is limited. Since there is no licensure, there is no state board to oversee their conduct. Some of them have a very little ability to prevent or handle emergencies.

Cervical gel
This usually refers to a prostaglandin medication that is prepared in a gel-like material. It is placed on the cervix to hasten cervical dilatation in preparation for delivery.

Cervicitis
Inflammation of the cervix.

Cervix
The lower portion of the uterus. The cervix is the part of the uterus that keeps thefetus from falling out of the uterus. During labor, the cervix thins and dilates to permit passage of the infant out of the uterus and into the vagina.

Cesarean section
Delivery of the baby through an incision in the abdominal and uterine walls when delivery through the birth canal is impossible or dangerous. This procedure was performed as early as 715 BC and can be lifesaving for both the infant and the mother in certain situations. However, elective cesarean sections (those scheduled in advance and performed before a woman goes into labor) when performed before term are a significant cause of medical problems in the baby. If a cesarean section is performed before the infant's lungs have completely matured, the infant may have serious respiratory problems. Elective cesarean sections should be performed only if there is good evidence that fetus has mature lungs. Recommendations of the American College of Obstetricians and Gynecologists (1995) for minimizing the risk of lung immaturity are presented below. They apply only to women who have had normal menstrual cycles and who had not been using oral contraceptives immediately before conception. Other women should be evaluated using other methods to make sure that the fetus' lungs are mature. The criteria are as follows:

1. Fetal heart tones should have been documented for 20 weeks by nonelectronic fetoscope or for 30 weeks by Doppler.

2. It has been 36 weeks since a positive serum or urine chorionic gonadotropin pregnancy test was performed by a reliable laboratory.

3. An ultrasound measurement of the crown-rump length, obtained at 6-11 weeks, supports a gestational age of at least 39 weeks.

4. An ultrasound, obtained at 12-20 weeks confirms the gestational age of at least 39 weeks determined by clinical history and physical examination.

An alternative method to assure fetal lung maturity is to perform an amniocentesis and measure chemicals in the amniotic fluid. The concentrations of these chemicals are a good reflection of lung maturity status.

Chaplain
Person trained to provide spiritual and pastoral care. Many hospitals have a chaplain assigned to the NICU. Chaplains work with individuals of all faiths and religious beliefs and can be a valuable listening ear. They also assist with religious rites and counseling.

Charge nurse
The registered nurse who has general responsibility for coordinating the nursing care of all children in a unit for a particular shift. Nursing shifts may be either 8 or 12 hours.

Chicken pox (Varicella)
An acute, communicable, infectious disease, usually contracted by young children. Chicken pox is caused by the varicella virus. The infections is characterized by a fever and itchy, red spots usually appearing on the chest and stomach first, then appearing in crops over the entire body. The red spots turn into small blisters that dry up and form scabs over about a week. They occasionally cause scarring (particularly if scratched) or if they become infected with bacteria. Although this is usually a mild disease, it has become the largest cause of vaccine-preventable deaths in the U.S. About 30-40 children die each year from complications of chickenpox.

Chicken pox vaccine
This is one of the newest vaccines available. Varicella vaccines prevent infection in 70-95 percent of recipients. Children who develop varicella despite vaccination have milder infections than those not immunized. It is not clear how long vaccine immunity lasts. With natural infection, immunity lasts a lifetime. The vaccine-induced immunity may not be so durable. More experience with the vaccine will be required to answer this question definitively.

Chlamydia
A shortened form of Chlamydia trachomatis, a bacterium that is the most common cause of sexually transmitted disease in women of reproductive age. Chlamydial infections can cause cervicitis, urinary tract infection, and salpingitis (infection of the fallopian tubes). This bacterium can be passed to infants at birth and can cause conjunctivitis and pneumonia.

Chorion
The outermost layer of the two fetal membranes. The chorion envelops the growing fetus and serves as a protective barrier to the fetus against infection.

Chorionic villus sampling (CVS)
A prenatal diagnostic test, done at 8-10 weeks of pregnancy, to assess the fetus' chromosomes. The advantage of this test over the amniocentesis is that CVS can be done earlier in gestation than the amniocentesis. However, the risks to the fetus are greater than with amniocentesis. Chorionic villi are a part of the placenta but contain fetal tissue. A needle is inserted into the chorionic villi of the placenta and a small amount of tissue is removed and sent for analysis. The placenta can be approached either through the cervix or through the mother's abdominal wall. The results are available in 5-10 days, sooner than with routine amniocentesis.

CVS increases the risks of fetal loss by about 1.2 percent over the risk without the procedure. There have been concerns about the procedure itself causing malformations of legs and arms. This risk seems to be about 0.03 percent and is probably greater the earlier the procedure is performed.

Chromosomal abnormalities
Also called chromosomal malformations, anomalies, or defects. This refers to abnormalities in the number or organization of chromosomes. A common example is trisomy 21 or Down syndrome, in which there is an extra chromosome number 21. This extra chromosome results in a constellation of abnormalities usually recognizable at birth and consistent from one patient with Down syndrome to another.

Chromosome
One of the 48 threads of genetic material in each somatic cell. Chromosomes are made up of genes of which there are 50,000 to 100,000, each regulating production of a different protein or other body constituent. Normally there are two sex chromosomes and 23 pairs of other chromosomes.

Circumcision
Removal of the prepuce or foreskin covering the penis. There has been a lot of controversy about this procedure in the past few years. Some believe that it is medically beneficial while others disagree. There are repeated studies showing that urinary tract infections are less common in circumcised boys. However, urinary tract infections are relatively rare in boys anyway. There have also been studies of sexual function in circumcised and uncircumcised males with very few differences found between the two groups. In some populations, circumcision reduces the risk of contracting AIDS. Penile cancer (also a very rare disease) is also less common among circumcised men.

When all costs and data were reviewed,the American Academy of Pediatrics and the Canadian Pediatric Society recommended against circumcision except in presponse to parents' personal preference. Some insurers no longer cover the costs of circumcision. There are risks to the procedure. Parents should review these with the doctor. Appropriate anesthesia should also be used. There is good evidence that circumcision without anesthesia is not in the baby's best interest.

Cleft lip and palate
Normally the palate and lip forms by the fusion of two embryonic masses of tissue that merge in the middle of the face. Failure of these two tissue masses to completely fuse results in a cleft or separation of the palate and/or lip. Some surgeons now repair the cleft lip in the first few days after delivery. Others prefer to wait for several months.

Clomiphene
A drug that stimulates ovulation and usually results in multiple ovulation. The chance of having twins or higher multiples after clomiphene therapy is about 8%.

Clostridium tetani
The bacterium causing tetanus. Tetanus (lock jaw) is caused by a toxin that is produced by Clostridium tetani. These bacteria live mostly in dirt. Gaining entry into the body through skin wounds, they produce an infection and a toxin that attacks nerves. The toxin causes sustained contraction or spasms of the muscles. These painful muscle spasms cause 'locking' of the jaw as well as problems with moving, breathing, eating, and drinking. Tetanus can be fatal even when treated. Tetanus is still seen in children that have not been vaccinated and newborns whose mothers lack immunity to tetanus. Tetanus also occurs in people in their 50s and 60s whose immunity has worn off. Vaccination with DTaP prevents tetanus.

Clubfoot
A birth defect of the foot and ankle manifested by an in-turning of the ankle. This may be a mild defect that can be corrected with stretching exercises and plaster casts or it may require surgical intervention. This is most often an isolated defect but may also present as one of several malformations in the same infant.

Cognitive development
The process of becoming aware of thoughts and perceptions, characterized by understanding and the ability to reason. Children develop their cognitive ability over the first two decades of life. The ability to think about abstract concepts does not usually appear until about 6-7 years of age.

Colic
Technically, this is any crampy, sharp abdominal pain caused by intestinal contractions. It is also the name of a common problem seen 6% to 13% of all infants. Colicky infants cry for an average of four hours a day! This is enough to drive any parent nearly to distraction. Evaluating this problem requires that the child's doctor make sure that there is no medical reason for the colic, although identified medical causes of colic are rare. However, if they are present, they should be treated. You should answer the following questions:

1. Is there a hernia or evidence of some other medical problem on exam?

2. Is your child stooling too much or too little? Is there any blood or mucous in the stool?

3. Is your child eating too much or too little?

4. Are the stools abnormally colored (clay-colored, frothy or very green)?

5. Is weight gain below what would be expected?

If the answer to any of these questions is yes, further medical investigation is required. If no medical problems are identified, the main issue is minimizing the colic. There is no agreement about whether breastfed babies have more or less colic than bottle fed babies. There is also controversy about the foods (in either the mother or infant) that might predispose to colic. Although there is no scientific evidence that any treatment reduces the symptoms, the following should be considered.

1. If the mother is breastfeeding, she might consider eliminating cabbage (and other cruciferous vegetables), milk products, caffeine, onions, chocolate and garlic from her diet. There is one study that suggests that these foods increase the risk of colic. If this makes a difference, the mother should add those foods back into the diet only one at a time and slowly to identify the offending food or foods.

2. If the mother is bottle feeding the infant, consider changing to a non cow milk-based formula. However, there is no good data to support changing formulas as a treatment for colic.

3. Motion seems to help. Consider rocking her or placing her in a body carrier.

4. If breastfeeding is well established, you might consider a pacifier.

5. Try laying the baby down across your lap and gently rubbing the back.

Since this is almost always a self-limited problem, the treatment should not involve significant risk. Again, checking with your doctor's office for suggestions is the smartest way to go since your doctor will be involved if the problem worsens or there is a complication from the potential remedies.

Colostrum
The thin, human breast milk produced shortly after delivery and before the regular breast milk is produced. Colostrum is rich in protein and immune factors that can help the infant resist infection.

Colposcopy
The examination of the cervix using a magnifying telescope-like instrument that permits better visualization of abnormal cells.

Congenital
Present before birth. Birth defects are sometimes called congenital malformations since they occur before birth. Many congenital malformations occurs well before birth as early as the first few weeks of pregnancy. Congenital abnormalities are disorders of form or function present before birth.

Congenital heart problems
Birth defects of the heart present at or before birth. This is an example of a congenital problem. Some heart malformations may not be apparent for several days to weeks after birth.

Continuous positive airway pressure (CPAP)
Supplemental oxygen or room air delivered under pressure though either an endotracheal tube (tube that goes directly into the infant's lungs) or small tubes or prongs that sit in the nostrils. Delivering oxygen under pressure helps keep air sacs in the lungs open and also helps maintain a clear airway to the lungs. Nasal CPAP (NCPAP) is commonly used immediately after removing the endotracheal tube to treat apnea and/or prevent the need for an endotracheal tube and ventilator.

Contraction
Almost always refers to the contracting of the muscles of the uterus during labor. The uterus contracts in an effort to expel the fetus into and out of the birth canal. Contractions are usually a sign of labor, although they can occur before labor, see Braxton Hicks contractions.

Contraction stress test
A test of uteroplacental function. Uterine contractions are initiated with pitocin and the fetal response to the contractions is analyzed as a measure of fetal well being.

Cord blood banking
Storage of blood from the umbilical cord. Blood in the umbilical cord is rich in blood cells that are able to replenish the bone marrow. Freezing cord blood cells immediately after delivery preserves these cells should the baby need a bone marrow transplant in the future. It is not now clear that this should be done or how useful these cord blood specimens will be in the future. The potential usefulness of cord blood is the object of much ongoing research.

Cord compression
Squeezing of the umbilical cord during pregnancy, labor or delivery. Pressure on the umbilical cord reduces blood flow from the placenta to the fetus. If prolonged pressure is applied, it can produce a dangerously low level of oxygen in the fetus.

Cradle cap
A waxy, scaly, skin rash that is common in newborn infants. The medical name is seborrheic dermatitis. Often the rash is confined to the scalp, but occasionally it can spread to the face and diaper area. If the problem is confined to the scalp, it can usually be controlled with shampoo and gently brushing the scalp. Applying baby oil to the scalp to loosen the scales has been recommended by some and not by others. If the cradle cap gets worse or does not improve with simple treatment, stronger medicated shampoo and other medications are available.

Craniosynostosis
An unusual condition in which the edges of the skull bones grow or fuse together. At birth the skull is made of up of several plates of bone. It is not a single, solid bone, but rather pieces of bone. The spaces between the bone plates allow the skull to expand as the brain grows. When the brain has stopped growing, the bony plates fuse. If the plates fuse too early, they prevent the skull from expanding normally and the skull will often appear abnormally shaped. In craniosynostosis some of the sutures fuse early restricting the growth of the bony skull. This usually requires major surgery to correct.

Crit
Slang for hematocrit. It is a test used to determine the percentage of red blood cells compared to total blood volume. It is commonly used to test for anemia.

Crohn's disease
A chronic inflammation of the intestine that can result in abdominal pain, diarrhea, and weight loss. It is often better during pregnancy than at other times. CytomegalovirusA common virus that affects 50-70% of adults. If a woman acquires cytomegalovirus (CMV) infection during pregnancy, there is about a 15% chance that her infant will have infection and serious complications. Women who have had CMV infection and who are considering breastfeeding their prematurely born infant should check first with their child's doctor since there is a risk of transmitting the virus to the infant through breast milk. Prematurely born infants may not be able to fight off the CMV infection as do infants born at term. CMV infection is usually a mild infection in adults. Infants born to women who have had CMV long before they became pregnant are at low risk of having an infant with serious CMV infection.

Croup
A condition resulting from narrowing of the larynx caused most commonly by infections and occasionally by allergy. This is almost always a disease of children and is characterized by resonant barking cough, hoarseness, and persistent stridor (whooping noise when breathing in). Viruses most commonly cause this infection and the associated fever. Narrowing of the airway can be life threatening and should be evaluated by a doctor.

Crowning
The stage in childbirth when the top of the infant's head becomes visible at the vaginal opening.

Cryotherapy
Treatment for severe retinopathy (disease of the retina) of premature infants. It is a procedure that stops the abnormal growth of blood vessels in the eye by freezing parts of the retina. Abnormal blood vessels can grow into the retina or back of the eye and cause the retina to pull away from the back of the eye. The freezing procedure is designed to prevent retinal detachment.

CT scan
Computerized tomography scan. This is a specialized procedure that takes multiple xray pictures at various angles and then integrates all of them into pictures of high resolution. In infants and toddlers, it is most commonly used to image the brain.

Cyanosis
A bluish discoloration, of skin and mucous membranes caused by low oxygen levels in the blood. There are many reasons why an infant or adult might be cyanotic. The usual reason is infection or other problem in the lung. Congenital heart disease can also cause cyanosis.

Cystic fibrosis
The most common, inherited disease in people of northern European descent. It occurs in about 1 of every 1600 births. The problem is a missing or defective enzyme that regulates sodium levels in secretions. Patients with cystic fibrosis have very thick secretions in their lungs and other organs and do not absorb nutrients normally from their intestine. The pancreas, lungs, sinuses, and reproductive organs are all affected. The degree of organ and glandular involvement varies, with consequent variations in the clinical picture. This is an autosomal recessive disease: it takes a gene from both the mother and the father to produce cystic fibrosis. About 1 in 20 white persons are carriers of the defective gene. Cystic fibrosis is much rarer in blacks (1:17,000) and even rarer in those of oriental descent.

Cytomegalovirus
A common virus that affects 50-70% of adults. If a woman acquires cytomegalovirus (CMV) infection during pregnancy, there is about a 15% chance that her infant will have infection and serious complications. Women who have had CMV infection and who are considering breastfeeding their prematurely born infant should check first with their child's doctor since there is a risk of transmitting the virus to the infant through breast milk. Prematurely born infants may not be able to fight off the CMV infection as do infants born at term. CMV infection is usually a mild infection in adults. Infants born to women who have had CMV long before they became pregnant are at low risk of having an infant with serious CMV infection.

D&C (dilation and curettage)
Surgical procedure in which the cervix is dilated and the lining of the uterus scraped. A D&C may be necessary to empty completely the uterus after a miscarriage. The D&C is also used on occasion to investigate abnormal menstrual bleeding.

Dehydration
Loss of water from the body. Babies can become dehydrated quickly if they have vomiting, diarrhea or fever. Dehydration is a serious problem for infants and toddlers with decreased fluid intake. Signs of dehydration are

1) infrequent urination or dark yellow urine

2) scant saliva and tears

3) dry mouth and skin

4) lethargy

5) sunken eyes and fontanelle (soft spot on the top of the head)

Delayed development
A term used to describe either failure to develop usual developmental milestones or the development of these milestones later than normal. It is sometimes used to describe a condition known as mental retardation. However, intelligence may be preserved in developmental delay although muscle function is poorly developed.

Delivery room
The room where the delivery occurs. In the past pregnant women routinely labored in one room and then were moved to a delivery room where the baby was actually delivered. Following delivery, the mother would then be moved to a recovery room. To prevent these cumbersome moves, many hospitals have now changed to a combination labor, delivery and recovery room (called the LDRP). This prevents having to move the mother to another room at the height of labor pains, just before delivery.

DES (diethylstilbestrol)
A synthetic, nonsteroidal estrogen that was prescribed to many women up until the early 1970s. It was thought to prevent or treat problems with pregnancy. However, female fetuses who were exposed to DES developed serious problems in their reproductive organs when they became adults. About 1/4th of exposed women develop anatomical problems with their cervix or vagina. Examples of these are underdeveloped cervix, small uterine cavities and abnormal fallopian tubes. These women are also more likely to have ectopic pregnancy, preterm labor, miscarriage and incompetent cervix. Women whose mothers took DES during pregnancy should mention this fact to their obstetrician so that potential problems can be identified and treated.

Developmental pediatrician
Specially trained pediatrician who is primarily concerned with the evaluation of children's development. They often work in neo-natal intensive care unit follow-up clinics and help to assess and treat developmental problems.

Dexamethasone
Steroid drug given to improve lung function in infants who have severe chronic lung disease or in some infants who have severe, acute lung disease. The use of dexamethasone is somewhat controversial because it often has a temporary effect only and carries the risk of high blood sugar, high blood pressure and other potential side effects. However, in some babies it results in a dramatic improvement in lung function and a marked reduction in the need for ventilator support.

Diabetes mellitus
An inability to regulate blood sugar levels due to insulin deficiency. There are two types of diabetes in pregnancy: 1) that which was present before conception and 2) that which develops during pregnancy (gestational diabetes). During pregnancy, women with pre-existing diabetes may experience an increase in their insulin requirements. Even some women with gestational diabeters may require insulin shots to manage their blood sugar.

Diabetes in pregnancy is categorized on the basis of severity, complications and duration prior to conception. Infants born to women with pre-existing diabetes are at increased risk for birth defects. It is essential that the blood sugar level be controlled at the time of conception and for the first months of pregnancy when the organs are forming. This is known to reduce the risk of birth defects.

Control of the blood sugar in later stages of pregnancy is important to prevent the baby from becoming excessively large and having problems in the newborn period with low blood sugar, a difficult delivery and elevated red blood cell count. Most diabetic women have successful pregnancies and healthy infants. However, they need to manage their, diet, insulin and blood sugar very carefully.

Diaphragm
A muscle layer that separates the abdomen from the chest cavity. With regard to child birth and newborn babies, this muscle comes to families' attention when there is a congenital absence of the muscle or when it is paralyzed and does not function properly. Although these are rare situations, the resultant problems for the newborn infant are often serious.

Diaphragmatic hernia
Defective development of the diaphragm occurring in about 1 of 2,300 births. A diaphragmatic hernia occurs when the embryonic components of the diaphragm do not fuse normally. Failure to fuse results in a hole in the diaphragm. Normally the diaphragm forms a solid layer of muscle that assists with breathing and keeps the abdominal contents from sliding up into the chest cavity. Failure of the diaphragm to form results in open communication between the abdomen and chest cavity. As a result, the intestines and other abdominal organs pass into the thorax compressing the lungs and heart. When infants with congenital diaphragmatic hernia (CDH) are born they have difficulty breathing on their own since their lungs and heart are underdeveloped from the pressure of the intestines and other abdominal contents being up in the chest cavity during fetal life. This problem can be identified on ultrasound long before pregnancy. Some doctors are performing fetal surgery to improve the outcome of this birth defect. Only certain babies with CDH are good candidates for fetal surgery and only a very few centers are skilled at the procedure.

Diarrhea
Abnormally frequent or watery stools. Anything that increases the speed with which food and secretions pass through the bowel can cause diarrhea. Anytime the normal bowel transit time is shortened the bowels do not have sufficient time to absorb water from the stool and watery stools occur. Infections, allergies, lactase deficiency and other intestinal problems increase the speed with which food and secretions pass through the intestinal tract. The stools of newborn infants, especially those who are breastfed, are more watery than those of older infants.

Diarrhea in a small infant can result in serious dehydration very quickly. Children with watery stools, vomiting, or reduced fluid intake are at risk of dehydration. Those with blood or mucous in their stool may also have serious problems and should be evaluated by their doctor. Over-the-counter medications to treat diarrhea should be avoided in children under age 2 years unless specifically recommended by the baby's doctor..

Diethylstilbestrol (DES)
Synthetic estrogen prescribed for women in the 1950s and 1960s to prevent miscarriages. Daughters of these women often have abnormal development of their reproductive tracts. They are more likely to have certain types of cancer and to go into labor prematurely.

Dilation
Opening up, enlargement of a tubular structure. This usually refers to the cervical dilation that occurs during labor. The opeining of the cervix must go from essentially 0 centimeters to about 10 centimeters, the usual size required for the baby to pass through the cervix, which forms part of the birth canal. The first stage of labor is that part of labor during which the cervix dilates up to 10 cm or is completely dilated. This usually takes several hours and is shorter with subsequent pregnancies.

Diptheria
Diptheria is a contagious bacterial disease that produces thick, gray membranes in the mouth, throat, and airway passages. The disease occurs largely because of a toxin produced by the infecting bacteria, Corynebacterium diptheriae. Diptheria can produce difficulty in breathing, pneumonia, heart failure, even paralysis and death. The entire process was described in epidemics in Europe in the 1500s and 1600s and in New England in the 1800s. All 50 states have laws requiring immunization against diptheria before entering school. The use of the DTP and DTaP vaccine has made it almost nonexistent in the U.S.

Disabilities
Handicaps resulting from premature birth and its associated medical problems. Babies born either very prematurely or who are very ill at birth are at increased risk for brain injury that can result in handicaps. Prematurity and severity of the baby's illness do not explain all of the disabilities seen in newborn infants. Other factors that occur before delivery, such as maternal hypertension or infection, also contribute to the disabilities seen in prematurely born babies.

Minor disabilities sometimes do not show up until the child is several years old. These disabilities may not be recognized until the child enters school. They include short attention span, specific learning problems isolated to an area of math or reading, and poorer than average hand-eye coordination.

Diuretic
Medication increasing urine output. The one most commonly used is Lasix (furosemide).

Doppler ultrasound
A special form of ultrasound that uses sound waves to measure the velocity of blood flow. Doppler ultrasound can be used to listen to the fetal heart beat, examine the fetal heart for defects, and estimate placental blood flow.

Doula
A woman trained to assist other women during labor, delivery and the postpartum period. Doulas support pregnant women, their partners and families through the emotional and physical issues of childbirth. Doulas function is some ways like a lay midwife. They are noninterventionists and primarily offer advice and support and comfort. Their contributions are reported to reduce the rate of labor and delivery complications including cesarean section.

Down syndrome
A syndrome of characteristic physical findings in children caused by an extra chromosome number 21. Another name for this condition is trisomy 21. Characteristic findings are a widely spaced first and second toes, a single palmar (simian) crease, short fingers, a fold of tissue (called epicanthal fold) across the inner aspect of the eye, eyes that slant upward, decreased muscle tone, a flattened back portion of the head and a protruding tongue. The only way to make the diagnosis with certainty is to perform a chromosomal analysis either before birth (chorionic villus sampling or amniocentesis) or after birth (blood or tissue chromosomal analysis). The range of outcomes for these children is quite broad and many function quite well although few have normal levels of cognitive development.

The risk of having a child with Down Syndrome increases with maternal age. The risk for otherwise healthy women is as follows:

Risk of Down Syndrome

Age

25 years 1 in 1300

30 years 1 in 900

35 years 1 in 350

40 years 1 in 100

45 years 1 in 25

49 years 1 in 12

DTaP vaccine
Like DTP, the DTa(acellular)P vaccine protects against diphtheria, pertussis, and tetanus. DTaP is similar to DTP, but it does not contain the whole pertussis cell, only part of it (see acellular). DTaP causes fewer side effects than the whole cell vaccine and is currently recommended for all immunizations against pertussis. Normally the DTaP is given ar 2, 4, 6, and 18 months and 4-6 years.

DTP vaccine
The DTP immunization also protects against diphtheria, pertussis, and tetanus and can be substituted for the DTaP vaccine in cases of DTaP vaccine shortage. The vaccination schedule is the same as for the DTaP. Commonly reported side effects of the DTP are irritability, lethargy, redness and tenderness at the site of injection, and fever.

Dubowitz/Ballard exam
Simplified assessments for measuring the gestational age of infants after delivery. These measurements are more accurate in full-term and moderately premature than in extremely premature infants.

Due date
The estimated date of delivery. The due date is also called the estimated date of confinement (EDC). Calculation of the EDC or due date is performed by counting forward 280 days (40 weeks) from the first day of the last menstrual period. Most women do not actually conceive until about two weeks after the first day of their last menstrual period. Therefore, for the purposes of calculating the EDC a woman is already 2 weeks pregnant when she actually conceives. The due date is only an estimate and only 1 in 20 actually deliver on their actual due date. However, most deliver within a week of their due date.

Dye
Inert substance used to obtain X-ray images of the body. Barium is often used to outline the intestine. Other dyes are used to image the kidneys and urinary tract, liver, and brain.

Dystocia
Literally, it means difficult labor and practically means abnormally slow progress of labor. The word comes from the Greek 'dys' meaning 'difficult, painful, disordered, abnormal' and 'tokos' meaning 'birth'. Four potential factors may cause difficult labor characterized by abnormally slow progress. They may occur separately or together.

1) Uterine contractions may be either too weak or too uncoordinated to open up the cervix. There may also be inadequate pushing with voluntary muscles during the second stage of labor.

2) The baby may be lined up wrong to easily pass through the birth canal. Alternatively, there may be other problems with the baby that also retard passage of the baby through the birth canal.

3) The maternal bony pelvis may be too narrow to allow the baby to pass through the birth canal.

4) Abnormalities of the birth canal other than those of the bony pelvis may obstruct fetal descent.

The most common cause of dystocia is a small bony pelvis and/or insufficiently strong and coordinated uterine contractions.

Early intervention program
Planned use of physical therapy and other interventions in the first few years of a child's life to enhance the child's development. This program is usually restricted to infants who may have long-term disability. These programs are often sponsored by individual counties and may vary considerably from one area to another.

Echocardiogram ("ECHO")
Ultrasound picture of the heart. This is a painless, non-invasive procedure that takes accurate pictures of almost all parts of the heart. Many premature babies have a cardiac ultrasound if the doctor is looking for evidence of a patent ductus arteriosus.

Eclampsia
An uncommon complication of pregnancy marked by convulsions (seizures). It is usually preceded by pre-eclampsia (hypertension, fluid accumulation in the tissues, and spilling protein in the urine). Prenatal visits are important to identify pre-eclampsia before it worsens to the point of threatening the welfare of the baby and mother. There is only one certain treatment for pre-eclampsia and eclampsia-delivery of the baby. Pre-eclampsia is a common reason for delivering a pregnant woman before term.

Eclampsia
An uncommon complication of pregnancy marked by convulsions (seizures). It is usually preceeded by pre-eclampsia (hypertension, fluid accumulation in the tissues and spilling protein in the urine). Prenatal visits are important to identify pre-eclampsia before it worsens to the point of threatening the welfare of the baby and mother. There is only one certain treatment for pre-eclampsia and eclampsia, delivery of the baby. Pre-eclampsia is a common reason for delivering a pregnant woman before term.

Ectopic pregnancy
Pregnancy in which the embryo develops outside of the uterus. Normally, conception occurs not in the uterus but in the fallopian tubes. The fertilized egg then moves down into the uterus where it should implant in the lining of the uterus. When the embryo implants anywhere else other than the uterine lining it is called an ectopic pregnancy. As the embryo grows outside of the uterus it is usually in a confined space, such as the fallopian tube. Eventually, the embryo enlarges the tube to the point of rupture, which causes hemorrhaging. This hemorrhaging can be so severe as to cause shock and death. Surgery is required to remove the misplaced, nonviable embryo. Ectopic (in the wrong place) pregnancy is the leading cause of maternal mortality in the first trimester and is a true emergency. Fortunately, the incidence remains low, about 4/10,000. Symptoms of ectopic pregnancy include abdominal pain, missing a normal period, intermittent or scanty vaginal bleeding, shoulder pain, weakness, dizziness, and fainting. Significant abdominal pain (anywhere in the abdomen) in the first trimester should be reported to your doctor.

Eczema
Usually refers to atopic dermatitis and for the most part occurs in families with a tendency towards eczema. In infants 2-6 months of age it usually first appears on the cheeks and scalp and then spreads to the trunk. Eczema looks like itchy, dry, flaky, red bumps, sometimes these bumps can ooze and crust over. Usually by 2-3 years of age the rash disappears, if not sooner. Chronic or long term eczema causes the skin to thicken and become scaly.

EDD (estimated date of delivery)
Estimated date of confinement for the mother. In other words, the estimated date when the baby will be born.

Edema
An accumulation of water in the soft tissues of the body. Any condition that causes the body to retain additional water can cause edema. Most often the swelling appears in the feet, face and hands. Towards the end of the third trimester most women develop edema. Excessive edema can be associated with high blood pressure and other signs of pre-eclampsia. Newborn babies almost always have some edema. They lose this excess water in the first few days after birth.

Edwards' syndrome (trisomy 18):
Normally, people have 46 regular chromosomes (23 pairs) and two sex chromosomes (1 pair). When there is a single extra chromosome (aneuploidy) such that there are 47 instead of 46 chromosomes, the condition is called trisomy. Trisomy 18 (along with trisomy 13 and trisomy 21) is one of the more common aneuploidy conditions. In Edwards' syndrome there are three, rather than the normal two, chromosomes number 18. Children with this condition have multiple malformations and severe mental retardation due to the extra chromosome number 18. Characteristically they have low birth weight, small head (microcephaly), small jaw (micrognathia), malformations of the heart and kidneys, clenched fists with abnormal finger positioning, and malformed feet. The mental retardation is profound with the IQ so low it can not be measured with the usual testing. Nineteen out of 20 (95%) of these children die before their first birthday. The condition is named after the British physician and geneticist, John Edwards, who discovered the extra chromosome in 1960. There is no good prenatal screening test for this condition. It is very uncommon and can be identified on amniocentesis. It is more common with increasing maternal age.

Effacement
Thinning of the cervix that occurs in preparation for childbirth. The cervical canal shortens from 2cm to paper thin edges and the canal itself disappears. Only the external opening of the uterus remains of what was the cervix. The edges of the internal opening of the cervix are drawn upward several centimeters to become part of the lower uterine segment. When the cervix becomes as thin as the adjacent lower uterine segment, it is considered to be completely effaced.

Egg
The mother's genetic contribution to her child. Each child normally receives one-half of her/his genes from the mother and one-half from the father. The mother's contribution is packaged within the egg which is present in the ovary until discharged in about the middle of the menstrual cycle. The egg (ovum) is then fertilized by the sperm which carries the other half of the child's genes. This union of the sperm and ovum is referred to as a fertilized ovum (or zygote) for the first two weeks. After that it is know as an embryo.

Ejaculate
The sperm-containing fluid released during male orgasm and ejaculation.

Electronic fetal monitor
An electronic device that is used to monitor the heart rate of the fetus before delivery. The electronic fetal monitor is usually used in labor and can identify fetal problems before delivery. There is some evidence that monitoring the fetal heart rate electronically may increase the rate of cesarean delivery. Most obstetricians believe that it identifies serious fetal problems earlier than other methods, thus improving outcome. Another method for monitoring the fetus' health during labor is listening to the fetal heart beat with a special fetal stethoscope or doppler ultrasound device at regular intervals. There are two types of fetal monitors: 1) external, which are attached to the mother's abdomen and 2) internal, which attach to the infant's scalp inside the uterus.

Embryo
The name given to a developing infant from about two weeks after conception to the end of the second month of pregnancy, when it is then called a fetus.

Encephalopathy
Abnormal functioning of the brain. It can be caused by asphyxia, kernicterus (damage to the brain from high bilirubin levels in the blood), infections, or metabolic problems.

Endocrine
Applied to organs whose function is to secrete a hormone into the blood or lymph to achieve a specific effect in another organ or part of the body. Examples of endocrine organs would be the pituitary, ovary, thyroid and pancreas.

Endometriosis
The presence of tissue that looks and acts like the uterine lining in places other than the uterus. This tissue is often in the abdomen and responds to hormonal changes during the menstrual cycle. Many women have no symptoms. However some experience considerable pain during menstruation and/or ovulation. Endometriosis is usually detected during a physical examination. Treatment includes pain medication, hormone therapy, and, in some cases, surgery.

Endometrium
The lining of the uterus. The thickness and structure of the lining vary with each phase of menstruation. This is a key structure in the normal development of pregnancy. It is the optimal site for blastocyst implantation and embryo/fetal/placental development.

Endotracheal tube (ETT or ET tube)
Tube placed through the mouth or nose into the throat and the child's trachea (windpipe). This tube provides a secure pathway through which air can be circulated to the lungs.

These tubes are fastened to the child's face with tape, but they still come loose and have to be replaced on occasion. They may also become partially or completely clogged with secretions from the lungs, which requires suctioning and, sometimes, replacement of the tube.

Engagement
Refers to the point in labor/delivery at which the baby's head, or other presenting part buttocks in a breech presentation), begins to descend through (engage) the pelvic canal.

Engorgement
Swelling and tenderness of the breasts resulting from excess fullness with milk. Usually this occurs about 3-5 days after delivery. Some things that may help to prevent engorgement are feeding your baby more often (8-10 times a day), messaging your breasts gently prior to and during breastfeeding, using an electric breast pump if your baby does not completely empty your breast during feeding, avoiding bottles and pacifiers that may reduce your baby's nursing vigor. To relieve the pain of engorgement, take a hot shower or apply warm, wet cloths to your breasts 15-20 minutes before pumping or feeding.

Epidermal
Pertaining to the epidermis or outer layer of the skin.

Epidural
Usually refers to the epidural space. This is the space just outside of the dura, the outermost covering of the spinal cord. An anesthetic, such as bupivacaine, is injected into this space to numb the tissues. This type of anesthesia is called regional anesthesia since it numbs only a region of the body. This allows you to be pain free but still awake.Also See:

Epidural block
An anesthetic technique that reduces pain during childbirth without altering the other's level of consciousness. This type of regional anesthesia is often given during labor to relieve the pain of contractions and delivery. A needle is inserted through the skin of the back into the epidural space. Anesthetic is then injected around the spinal cord anesthetizing the nerves of the lower part of the body. An well-placed epidural block provides excellent pain relief. A potential disadvantage is a reduction in a woman's ability to push the baby out of the birth canal. Some people feel that the use of an epidural block may increase the likelihood of a cesarean section. The epidural block may also lower a woman's blood pressure, affecting blood flow to the baby. However, in the hands of alert, experienced personnel, the risks of an epidural are low.

Episiotomy
A minor surgical procedure which widens the birth canal by cutting the introitus (vaginal opening). Episiotomy is performed to prevent the jagged, less controlled tearing of the introital tissue during the stretching associated with delivery. The routine use of an episiotomy may cause more problems than it solves and has been linked to increased rectal tearing. It is a painful procedure that may predispose to infections other complications. An episiotomy may be very helpful when forceps or vacuum extraction are used and with breech presentations. Talk to your doctor about whether you might need one. The use of episiotomies has decreased in the past few years.

Ergotamine
An alkaloid medication that has in the past been used to treat migraine headaches. It is contraindicated during breastfeeding since it can lead to vomiting, diarrhea, and convulsions in infants.

Erythrocyte
Red blood cell. The hemoglobin-containing and oxygen-carrying cells of the blood.

Esophageal atresia
Developmental obstruction in the esophagus. Sometimes the esophagus does not run all the way from the back of the throat to the stomach. Instead, the esophagus terminates in a blind pouch part way to the stomach. Children who have esophageal atresia often have an abnormal fistula or connection (known as a tracheo-esophageal fistula) between one of the sections of the esophagus and the trachea (windpipe). This abnormality occurs in about 1 out of every 2,500 live births.

Estrogen
A very important hormone produced by the ovary. Estrogen regulates changes in the uterine wall, breasts, and other tissues. It is a key hormone that mediates many of the changes seen in a woman's body during pregnancy.

Exchange transfusion
Replacing the child's blood with blood from a blood bank. This special transfusion takes a small amount of the baby's blood out and replaces it with an equal amount of blood. This process is repeated many times over until essentially all of the baby's blood has been replaced.

Exchange transfusion is usually done through an umbilical arterial and umbilical venous catheter. An exchange transfusion is done when the baby's bilirubin level is dangerously high or when the baby has abnormally low levels of blood clotting factors.

This procedure can be life saving, but it also carries with it chances of metabolic problems such as high potassium and low calcium in the blood. Other problems sometimes seen are bleeding and infection. The complication rate for a specific infant varies according to the child's condition and the skill of the health care team. The quoted risk of death for this is usually about one percent. In my experience, the actual risk for most infants is less than one percent.

External cephalic version
Turning the baby so that the head is pointed down toward the pelvic inlet. In most pregnancies, babies orient themselves with the head down toward the pelvis in preparation for labor and delivery by about the 34th week. If the baby is oriented with the head up or lying with the back toward the pelvis, labor is more complicated and a cesarean delivery is more likely. Your doctor may try to turn the baby before delivery- this is called an external version. The doctor will try to turn the baby so that the head is down, pointing toward the pelvis. This is done with pressure on the baby applied through the mother's abdomen. External cephalic version reduces the necessity of a cesarean section, but is not indicated in every case of breech presentation. Ask your doctor more about version to see if this procedure is appropriate for you. There are both risks and benefits from this procedure.

Extracorporeal membrane oxygenation (ECMO)
A technologically complicated and somewhat risky procedure performed on infants with extremely serious respiratory problems. Basically, one or two large catheters are placed in the blood vessels of the neck and the blood returning to the hearts is aspirated out of the heart and pumped through an artificial lung. The blood is then returned to the baby's body. Although there are significant risks with this therapy is successful about 80% of the time depending on the lung problem.

Exubation
Removal of the endotracheal (breathing) tube from the infant's lungs. This terminates ventilator-assisted breathing.

Eye patches
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