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
Gauze-like material covering and protecting the infant's eyes during phototherapy treatment using intense light.

Failure to thrive
Failure of an infant or child to gain weight appropriately. The best way to know if your child is gaining weight appropriately is to compare weight and length with published standards. These standards allow you to know how your child compares to other children of the same gender and age. The most common reason that children don't gain weight properly is that they do not receive enough calories. You might consider keeping a diary of your child's caloric intake so that your child's doctor can compare it to your child's needs. There are some illnesses that result in poor utilization of calories. Your child's doctor should be able to screen for these. They include many medical problems, which are fortunately rare. Chronic infections, hormone problems, and many others may present as failure to thrive. Your doctor's task can distinguish between a normally small child, inadequate caloric intake and medical conditions. Finally, there are some children who are genetically or otherwise destined to be light and short, for example, infants who sustain severe growth restriction before they are born.

Fallopian tube
The ducts that conduct the egg from the abdomen to the uterus after ovulation and conception. It is within the fallopian tube that the sperm usually meets and fertilizes the egg.

Family practitioner
Family Practitioners are primary care physicians who have had three years of residency to prepare themselves to treat all family members. Eligibility to take their certifying exam in family practice depends on having met certain training requirements.

In the U.S., general practitioners usually refers to physicians who have not completed a family practice residency but still work as primary care doctors. Many years ago physicians who did not specialize needed to have only one year of post medical school training (internship) before entering practice. These physicians were called general practitioners. State licensure and even hospital privileges in some areas require no more training than this. There are some very competent general practitioners around, especially older ones. Dr. Nathan would be concerned about receiving care from a general practitioner unless he either had a very strong recommendation from a colleague or had a long association with the general practitioner and was certain of his/her commitment to continuing education. There is no international standard for certification so that the words "general practitioner" and "family practitioner" may mean different things in different countries. For example, in the U.K. a general practitioner may well have completed special post medical school training in familypractice.

Advantages of a Family Practitioner

Many patients who visit doctors have symptoms that are related to diet, stress, and psychosocial issues, but are manifested as bodily dysfunction. It is often impossible to disentangle family relationships, personal stress, and physical illness. The family practitioner may be better prepared to recognize and work with these interactions than the specialist who focuses on just the bodily symptoms. A good primary care doctor can become one of your family's best advisors and friends. Not all family practice doctors provide delivery services. You should check with your family practitioner to be sure that she delivers babies.

Febrile seizure
Convulsion that occurs in some otherwise normal children when their body temperature rises quickly. Children usually outgrow these types of seizures. Children show no neurological damage, but have a slightly increased risk of developing epilepsy in the future, although this is still not universally agreed upon. Any seizure that lasts five minutes or is associated with respiratory difficulty requires immediate emergency help (Dial 911).

Fetal alcohol effects (FAE)
Effects of maternal alcohol consumption on the unborn child. FAE represents less pronounced findings than those seen from more intensive alcohol exposure, which produces the fetal alcohol syndrome (FAS).

No amount of alcohol is safe during pregnancy and even small amounts can cause severe complications to an unborn baby. DO NOT DRINK DURING OR JUST BEFORE PREGNANCY.

Fetal alcohol syndrome (FAS)
Damage to an unborn child as a direct result of alcohol consumption during pregnancy. Characteristics of FAS are the following:

Delayed development or intellectual impairment

Reduced growth before and after birth

Small head and eyes

Thin upper lip

Flat cheekbones (maxillary hypoplasia)

Narrow, small eye openings (palpebral fissures)

Small jaw (micrognathia)

Holes between the two sides of the heart (septal defects)

Decreased joint movement

No amount of alcohol is safe during pregnancy and even small amounts can cause severe complications to an unborn baby. DO NOT DRINK DURING OR JUST BEFORE PREGNANCY.

Fetal distress
Problems with the unborn child during labor. Sometimes during labor and delivery, the fetus may not be getting enough oxygen from the placenta. When this occurs, the fetal heart rate may show characteristic patterns. These patterns can been seen on the fetal heart rate monitor and when these patterns are seen it is called fetal distress. Fetal distress alerts the obstetrician that either further investigation or intervention is required to assure the fetus' well-being.

Fetal hydantoin syndrome
Pattern of birth defects connected to the mother's use of hydantoin during pregnancy. Hydantoin is a type of medication used to prevent seizures. Decreased fetal growth, small head (microcephaly), and mental retardation are characteristic of this syndrome.

Fetal monitoring
Monitoring of the baby before birth. This usually refers to monitoring of the fetal heart beat. There are two ways to do this. Before the mother's membranes have ruptured (water has broken) a belt containing a receiver similar to an ultrasound can strapped to her abdomen and used to monitor the fetal heart rate and uterine contractions. After the membranes have ruptured and the cervix has dilated, an internal monitor can be attached directly to the baby's scalp. There are other tests that can be used to monitor the fetus during and before labor such as ultrasound, scalp pH measurements, and others.

Fetal presentation
The part of the fetus that enters the birth canal first. When the head enters the birth canal it is called a vertex presentation. When the buttocks present first it is called a breech presentation. There are several methods used to diagnose fetal presentation: abdominal palpitation, vaginal examination, locating the fetal heart beat on the abdomen, and ultrasound scans. At or near term 96% of babies are in a vertex position, 3.5% are in a breech presentation, 0.3% in a face presentation, and 0.4% are in a shoulder presentation. About 2/3 of vertex presenting babies are in a left occiput anterior (See Anterior.) and 1/3 are in a right occiput anterior position. Up to 14% of babies are in a breech presentation until the 29th-32nd week of gestation. Many of these babies change to a vertex presentation birth. See external version.

Fetoscopy
Use of a special, fiber optic, tubular telescope to look at the fetus while it is still in the mother's uterus. Use of this scope requires a tiny incision in the mother's abdominal wall so that the telescope can be passed into the uterus to directly view the fetus. Technically, listening to the fetal heart rate with a fetoscope, a special type of stethoscope is also fetoscopy.

Fetus
The name given to the embryo after the 8th week. Technically this name should be used until the baby is completely outside of the mother's body.

Film
Slang term for X-ray.

Floppy infant syndrome
Hypotonia in an infant. Passive resistance to movement of the extremities is called tone. Normally infants give only a moderate amount of resistance to you when you move their extremities. The amount of tone present is one way of assessing the condition of the nervous and muscular system in an infant. Tone should be examined when the infant is resting quietly, but awake. Infants with too much tone, too much resistance to passive movement, are called hypertonic and an extreme example of this is spasticity. Infants with too little tone, too little resistance to passive movement are called hypotonic. Severely hypotonic infants are like rag dolls with little resting tone in their muscles. Some of these infants even have difficulty breathing they are so hypotonic. Many different neurological and muscle problems can cause hypotonic muscles or floppy infant syndrome. If your child has been diagnosed with this, the most important question is why. There are many causes and the prognosis depends on the cause.

Folic acid
A vitamin critical to the normal development of the fetus. Inadequate folic acid intake can lead to neural tube defects (NTDs) such as spina bifida and malformation of the brain. Consumption of 0.4 mg per day is recommended before conception and throughout pregnancy, especially the first trimester. Some women may require even larger amounts of folic acid if they are in high risk situations such as having had a previous child with a NTD. Taking folic acid is one of the best ways to minimize the risk that your child will have a birth defect.

Follow-up clinic
Outpatient clinic operated for the specific purpose of evaluating babies' progress after premature delivery and care in the neonatal intensive care unit. Some of these clinics are diagnostic only, which means they assess babies' progress and make recommendations, but they do not prescribe specific therapy. Other follow-up clinics diagnose and prescribe treatment.

Fontanelle
The soft spot on the top of the head. At birth the skull is made of up of several plates of bone- it is not a single, solid bone. The spaces between the bone plates allow the skull to expand as the brain grows. Where four of these bony skull plates come together it forms a soft spot in the skull called a fontanelle. There is no bone in these soft spots, making these areas softer than the surrounding areas. There are usually two soft spots in the skull of a newborn, the anterior and the posterior fontanelle. The posterior fontanelle will close by about 2 months of age. The anterior fontanelle usually closes between 9 and 18 months of age. Fontanelles that close either too early or too late can be a problem. Your doctor will examine your child for abnormalities of the fontanelle during routine exams.

Footling presentation
Presentation with the feet entering the birth canal ahead of any other part of the body. This may occur with two feet (double footling) or a single foot (single footling). Most often one leg is extended while the other is flexed at the knee. It is usually safer to deliver this kind of baby by a Cesarean section early in labor or before labor begins. If a footling breech is delivered vaginally, there is a risk that the head may not easily through the birth canal.

Forceps delivery
A delivery in which forceps are used to help assist the baby from the birth canal. Forceps are a two-bladed instrument that could be compared to a pair of kitchen tongs in design. Forceps have the additional feature that the two blades are easily taken apart to facilitate placement on the baby within the birth canal. After placing the two blades on the baby's head, the doctor reconnects the two blades and then uses the forceps to apply traction to the infant, assisting delivery. The forceps are not sharp, but they firmly grasp the baby's head. Forceps may be used for several different reasons, to shorten the second stage of labor, end an abnormally long second stage, when the fetal heart rate suggests problems, when the mother suffers from cardiac disease, or whenever the health of the mother and baby are declining and a speedy delivery is required. Although once used often, they are almost never used now.

Formula
A substitute for breast milk. When a mother chooses not to breastfeed, a nutrient rich liquid feeding is required by the infant. Commercial formulas are patterned after the composition of breast milk. Formulas can use various protein and carbohydrate sources. Cow's milk is the most common protein source for commercial formulas.

Fraternal twins
Twins that not genetically identical, also called dizygotic twins. When women ovulate two different eggs and they are fertilized at the same time by two different sperm the result is fraternal twins. These infants have different a genetic make-up although they share the uterus during gestation. In vitro fertilization often results in fraternal twins (or higher order multiples such as triplets or quadruplets).

Full-term
Refers to a full term pregnancy. Infants who are not prematurely born are considered to be full-term. The World Health Organization considers full-term any infant born after 38 completed weeks of gestation. The American College of Obstetricians and gynecologists considers full-term any infant born after 37 completed weeks of gestation.

Full-term infant
Baby born between the 38th and 42nd week of pregnancy.

Fundal height
Height of the uterine fundus. This is a rough estimate of the size of the fetus and is used to screen for problems with fetal growth. This is a basic statistic that will be measured at most prenatal visits. The fundal height (in centimeters) is measured with a tape measure from the top of the pubic bone to the top (fundus) of the uterus. The fundal height increases as the uterus enlarges and between 18 and 30 weeks of gestation, the fundal height in centimeters coincides with the weeks of gestation.

Fundus
The top of the uterus. The fundus rises during pregnancy as the baby grows. The obstetrician will measure the fundal height as a measure of how much your baby is growing. Toward the end of pregnancy the fundal height may decrease slightly or stop growing as the baby settles into the pelvis preparatory to labor and delivery.

Gamete
Reproductive cell, sperm in men and egg in women.

Gamete intrafallopian transfer (GIFT)
Combining of egg and sperm outside of the body and immediately placing them into the fallopian tubes to achieve conception. Also See:

Gardnerella
A type of bacteria that can cause infection of the vagina and has also been associated with premature labor and delivery.

Gastroesophageal Reflex (GER)
Contents on the stomach coming back up into the esophagus. It occurs when the junction between the esophagus and the stomach is not completely developed or is abnormal. Normally, this junction prevents food from rolling out of the stomach and up into the esophagus and sometimes the mouth. GER is very common, especially among prematurely born infants. Reflux of the acid in the stomach can irritate the lining of the esophagus and cause a form of "heartburn" in some babies with GER. Babies may feel this heartburn and become irritable and uncomfortable.

Since mild forms of GER are common, require no treatment, and go away on their own over a period of months, it is first necessary to evaluate how severe the GER is and whether or not it requires treatment.

If the GER appears to be a significant medical problem, a barium (a harmless substance used to visualize the intestinal tract on X-ray) swallow or nuclear medicine scan of the stomach emptying may be performed. These tests confirm that GER is occurring and look for stomach outlet obstruction or other contributing cause. Endoscopy and pH probe studies may also be done to evaluate this GER.

Treatment of GER may include keeping the baby in the upright position, thickening of the feedings, giving medication to reduce stomach acid, and sometimes giving medication to increase the ability of the stomach to contract. Medical treatment is effective in most cases. GER often improves on its own over time. Surgery is reserved for the severe or unusual cases. Most children do very well in spite of GER.

Gastroschisis
Herniation (bulging) of the intestines through a defect in the abdominal wall. A loss of tissue from the abdominal wall creates a hole in the right side of the abdominal wall through which the abdominal contents can herniate. In this situation the bowel is exposed to the amniotic fluid throughout much of the pregnancy.

This exposure results in thickening and shortening of the bowel. Following delivery and surgical repair of the gastroschisis, the bowel often does not function properly for weeks to months. Putting the intestines back in the abdominal cavity increases the pressure in the abdomen and also within the chest.

Following surgery, this increased pressure in the abdomen can also interfere with lung function. Occasionally, it is necessary to put a chimney on the abdomen, which encloses the bowel. The intestines are then gradually placed back into the abdomen by squeezing on the chimney until the abdomen has stretched enough to allow the complete replacement of the intestines into the abdomen.

Gavage feeding
Feeding an infant through a nasogastric tube. Also call tube feeding.

Gender differences
Premature male infants have a higher mortality rate and greater severity of illness than female infants of the same gestational age.

Gene
Genetic material that is combined in long threads or strands to constitute chromosomes.

Gene therapy
Therapy of defective or missing genes. Increasingly, medical and surgical conditions are being identified as the result of defective genes. In the future, altering of one's genes may become an important way of treating many, common diseases.

Genetic counseling
Many birth defects occur from inheritable problems. If there is a family history of birth defects or you are at increased risk of having a baby with a birth defect due to your age or other problem, you should discuss these situations with someone knowledgeable about genetically inherited problems. A meeting between you, your partner, and a genetic counselor can help you understand your risks and alternatives. These sessions are confidential and may require more than one visit. People who should receive genetic counseling are women over 35, those with a family history of genetic disorders such as, spina bifida, Down syndrome, sickle cell anemia, and neurological problems; those whose partner is a relative, and women who have had previous miscarriages. In some situations, your doctor or other professional may provide this information.

Genetic disorder
A disease or disorder that occurs because of defective genetic material. Virtually everyone carries some defective genes, but they rarely cause problems. If you or your spouse have a genetic problem, you should know that and obtain counseling.

Genetic screening
Screening to identify a person at risk for having or transmitting a genetic problem. For example, pregnant women can be screened for the risk that their unborn baby will have Down syndrome or spina bifida . The maternal alpha-fetoprotein screening for spina bifida and triple screen for Down syndrome risk are examples. After birth, screening of newborn babies is required in almost all states. Diseases commonly included in this screening are phenylketonuria (PKU), a serious inherited and treatable disease, sickle cell anemia, galactosemia and others. Genetic screening is important in the prevention and early treatment of genetic disorders.

Gestation
Refers to the time between conception and birth. It is measured in weeks.

Gestational age
The length of the pregnancy. It is counted by weeks from the first day of the mother's last menstrual cycle. If a baby's gestational age is 37 weeks, it has been 37 weeks from the first day of the mother's last period and 35 weeks since conception. At birth, an important part of the examination of the infant is the estimation of the gestational age.

Gestational age assessment
Measurement of gestational age. The length of time from the first day of the mother's last menstrual period until the time of delivery. Since the health of the baby after birth is related to gestational age, estimating gestational age is critical to both obstetrical management of the mother and neonatal management of the infant.

Estimates of gestational age in pregnancy have improved greatly over the past decade. With artificial insemination, in vitro fertilization and related techniques, the gestational age can be measured to within hours. In all pregnancies, ultrasound measurements early in pregnancy can estimate gestational age to within days. After birth an examination of the infant usually permits measurement of gestational age to within a week or so; however, the techniques for assessing gestational age do not work well in extremely premature infants (<26 weeks gestational age).

Gestational diabetes
A form of diabetes that occurs in pregnancy. Some women develop diabetes in pregnancy despite never having had this previously. Risk factors for this are:

Women who have gestational diabetes are at high risk for developing diabetes that is not associated with pregnancy. About 50% of women with gestational diabetes will become diabetic in the subsequent 20 years. The infants of women with gestational diabetes may also be more likely to become obese and diabetic. Gestational diabetes should always be treated with diet modification. Insulin may also be required. The risk of recurrence in a subsequent pregnancy is at least 30%.

Gonadotropins
Hormones that are produced by the pituitary gland and that control reproductive organ function.

Grantly Dick-Reed method
Based on the belief that fear causes tension, which in turn causes pain. By breaking this fear, tension, pain cycle, and childbirth can be less painful. This method focuses on relaxation techniques and massage.

Grasping reflex
Newborns have many naturally occurring reflexes to external stimuli. When the infant's hand is stroked or the palm is pressed by your finger, the infant will grasp your finger. This grasp may be strong enough to support the infant's own weight, but doesn't last very long. This reflex is present for about 3-4 months and then disappears.

Gravida
A pregnant woman. If this is the first pregnancy, a woman would be called a primagravida. If this were the second pregnancy, the woman would be referred to as a gravida 2. If it were the third pregnancy, she would be a gravida 3 and so on for subsequent pregnancies.

Group B strep
Short name for Group B streptococci. The most common cause of infection in newborn infants is GBS. About 7,000 infants are infected each year. Despite modern therapy, about 10-15% of infected infants die. Roughly 20% of all women in the U.S. harbor GBS in their birth canal at delivery. It is not a venereal disease nor is it a sign of ill health or poor hygiene.

Women who harbor GBS in their rectum or birth canal are considered 'colonized' with GBS. For most of these women, colonization causes no problems to either the mother or child. However,1-2% of colonized women deliver babies that develop serious infections. Unfortunately, it is hard to predict which babies born of colonized mothers will develop infection. The mother is often completely healthy and the pregnancy uncomplicated. Furthermore, infants can acquire this potentially deadly infection before birth and yet appear well or only slightly ill for the first few hours after birth.

Growing pains
Unexplainable pain, usually in the legs, that occurs in growing children. These pains are not accompanied by swelling or any other symptoms. Treatment includes massage, acetaminophen, and rest. The problem is distinguishing this pain from that caused by more serious problems. Even physicians often have difficulty knowing how many laboratory and X-ray tests to perform.

Habitual abortion
Repeated miscarriages. The commonly accepted definition for this is three consecutive miscarriages. Medical evaluation of this problem can result in an explanation and possible therapy. The risk of a single miscarriage in an otherwise healthy woman would is about 15%.

Haemophilus Influenza type B (Hib)
A bacterium that causes serious bacterial infections such as meningitis and pneumonia. This bacterium is the not the cause of influenza. Influenza is caused by a virus. However, Hib does cause life-threatening disease, especially in young children. These bacteria can cause ear infections, pneumonia. meningitis, possible brain damage, airway obstruction, and upper respiratory and other infections. The vaccine against Hib has proven very effective in reducing disease. For information on the vaccine, see Hib vaccine.

Handedness
The tendency to use one hand more than another. Most babies start out using both hands equally, but will have developed a preference by 1 year of age. Although it is not known exactly what causes us to prefer one hand over another, it is thought to be genetic and is associated with development of the right and left hemispheres of the brain. About 70% of people are right handed, 10% left handed, and 20% are ambidextrous (use each hand equally).

Hearing screen
Test to examine the hearing of a newborn infant. It is now a national recommendation that all newborn infants have a hearing screening test to be sure the infant is able to hear. If the infant does not pass the hearing-screening test, it does not mean the infant is deaf. It does mean additional testing needs to be done. Congenital hearing loss occurs in about 1 out of 1,000 infants.

Heart murmur
A noise heard between beats of the heart. Innocent, functional heart murmurs are common and often heard in infants and toddlers. If your doctor has a question about a heart murmur, she may refer your child to a specialist in pediatric heart issues, a pediatric cardiologist.

Heel stick
The procedure of pricking the baby's heel to obtain small amounts of blood for laboratory testing.

Hemoglobin
The chemical in red blood cells carrying oxygen to the tissues. The hemoglobin level is measured as grams of hemoglobin per 100 milliliters of blood. The hemoglobin measurement is commonly used to identify anemia and determine when an infant needs a blood transfusion. The test may also be used to identify abnormal bleeding in an infant.

Hemolytic disease of the newborn
Condition in which mother and baby have different blood types. A woman who has a different blood type than her fetus may occasionally produce antibodies against the fetus' blood cells. This is usually caused by Rh incompatibility, although other types of incompatibility can rarely cause hemolytic disease.

During pregnancy, a few of the baby's red blood cells pass through the placenta into the mother's bloodstream. In Rh incompatibility, the mother's immune system recognizes these red blood cells as incompatible and "foreign." She then begins making antibodies to her own baby's red blood cells. These antibodies cross the placenta and attack and destroy the baby's red blood cells. This leads to fetal anemia and even heart failure before delivery. After delivery, this incompatibility can result in continued red blood cell breakdown and high bilirubin concentrations.

Before delivery, Rh incompatibility can be treated with intrauterine blood transfusions to correct the anemia. Although there is some risk to this procedure, it can be very effective in helping to postpone delivery and improve the condition of the infant at delivery. Hemolytic disease of the newborn often leads to premature delivery and the need for neonatal intensive care. After delivery these infants almost always require intensive phototherapy to reduce their bilirubin levels. Sometime they have such high levels of bilirubin that an exchange transfusion is required. They are also more prone to have immature lungs if delivered prematurely.

Although all of these problems are treatable, prevention is better than the best treatment. Your doctor will test your blood type and screen for the presence of potentially dangerous antibodies as part of your routine prenatal care. If you are Rh-negative, you will probably receive a special antibody preparation, Rhogam, that reduces the likelihood you will develop antibodies to fetal red blood cells. You should discuss this issue with your doctor if your blood type is Rh-negative.

Hemophilia
A genetically inherited disease characterized by hemorrhaging and severe bleeding. The problem is the deficiency of a key clotting factor which is absent in hemophiliacs. The hemophilia A gene is carried by females, but does not affect the female. It only affects their sons, who have a 50% chance of having hemophilia. One of the first signs of hemophilia can be excessive bleeding from circumcision. When bleeding occurs, plasma or other clotting factor VIII preparations may be infused to promote clotting. These patients are best treated in a clinic that specializes in these problems.

Hemorrhoid
An enlargement of the veins around the anus. It is very common to experience hemorrhoids or worsening of hemorrhoids during pregnancy due to increased blood flow to the uterus and slowed venous drainage from the pelvic region due to the enlarging uterus. Treatment includes stool softeners (to avoid constipation which can be especially painful), warm baths, ice packs, and suppositories.

Hepatitis B
A viral infection of the liver. It can be passed by needle sharing, tattooing, sexual and other intimate contact. It has a 1-6 week incubation period. Some people become very sick with hepatitis and some also retain a smoldering infection for many years. Some patients with chronic hepatitis B infections of the liver may have such severe damage that much of their liver is destroyed. People who are chronically infected may also be at increased risk for liver cancer. It is now recommended that all infants be immunized against hepatitis B starting shortly after birth. Immunization greatly reduces the risk of acquiring hepatitis B infection. Breastfeeding by a hepatitis B-positive woman increases the risk that her child will acquire hepatitis B. If you are hepatitis B-positive, you should discuss the issue with your doctor. Screening for hepatitis B is a routine part of prenatal care.

Hepatitis B vaccine
A vaccine to protect against hepatitis B. In the U.S. all babies should receive within the first year a series of 3 immunizations against hepatitis B. The first is usually given in the hospital after birth, the second 1-2 months later, and the third about 6 months after the last shot. A booster is given at about 12 years of age and to adults with increased risk (e.g. dentists, dialysis patients, and family members of someone with hepatitis B, etc.). Two different vaccines are available in the U.S. and either can be used.

Hernia
A protrusion of an organ or other tissue through an abnormal opening. The most common reference to hernia occurs in young boys, especially prematurely born ones, in which inguinal hernia is common. Normally the testes are formed in the abdomen and migrate down into the scrotum through the inguinal canal. Before birth this canal should seal off. If it is not completely sealed off, bowel may follow the same path to exit the abdomen into the inguinal canal or scrotum. This is an inguinal hernia and requires surgical repair.

Another hernia seen in newborn infants is that of the diaphragm (See diaphragmatic hernia.) where bowel from the abdomen protrudes up into the thorax, usually through a hole in the diaphragm.

About the only hernia which resolves on its own is an umbilical hernia that is covered with skin. This hernia results from an incomplete fusion of the abdominal muscles that permits part of the bowel to protrude up at the level of the umbilicus or belly button. As the infant grows, the muscle layers often increase and fuse gradually eliminating the hernia.

Hib vaccine
A vaccine to prevent Haemophilus influenzae type B (Hib) infection. The Hib vaccine has markedly reduced the occurrence of serious and fatal Hib infections. Some minor reactions to be aware of are soreness, redness at the injection site, a fever under 102°F, and irritability.

High frequency ventilation
Method of respiratory support for the lungs using very high frequencies of breaths per minute. There are several types of ventilators providing high frequency respiratory support.

High-risk pregnancy
Pregnancies at high risk of fetal or maternal complications. There are many factors that contribute to complications during pregnancy and delivery. Chronic medical problems in the mother, past history of repeated preterm delivery, and abnormalities of the fetus or placenta all increase the risk of complications. Women with high-risk pregnancies should be seen and treated by someone who is experienced in caring for complicated pregnancies. Usually, this is an obstetrician or a perinatoligist, an obstetrician with additional training in treating high-risk pregnancy problems. In some cases a consultation with neonatologist (specialist in the care of sick newborns) can prepare you for what to expect if your baby has problems. Some hospitals have high-risk pregnancy units, where mothers stay during part of their pregnancy to receive the care they need. This is one of those conditions that is best treated by a hospital that has a high volume of these types of patients.

Hirschsprung's disease
A congenital disorder of the colon. Its chief feature is impaired intestinal function. The affected part of the colon lacks nerve cells and so it is unable to relax and contract properly. The result is chronic constipation, enlargement of the bowel and, in some infants, bowel obstruction. It almost always requires surgery to fix it.

Hirschsprung's disease affects about 1 in every 5,000 live births in the U.S. It is usually diagnosed in infancy and is more common in infants with Down syndrome.

Home uterine monitoring
Measurement of uterine activity at a patient's home. Women wear a special belt that identifies uterine contractions and either notifies the woman directly or transmits the information to the doctor. It can be especially helpful in monitoring women with premature labor. Use of this technique puts patients in daily contact with their health care provider. The contractions are transmitted by telephone to a center so the doctor can evaluate them on a computer. This can be an alternative to hospitalization.

Hormone
A chemical produced by one organ but affecting the function of another organ. For example, the ovary produces estrogen and progesterone but these hormones have effects throughout the body. Hormonal function is critical to pregnancy and breastfeeding.

Human Chorionic Gondotrophin (hCG)
A hormone produced by the placenta and which is essential to normal pregnancy. hCG can be detected as soon as 7-10 days after conception using a home pregnancy test kit. Those kits and the ones used in the doctor's office, rely on the measurement of hCG level, which increases rapidly after conception. hCG is also a component of the 'triple screen' used to screen women for the risk of Down syndrome in their fetus.

Human menopausal gonadotropins (hMG)
Postmenopausal women produce high levels of gonadotropins, follicle stimulating hormone and luteinizing hormone. These hormones can be purified and used to stimulate ovulation. The commercial preparation of this is Pergonal.

Hyaline membrane disease (HMD)
Also called respiratory distress syndrome (RDS). Respiratory distress simply means the child is having trouble breathing. It differs from respiratory distress syndrome, which is a specific condition of lung immaturity causing respiratory distress mostly in premature babies.

RDS occurs because surfactant is missing in the lungs.Surfactant is a soap-like material normally present in the air sacs of the lungs. Without surfactant, the alveoli (air sacs) collapse when the baby breathes out. These collapsed air sacs can only be reopened with increased work at breathing. Most newborn babies do not have a normal amount of surfactant in their air sacs until 34 to 36 weeks' gestation. However, some very premature infants (27 to 30 weeks' gestation) will have adequate surfactant production and function and some full-term infants (37 to 40 weeks' gestation) will not.

Prematurely born infants with immature lungs don't have enough surfactant. If RDS is severe, babies require ventilators and breathing tubes. Surfactant taken from calf lung or other sources can be put into the lungs and can serve as a replacement for natural surfactant until the baby starts to manufacture her own surfactant. Surfactant treatment has considerably reduced death among very premature infants.

Hydrocele
Collection of fluid around the testis. It usually goes away on its own and surgery is not needed. In some babies, the fluid collection increases, stays the same, or is accompanied by a hernia. These cases may require surgery.

Hydrocephalus
Abnormal accumulation of cerebrospinal fluid within the ventricles of the brain. It is sometimes known as "water on the brain." Within the center of our brains each of us has two fluid-filled areas called cerebral ventricles. Cerebrospinal fluid is made within these ventricles and distributed over the surface of the brain and spinal cord. When the normal circulation of cerebrospinal fluid is interrupted, fluid can accumulate within the ventricles, which leads to increased pressure and enlargement of the ventricles, a condition called obstructive hydrocephalus. Abnormal re-adsorption of the cerebrospinal fluid also can lead to fluid accumulation, a condition known as communicating hydrocephalus.

The accumulation of fluid puts pressure on the brain, forcing it against the skull and enlarging the ventricles. In infants, this fluid accumulation often results in bulging of the fontanelle (soft spot) and abnormally rapid head growth. The head enlarges because the bony plates making up the skull have not yet fused together. In premature infants the ventricles can enlarge without the head getting bigger.

Hydrocephalus can be caused by birth defects in the brain's development and may be associated with other congenital anomalies, such as spina bifida. In prematurely born infants the most common cause of hydrocephalus is intraventricular hemorrhage.

Hymen
A thin membranous tissue fold which partially or wholly occludes the external orifice of the vagina. A woman's first coitus usually tears the hymen, resulting in a permanent change in the appearance of the hymen. In some women the membrane may be resistant to tearing and a simple, surgical procedure, hymenectomy, may be required. Some bleeding may occur with rupture of the hymen.

Hyperalimentation
Method of feeding through a vein using a solution of sugar, protein, minerals and, usually, fats to provide nutrition for an infant or older child. It is used as a substitute for formula or breast milk feedings when a child cannot take an adequate amount of calories by mouth or through a stomach tube.

Hyperbilirubinemia
An elevated bilirubin level, sometimes called jaundice. As red blood cells and other tissues are replaced in the body, the waste products from this replacement are normally eliminated by the liver. Bilirubin is one of those waste products. Before birth, the placenta is very efficient in removing bilirubin from the baby's body; the baby's liver does not need to remove the bilirubin. After delivery the infant's liver must take over this elimination function. Until the liver can keep up with the formation of bilirubin, there is a bilirubin build-up in the body. Bilirubin is yellow, and when the levels are high, it stains the skin and other tissues, which also take on a yellowish color.

At low to moderate levels the main effect of bilirubin is to make the skin appear yellow. However, when the levels get high, the bilirubin can enter the cells of the brain and damage them. Concern about brain injury prompts frequent measurement of the bilirubin level in newborns. It is much easier to treat the bilirubin level when it is only moderately high rather than when it is dangerously high.

At low levels of bilirubin accumulation, increasing an infant's fluid intake and using phototherapy (light therapy) may be all that is required to reduce the bibirubin level or keep it at a safe level. At high levels of bilirubin, an exchange transfusion that essentially exchanges the baby's own bilirubin-laden blood with low-bilirubin-containing blood from an adult donor may be necessary to reduce the risk of brain injury. It is the need to keep the bilirubin level from getting too high and the complex nature of the exchange transfusion for high bilirubin levels that prompts doctors to measure and be concerned about the bilirubin level. Almost all premature infants will have jaundice and hyperbilirubinemia. It is rare for a premature infant to require more than phototherapy for jaundice.

Hyperglycemia
Elevated blood sugar level. It is more often seen as a consequence of therapy in premature infants. Steroid medication, excessive intravenously administered glucose, and infection can all cause elevated glucose levels.

Hypertension
High blood pressure. Hypertension induced by pregnancy is one of the most common complications of pregnancy, occurring in about 3-4% of all pregnancies. The definition of hypertension is generally taken to be a blood pressure of 140/90 or greater, although there is not total agreement among physicians about these criteria. Hypertension is an important cause of serious problems in both the both mother and the child. Maternal problems include placental abruption, preterm labor, reduced kidney function, and many other problems. Maternal hypertension is also associated with reduced blood flow to the fetus resulting in intrauterine growth retardation (IUGR) and premature birth. Pregnancy-induced hypertension occurs more commonly in older and obese women and in those who have hypertension before pregnancy. Treatment of hypertension in pregnancy varies depending on the severity. Monitoring blood pressure is one of the important functions of the prenatal visit

Hypocalcemia
Low blood calcium level. Premature infants, infants of diabetic mothers and growth restricted infants are all more prone to low blood calcium levels than full-term infants.

Hypospadias
A birth defect of the urethra. The urethra is the tube that carries the urine from the bladder to an external opening. In males, the urethra should open at the tip of the penis. If the urethra opens below the tip of the penis, this is called hypospadias. There are various grades of hypospadias depending on how far down the shaft of the penis the urethral opening is located. The only way to correct this is with surgery, which is usually performed at 1-2 years of age. Children with hypospadias should never be circumcised as the foreskin may be used to repair the hypospadias.

Hypothyroidism
A low level of thyroid hormone. Thyroid hormone is critical to normal metabolism. Hypothyroid women have problems conceiving and may have more problems with pregnancy and with their newborn infants. Replacement thyroid hormone can be given during pregnancy to re-establish normal metabolism.

Hypovolemia
Decrease in the total blood volume. It may result from blood loss just before or during delivery, hemorrhage (bleeding) after birth, or the frequent withdrawal of the infant's blood for laboratory analysis.

Hypoxemia
Low concentrations of oxygen in the blood. The term is sometimes used as an adjective to describe patients who have hypoxemia.

Hysterectomy
Surgical removal of the uterus. A hysterectomy can be performed through the vagina or through the abdominal wall.

Ibuprofen
Chemical name of drug commonly used to reduce fever, swelling, and pain. A common commercial brand is Advil®. Ibuprofen, although used extensively, is a relatively new medication so there is not as much information about its safety when used during pregnancy, breastfeeding, or infancy. Some research indicates that it may be safer than acetaminophen or aspirin for a breastfeeding mother. Talk to your doctor before taking this or any other medication during pregnancy or if breastfeeding.

Identical twins
Twins who share the same genetic makeup, also known as monozygotic twins. When a single fertilized egg divides in two separate embryos before the 8th day after conception identical twins result. (If the division occurs after the 8th day, conjoined, or Siamese, twins result.) Identical twins share the same placenta, are always of the same sex, blood type and usually closely resemble one another. Twins, have a higher risk of complications and premature birth. Identical twins happen in about 1 of every 250 births and make up 33% of all twin births. The incidence of twin pregnancy is very similar for all races and age groups.

Ileal perforation
Puncture or hole in the last part of the small bowel (ileum). This usually occurs spontaneously in extremely premature babies. Its cause is unknown. Often an ileal perforation requires surgery to form an ileostomy and to repair the hole in the bowel. Some neonatal intensive care units have reported success simply by putting a piece of drainage tubing into the abdomen to drain out the infection and let the perforation seal on its own.

Ileostomy
Loop of the ileum (last part of the small bowel) that is brought to the surface of the abdominal wall and surgically attached. The infant passes stool through this hole. An ileostomy is almost always a temporary condition. It is usually caused by bowel problems that occur either spontaneously or with infection.

Immune system
The body's defenses for fighting disease and infection. The immune system produces antibodies and special cells that attack viruses and bacteria. Antibodies and other factors in breast milk can increase the breastfed infant's ability to fight infection. Prematurely born infant's immune systems are not be fully developed and they are more susceptible to illness than infants born at term.

Immunization
The use of bacterial or viral components to stimulate the body to produce infection -fighting substances. Immunizations are sometimes called vaccinations. Immunizations consist of a either a weakened strain of a the entire virus/bacteria or parts of the bacteria or virus. They stimulate a healthy immune system to recognize the bacteria or virus, and then produce antibodies which destroy the bacteria or virus preventing future infection. Most immunizations require a series of shots in order to be effective. Some vaccines also require a booster injection many years after the original series of vaccinations. There is information on each specific immunization under its respective name.

Impetigo
A common, contagious skin infection caused by Streptococci. Streptococcal impetigo is a common infection of young children and occurs on the legs, arms and face. The infection usually causes blisters first, followed by yellow, crusty scabs. The infected areas should be cleaned with soap and water. Impetigo should also be treated with antibiotics. Without antibiotic treatment, impetigo can lead to more serious infections and, occasionally, to severe kidney problems. Impetigo is contagious until after the second day of antibiotic treatment.

Implantation
Attachment of the fertilized egg to the uterine lining. This usually occurs about five days after ovulation.

In utero
Inside the womb.

In utero surgery
Also known as fetal surgery. Surgery to correct birth defects can, in rare instances, be performed before delivery. For example, some centers are studying surgery in utero to correct congenital diaphragmatic hernia, a birth defect that has been extremely hard to treat after delivery. Many obstacles remain before in utero surgery becomes common.

In vitro fertilization (IVF)
Laboratory fertilization of an egg by a sperm. The fertilized egg is then implanted in the female reproductive tract.

Incompetent cervix
Painless cervical dilatation in the 2nd trimester often followed by premature delivery of the fetus. This can sometimes be diagnosed early on with the use of an ultrasound. The only real treatment is a surgical procedure called cerclage, which reinforces the cervix with sutures. An alternative to surgery is bedrest, but this is not always effective. Possible complications to cerclage are bleeding, contractions, and ruptured membranes, but if done by the 18th week these risks are decreased. The success rate is about 85-90%. If an incompetent cervix is not properly treated it will cause problems with each subsequent pregnancy.

Incubator
An enclosed, heated, plastic bassinette used to provide warmth and, sometimes humidity, for prematurely born infants. Incubators are sometimes called isolettes. They are used in the care of premature infants to give them a controlled thermal environment to reduce the infant's heat and water loss.

Indomethacin
Aspirin-like drug sometimes used to close the patent ductus arteriosus (PDA). It may be given either to treat or prevent a PDA.

Induction
(Initiation of labor). If labor has not started at an appropriate time or if there are maternal indications for delivery before labor starts naturally, medications may be used to initiate labor. Prostaglandin gel and oxytocin (Pitocin®) are the most common medications. Rupture of the amniotic membranes may also hasten the onset of active labor.

Infant
Refers to a baby 1 month of age to 12 months. This term is also used on occasion to describe a child up to 2 years of age.

Infant mortality rate
The rate at which infants up to one year of age die. The rate is calculated by taking the number of children who died at less than 12 months of age and dividing it by the number of live births. The usual time period for calculation is a calendar year. The infant mortality rate in the U. S. is declining and was 0.76% in 1995 (in other words about 7-8 children die of every 1000 who are born alive).

Infant of a diabetic mother (IDM)
Infant born to a mother who had diabetes mellitus during pregnancy. These infants often have a characteristic set of problems, including too much subcutaneous fat, low blood sugars, and large size for gestational age.

Infertility
The inability of a couple to achieve pregnancy after one year of unprotected intercourse.

Intensive care unit (ICU)
A hospital ward for very sick or critically ill newborns. Intensive care usually refers to intensive nursing care. If your baby is born prematurely, underweight, or with other problems he may be taken to a special nursery called the Neonatal Intensive Care Unit or NICU. Here, your baby can receive more intensive treatment for his medical and surgical problems.

Intestinal atresia
Complete blockage of the intestine usually caused by a birth defect.

Intestinal stenosis
Narrowing of the center passage within the intestine. In some cases, complete closure of the intestine is present at birth because of intestinal atresia. Narrowing of the intestine obstructs the passage of food through the intestine and prevents normal feeding and intestinal function.

Intracranial hemorrhage
Bleeding within the skull. Bleeding most often occurs within the ventricles of premature infants, but it can occur anywhere within or on the outside of the brain.

Intracytoplasmic sperm injection (ICSI)
Direct injection of sperm into an egg.

Intrapartal care
Care given during labor and childbirth

Intrauterine
Within the uterus.

Intrauterine growth retardation (IUGR)
A condition in which the fetus doesn't grow as big as it should while in the uterus. These babies are small for their gestational age, and their birth weight is below the 10th percentile. IUGR can be caused by decreased blood flow to the placenta, maternal hypertension, drug use, smoking, poor weight gain, dieting during pregnancy, pre-eclampsia, alcoholism, multiple fetuses, abnormalities of the cord or placenta, prolonged pregnancy, chromosomal abnormalities, or a small placenta.

A baby with IUGR has a higher risk of serious health problems and infant mortality in the newborn period. Diagnosis can be difficult which is why it is important to be weighed at each prenatal appointment. The use of an ultrasound can also help detect IUGR. Treatment includes better nutrition through the remainder of the pregnancy, bedrest, a sometimes a C-section (these babies don't tolerate labor well) and delivery before term (these babies have an increased risk of dying in utero before delivery).

Intravenous (IV)
A catheter (small tube) placed directly through the skin into the vein in a baby's hand, arm, foot, leg or scalp. Nutrients, fluids and medications can flow through this tube. Using an IV is a common route for delivering fluids to newborns and other patients. Babies' veins are very fragile, so the location of the IV may need to be changed frequently.

Intraventricular hemorrhage (IVH)
Bleeding into the ventricles (fluid-filled spaces) within the brain. All of us have two small, fluid filled ventricles in the center of our brains. These ventricles manufacture cerebrospinal fluid. The fluid-filled space within those ventricles are called the intraventricular space. The areas just outside of those ventricles are the periventricular areas. Adjacent to the outer wall of the ventricle is the germinal matrix, an area of immature nerve cells and tender blood vessels. As the preterm baby matures, the germinal matrix tissues migrate out into the substance of the brain, and the germinal matrix gradually disappears.

The tender blood vessels within the germinal matrix can rupture and cause bleeding within the germinal matrix. This is called a germinal matrix hemorrhage or grade I intraventricular hemorrhage (IVH). The bleeding, if severe, can lead to bleeding within the ventricle itself, a grade II IVH. If there is a lot of bleeding, the ventricles can become enlarged and swollen by the blood, which is a grade III IVH. If the bleeding either involves or secondarily injures the periventricular brain tissue, it is a grade IV IVH or IVH with extension of the hemorrhage outside of the ventricular system into the brain substance.

The incidence of bleeding goes up with decreasing gestational age. The most severe bleeding (grades III and IV IVH) occurs in about 8 percent of infants with birth weights < 1500 grams (3lbs. 5oz.). The causes of IVH are not clearly known, but it is thought that changes in blood pressure, pressure within the thorax and inability to clot the blood normally may contribute.

Isolette
Also known as an incubator, an isolette is a clear plastic, enclosed bassinet used to keep prematurely born infants warm. Premature babies often loose heat very quickly unless they are put in a protected thermal environment. The temperature of the isolette can be adjusted to keep the infant warm regardless of the infant's size or room temperature. Some isolettes also provide humidity control.

Isotopes
A chemical element having the same atomic number as another but posing a different atomic mass. Radioactive isotopes are used in certain diagnostic tests to evaluate body function and anatomy. The amount of radioactivity is very small posing essentially no risk to the patient or those around the patient.

IUPC (intrauterine pressure catheter)
A catheter inserted into the uterus during labor to measure the actual pressure within the uterus. These measurements are important in measuring the frequency and intensity of uterine contractions. The fetal heart rate is usually measured simultaneously. The combination of these measurements facilitates the evaluation of labor and fetal well-being.

Jaundice
A yellowish discoloration of the skin and other tissues. Jaundice comes from the accumulation of a natural waste product, bilirubin. As red blood cells and other tissues are replaced in the body, the waste products of their breakdown are normally eliminated by the liver. Before birth, the placenta is very efficient in removing these waste products; the baby's liver does not need to remove the bilirubin. After delivery, the infant's liver must take over this elimination function. It takes a few weeks for the baby's liver to fully assume this function. Until liver excretion has increased to keep pace with formation of the bilirubin waste product, there is a build up in the body. Bilirubin has a yellow color, and when the levels are high it stains the skin and other tissues.

Kangaroo care
Parent holding the baby skin to skin. During kangaroo care, the baby is placed on the parent's chest, dressed in a diaper and sometimes a cap. The baby's head is turned to the side so the baby's ear is against the parent's heart. Vent tubing and wires are taped to the parent's clothing or gown. In this position the baby is able to find comfort in the parent's heartbeat and feel the parent's warmth. This procedure is effective, but it is limited to babies whose condition is not critical.

Karyotype
The chromosome profile of a person. In men the karyotype would include 23 pairs (46) regular chromosomes and two sex chromosomes, one X and one Y chromosome. In Down syndrome a male would have a karyotype with 47 regular chromosomes (an extra copy of chromosome 21) and the usual two sex chromosomes.

Kernicterus
Damage to the brain from high bilirubin levels in the blood. When bilirubin finds its way into brain cells it paralyzes the energy producing mechanisms causing the cells to die. Premature infants are particularly prone to kernicterus. Excess bilirubin produces signs of jaundice and high levels of bilirubin in the first few days of life. The baby also becomes progressively inactive, sometimes adopting a characteristic posture with arched back and neck. Without treatment, the baby is likely to die at the end of the first week of life. Kernicterus is completely preventable if jaundice is treated adequately.

Kilogram
A unit of weight in the metric system. It is equal to 2.2045 lbs. Neonatal intensive care unit personnel often use the metric system of weights and measures. It is easier to use than the pound system.

Labor
The process of expelling the baby and it's placenta from the uterus, through the birth canal, and outside the mother's body. Labor is divided into four different stages.

1st stage: Also called the stage of dilation because during this stage the cervix dilates to 10 centimeters.

2nd stage: Also called the stage of expulsion. Starts when the cervix is fully dilated and lasts until the baby is totally out of the birth canal.

3rd stage: Also called the placental stage. Begins with the birth of the baby and continues until the placenta and the rest of the afterbirth have been delivered.

4th stage: Occurs after delivery and lasts 1 to 2 hours while the uterus contracts back down to reduce bleeding.

Lactation
The secretion of breast milk.

Lactation specialists
Specially trained individuals who help women with lactation. Breastfeeding is a simple and straightforward process in many ways. However, it can be difficult for some women to establish successful breastfeeding, especially if there are maternal or infant problems. Therefore, many hospitals are now establishing lactation specialists to assist women with breastfeeding. This assistance is particularly helpful for women who have never breastfed before.

Lamaze
The oldest, most common technique for reducing the stress and pain of labor and delivery. Lamaze trains women to replace unproductive behavior during labor and delivery, such as anger and screaming, with more productive actions, such as relaxation and deep breathing. Emphasis on relaxation and breathing make pushing more effective and less painful.

Lanugo
The fine, downy hair that often covers the shoulders, back, forehead, and cheeks of a fetus of a prematurely born newborn. Lanugo is replaced by more normal appearing hair toward the end of gestation.

Large for gestational age (LGA)
Newborn infant whose weight is greater than the 95th percentile for gestational age (infant weighs more than 95 percent of infants his same age). Being LGA does not necessarily mean there is something wrong with the infant. It does mean the physicians and nurses must observe the infant more closely for complications.

Lasix
Diuretic drug that reduces the amount of fluid in the lungs and other tissues. One of the ways it reduces fluid is to increase urine output.

Lay midwife
A woman without professional training who assists women with labor and delivery. Many of these women have considerable experience, however they are not licensed and there is no way of knowing what their training and education has been. They are helpful for routine deliveries but unreliable for complicated labors or those that develop emergencies.

Lead wires
Wires connecting the sensors on the patient's chest to the vital signs monitor. They pick up the electrical signal of the heart and convey it to the monitor. The wires also measure chest wall movement, although those measurements are not as accurate as the heart tracing.

Leg cramps
Muscle cramps of the legs, often associated with pregnancy. This is a common problem during pregnancy, usually occurring toward the last half of pregnancy.

Let down reflex
An involuntary reflex during breastfeeding which causes the milk to flow freely.

Level II NICU
Neonatal intensive care unit (NICU) that takes care of moderately ill or recuperating infants who are over their acute phase of illness. Babies treated in a Level III NICU are sometimes transported to a Level II NICU for further care, if the location is more convenient for the parents.

Level III NICU
Neonatal intensive care unit (NICU) that has the ability to care for the most complex and severely ill babies. NICUs are categorized into Level I (normal newborn infants only), Level II (moderately ill infants), and Level III. However, the types of infants treated in Level II and Level III NICUs often overlap and are inconsistent from region to region.

Licensure
The obtaining and possessing of a license. States regulate medical and other health care professionals through licensure. To be licensed you must prove qualifying background education, appropriate training in your area and be free of felony convictions. The importance of licensure is that it somewhat regulates the quality of care provided in the state and gives patients someone to whom you can complain (licensing board) if there is a serious problem with your provider.

Ligation
Surgical closure of a vessel so nothing can pass through it. Surgical ligation is sometimes used to correct patent ductus arteriosus.

Lightening
Also called dropping because the abdomen changes shape as the baby appears to drop several inches. This occurs when the head of the baby drops into the pelvis. This happens at the end of pregnancy, usually between two or three weeks before labor. Lightening makes breathing easier, but increases pressure in the pelvis and on the bladder.

Lithium
A mineral salt used to treat manic depression. Lithium is very effective in treating some forms of depression. However, it has been associated with cardiac malformations, especially, Ebstein's anomaly. If lithium must be used, fetal ultrasound is recommended to evaluate fetal cardiac status. There are alternative medications that may be useful substitutes for lithium during pregnancy.

Lochia
Fluid that seeps from the uterus and ultimately from the vagina during the weeks following childbirth.

Low birth weight
Technically, any baby with a birth weight under 2500 grams is a low birth weight baby (LBW). LBW babies are usually premature as well. However, some LBW are full term but undernourished and undergrown. LBW babies have increased risks of lung, heart and metabolic problems. They often require treatment in a special care nursery or NICU.

Low lying placenta
Placenta that implants at the lower end of the uterus. Normally, the placenta implants in the mid or upper portion of the uterus. If it implants in the lower section, the placenta may separate from the uterine wall as the uterus expands and the cervix dilates. An extreme form of this is placenta previa. On occasion a low lying placenta will appear to migrate up the uterine wall over the course of the pregnancy. This puts the placenta in a safer position. Ultrasound evaluation is essential in monitoring the position of the placenta.

Lupus anticoagulant
An abnormal antibody that has been associated with frequent pregnancy loss. The lupus anticoagulant is often found in people with lupus erythematosus, but may also be found in those who do not have true lupus erythematosus. Anticoagulants are substances that prevent the blood from clotting normally. The lupus anticoagulant has that effect on one test of blood clotting function. However, the lupus anticoagulant has the opposite effect in pregnant women: it causes abnormal blood clots to form. There are treatments for this and it is possible to have a normal baby despite the presence of the lupus anticoagulant.

Lupus erythematosus
A condition in which the body makes antibodies against itself. It can present with arthritis, skin rashes and multiple other problems. About 500,000 people in the U.S. have lupus, mostly women. Many women have successful pregnancies despite having lupus.

Macroglossia
Abnormally large tongue.

Magnesium
A mineral salt important to nerve signaling, healthy bones, and normal muscle contraction. Magnesium is found in unprocessed foods such as nuts, unmilled grains, and legumes. A magnesium deficiency causes problems with the nervous system including hand and foot spasms, twitching, and cramping. The average woman should consume about 320 milligrams per day. Magnesium, as a salt mixed with sulfate, is sometimes used to inhibit premature labor and treat pre-eclampsia.

Magnesium Sulfate
Mineral salt important in maintaining nerve signaling, healthy bones, and normal muscle contraction. Magnesium sulfate is sometimes used to slow down premature labor and treat pre-eclampsia. It has the ability to reduce contractions.

Malrotation of the intestine
Intestine that is not placed correctly in the abdomen. As the intestine finds its final position in the abdomen it should rotate and lay in a specific orientation. Sometimes this orientation is not achieved. A thick band of tissue often lays against and crosses the upper small bowel, which causes blockage of the intestine. Because the intestine is not properly placed in the abdomen, it also can twist on itself and cut off its own blood supply. Some people have malrotation all their lives and never have problems with it. Others have problems with intestinal obstruction in the newborn period.

Maternal mortality rate
The number of maternal deaths divided by the number of live births (including fetal deaths). The time period for calculation is usually one year. The maternal mortality rate in the U. S. in 1994 was 0.01% (1/10,000).

Measles, Mumps and Rubella (MMR) Vaccine
This combination vaccine protects children against Measles, Mumps and Rubella. These childhood infections are quite contagious and once were common among children. There were a record low 138 U. S. cases of measles in 1997. The reduction in measles infections has largely been accomplished through maintenance of high rates of measles immunity. In 1996, 91% of all children aged 19-35 months had received at least one dose of measles vaccine. Many cases of measles were imported from other countries to the United States. Therefore, even with few cases in the U.S. it is important to maintain high levels of immunity among U.S. children.

Meconium
A dark green, sticky mucus normally found in infants' intestines. It is the first stool passed by the newborn. Meconium is a mixture of amniotic fluid and secretions from the intestinal glands. Passage of meconium within the uterus before birth can be a sign of fetal distress. The meconium is very irrtiating to the lungs. If an infant is at risk for having thick meconium within the lungs, a tube is inserted into the trachea and loose meconium is suctioned out of the lungs. This tube, called an endotracheal tube, can also be used to help an infant breathe after the meconium has been removed.

Microcephaly
Abnormally small head usually associated with developmental delay. Microcephaly may happen if the brain is damaged before birth by congenital rubella (German measles), other viral infections, maternal alcohol use in pregnancy, or other problems. It may also result from brain damage during birth, injury, or disease in early infancy. There also is a rare inherited form of microcephaly.

Micrognathia
Abnormally small jaw. The jaw may be so small that it interferes with the infant's breathing or eating. The infant may need special nipples, special positioning, or even surgery so the baby has an unobstructed airway. Micrognathia may occur as the only abnormality or in combination with other problems. It may correct itself during growth, especially at puberty when the jaw grows significantly.

Micromelia
A birth defect or anomaly characterized by abnormal shortness of the limbs.

Midwife
A person who assists the mother during childbirth. A midwife can be a man or woman. Today, midwifes are usually nurse-midwifes, meaning they have had formal training as nurses and then pursue specialized training in midwifery. If you chose to use a midwife make sure he or she is certified and that you have a backup plan should something go wrong and you or your baby need immediate medical or surgical intervention.

Milia
Small whitish nodules on the skin usually of the face. Milia represent retention cysts of sebaceous gland secretions. They appear on the face of newborns and go away without treatment.

Miscarriage
Spontaneous abortion or loss of the fetus before 21 weeks of gestation. Habitual abortion is defined as the spontaneous loss of 3 or more consecutive pregnancies. Habitual or recurrent abortion is a form of infertility. Couples who have had 2 or more miscarriages (spontaneous abortions) have about a 5% chance that one member of the couple is carrying a chromosome problem that is contributing to the miscarriages. A considerable proportion of pregnancies end in miscarriage.

Molar Pregnancy
A pregnancy in which the normal placental tissue does not develop normally. Another name for this is gestational trophoblastic disease. The abnormal placental tissue grows and often causes enlargement of the uterus that is more rapid than usual. This condition occurs in about 1:1000 pregnancies. It is more common in the early and late years of childbearing. The recurrence in subsequent pregnancies is about 2%.

Symptoms are uterine bleeding, rapid enlargement of the uterus, absence of fetal heart activity, nausea and vomiting. Ultrasound easily diagnoses a molar pregnancy.

A D&C is performed to remove the abnormal tissue. Continued pregnancy puts the mother's health at grave risk. Many doctors recommend postponing pregnancy for at least 1 year after a molar pregnancy.

Molding
The creation of shape, or fashioning of an object. Usually refers to the newborn's head that is molded by passage through the birth canal during vaginal delivery. The head takes on a pointed shape that quickly returns to normal after a few days. The brain is very plastic and tolerates this molding well.

Mongolian Spot
Large, flat area on the back, buttocks, and less commonly the legs or shoulders, that contains extra pigment and looks similar to a bruise. About 90% of cases occur in dark skinned babies. These usually disapper after the first year, rarely lasting to adulthood.

Monitor
Machine that displays and often records the heart rate, respiratory rate, blood pressure and blood oxygen saturation of the infant. An alarm may sound if one or a number of these vital signs are abnormal. For example, in a normal infant the heart rate is usually between 120 and 180 beats per minute and oxygen saturation ought to be above 90 percent. False alarms are common, as the baby's abrupt movements cause the monitor to register inaccurate readings.

Morning sickness
Nausea and vomiting associated with pregnancy and occurring most often in the morning. About half of pregnant women experience morning sickness. Nausea may occur throughout the day, not just in the morning. This condition usually lasts for three to four months. It, but may continue throughout the pregnancy. For most women it is an annoyance. For some it can result in dehydration necessitating hospitalization.

One way to minimize this problem is to eat small snacks throughout the day (light dry foods like crackers are best), drink plenty of liquids, avoid spicy foods, and avoid preparing food. There is a physiological basis for morning sickness- it is not 'all in the mother's mind'.

Moro reflex
A newborn reflex. This reflex begins by extention of the baby's arms, fingers, and legs while arching their back and throwing their head back, then quickly bringing arms back into the chest with fists clenched. At times it resembles an attempt by the baby to embrace someone. It is present for 2-4 months and occurs when babies hear a sudden loud noise or feel like they are falling.

Mucus plug
A plug of mucus that fills the cervical canal during pregnancy, discharge of the plug is usually followed by rupture of the membranes and progressive labor.

Multigravida
The name given to a woman who is pregnant for the third or more time.

Multipara
The name given to a woman who has had two or more pregnancies ending in birth regardless if the babies were alive at birth.

Multiple birth
Delivery of more than one infant (twins, triplets, etc.).

Multiple gestation
Pregnancy with two or more fetuses

Myopia
Nearsightedness (not able to see things far away). Newborn babies and especially prematurely born infants are usually nearsighted. As they mature their vision improves.

Nasal cannula
Light, flexible tube used to give supplemental oxygen to a child. Oxygen flows through two prongs extending into the nostrils.

Nasogastric tube (NG tube)
Narrow, flexible tube inserted through the nostril, down the esophagus, and into the stomach. It is used to give food or to remove air or fluid from the stomach. Sometimes air or fluid can build up and painfully expand the stomach or intestine. Removing the air or fluid from the stomach makes the child more comfortable and prevents vomiting.

Natural childbirth
The process of giving birth without anesthesia and medication to relieve pain. Natural childbirth is not possible for everyone, if you would like to experience a natural childbirth discuss this with your doctor.

Naturopath
Physicians who emphasize the use of natural (as opposed to surgery and manufactured drugs) remedies to increase and maintain the health of their patients. There are three main principles that many naturopaths use as the foundation of their practice.

Necrotizing enterocolitis (NEC)
Swelling, tenderness and redness of the intestine caused by an infection or decreased blood supply to the intestine. NEC may injure or destroy parts of the bowel. The seriousness of NEC varies. It may affect only the innermost lining or the entire thickness of the bowel. Premature babies, especially those who are born small for gestational age or who are twins, are at greater risk for NEC than babies who are born at full-term.

Neomycin
An antibacterial ointment used to treat rashes or other minor skin irritations. It should not be taken internally or used for prolonged periods of time.

Neonatal intensive care unit (NICU)
A special care nursery for newborn infants with severe medical complications, who can't get the intense kind of care they need in a normal newborn nursery. They are cared for by doctors (neonatologists) and nurses with specialty training in caring for these infants. Walking into one of these units can seem frightening because the babies are usually very small, in isolettes or warming beds, and there are often machines, monitors, and tubes about the bedside. Many parents feel disconnected from their infants in this situation; however, parents can participate in feedings, baths, and diaper changes. Talking to, holding or just touching the child can help parents stay involved in the care of their child and comfort their baby as well.

Neonatal nurse practitioner
Registered nurses who are qualified through additional education and training to provide certain aspects of a baby's medical care. They often transport critically ill infants, attend high-risk deliveries and perform procedures in the NICU (placement of breathing tubes, special intravenous lines, etc.). In many NICUs they also take responsibility for primary management of sick newborns. A doctor, usually a neonatologist, supervises them.

Neonate
The name given to a newborn infant for the first four weeks after birth.

Neonatologist
A pediatrician who has received 4-6 years of training after medical school in preparation for treating sick newborns. This is the person who usually directs your baby's care if hospitalization in an NICU is required.

Neural tube
The neural tube is a embryonic fetal structure that forms the spinal cord and brain during the first trimester. The risk of NTD's (neural tube defects) can be reduced by taking appropriate amounts of folic acid before conception and throughout pregnancy.

Nevus
Commonly referred to as a mole. A nevus (plural is nevi) may be light brown to almost black and may have hair growing from it. They usually appear after 5 yrs of age, but can develop earlier. If the mole is large, changes color, or grows you should report this to your doctor. Occasionally, moles may become malignant. Small moles are common; the average light skinned adult has 10-30 of them.

Nevus flammeus
Also called portwine stains. They are caused by dilated capillaries. They start as pinkish-purple areas of skin at birth. They usually fade, but do not completely disappear. If they are very bothersome or in a prominent place most can be removed by laser when the child is older.

NICU staff nurse
Registered nurse who is educated and trained to care for critically ill babies.

Occupational therapist
This person has special training in child development. An occupational therapist assesses development and also provides therapy for developmental problems.

OFC or occipitofrontal circumference
A measure of head size. This common measure of head size is used to monitor normal growth and to identify problems with the brain. Standard graphs of the expected head size growth are available to help the doctor know if the brain is growing properly.

Oligohydramnious
Below normal amount of amniotic fluid. Amniotic fluid provides a cushion to the fetus against physical trauma and also permits the fetus to move while in the uterus. the volume of amniotic fluid increases throughout pregnancy until about 36 weeks of gestation. If the pregnancy is prolonged beyond the normal due date, the amount of amniotic fluid may start to decrease. the amount of amniotic fluid present is usually measured by ultrasound. If there is a decreased amount of amniotic fluid, there is increased risk of cord compression and fetal distress.

Oligohydramnios is associated with long standing maternal diabetes, pre-eclampsia, hypertension, and congenital anomalies. When oligohydramnious is present a woman is 5-7 times more likely to have a Cesarean section.

Omphalocele
Protruding of the abdominal contents through an opening at the umbilical cord. The bowel is usually covered with a membrane layer protecting it from the irritating effects of the amniotic fluid. Surgery is required to repair an omphalocele. This condition may be associated with other birth defects. It occurs in about 1 out of every 5,000 births.

Oximeter
Machine monitoring the amount of oxygen in the blood. A tape-like cuff is wrapped around the baby's toe, foot, hand or finger. Light shines through the tissues from one side of the cuff to the other. As the light passes through the finger, the light waves are altered. How much the light waves are altered depends on the amount of oxygen in the blood. This machine allows the NICU staff to monitor the amount of oxygen in the baby's blood without having to obtain blood for laboratory testing.

Oxygen
A gas normally found in the atmosphere that is essential for our bodies' metabolism. The lungs take oxygen from the atmosphere and allow it to bind to the hemoglobin in the blood. The blood then transports the oxygen to the body tissues. Extra oxygen is needed when lungs are not working well or they are immature. Poorly functioning lungs require ventilators to help them work properly.

Oxygen analyzer
Device measuring the amount of oxygen in the air. Room air is 21 percent oxygen. Increasing the amount of oxygen in the air improves the transfer of oxygen from the atmosphere to the hemoglobin in the blood and, subsequently, to the tissues.

Packed cells
A slang term for a red blood cell transfusion made up of `packed' red blood cells (PRBC). When donors give blood, the blood bank concentrates the red blood cells in a small volume of plasma. The excess plasma is saved for transfusion to those who need plasma. The concentrated red blood cells are `packed' because they are in a smaller volume of blood than they were in the donor's blood.

Packed red blood cells
Term for a red blood cell transfusion made up of concentrated red blood cells (PRBC). When donors give blood, the blood bank concentrates the red blood cells in a small volume of plasma. The excess plasma is saved for transfusion to those who need plasma. The concentrated red blood cells are called `packed' because they are in a smaller volume of blood than they were in the donor's blood.

Parenteral nutrition (hyperalimentation)
Solution put directly into the bloodstream, giving necessary nutrients, such as protein, carbohydrates, vitamins, minerals, salts, and fat. Other names for this are hyperal, total parenteral nutrition (TPN) and intravenous feedings.

Patent ductus arteriosus (PDA)
The ductus arteriosus is a blood vessel connecting the pulmonary artery and the aorta. Before birth, this vessel allows the baby's blood to bypass the lungs because oxygen is supplied by the mother through the placenta. The ductus arteriosus should close soon after birth. If it does not, it is called a patent (open) ductus arteriosus, or PDA. A PDA may be treated either with medication or surgery.

Pediatrician
Specialists in pediatrics spend at least three years after medical school studying children's health problems. Many devote additional years to subspecialize in a particular area of pediatrics such as heart, lung, or endocrine problems. Pediatricians often employ nurse practitioners or physician's assistants. These individuals work under the supervision of the pediatrician and are often an important part of a pediatric clinic.

Percutaneous umbilical blood sampling (PUBS)
Procedure in which a blood sample is withdrawn from the umbilical cord while the fetus is still within the uterus. The blood sample is used mainly to check for chromosome problems and a number of blood disorders, such as anemia or low platelet count.

Perfusion
This term often means the circulation of the blood in the skin. It can be checked by gently pressing on the skin of the chest. The skin become white as the blood is pressed out of it. The time it takes for the blood to refill the capillaries in the skin is a rough measure of how well the heart and circulatory system are working.

Perinatal
Refers to the time period after the 28th week of gestation and ending the first week after birth. Some sources extend the perinatal period until the fourth week after birth.

Perinatologist
An obstetrician who has subspecialized in the care of pregnant women and unborn babies. If you have a complicated pregnancy or one at high risk of having complications, you may be referred to one of these physicians. They are often the specialists who perform the level 2 or detailed ultrasound examination.

Periodic breathing
Irregular breathing pattern marked by pauses for as long as 10 to 20 seconds. This is common in premature and full-term babies and does not usually mean there is a problem.

Periventricular leukomalacia (PVL)
Within our brains are two small fluid-filled areas called ventricles. Cerebrospinal fluid is made within these ventricles. Periventricular tissue is just to the right and left sides of the ventricles. The tissue gets its blood supply from the arteries just before the arteries narrow down into capillaries. Because this tissue is at "the end of the row," it can be deprived of its blood supply by changes in blood pressure or the amount of oxygen in the blood supplying this area. When the periventricular tissue does not receive an adequate blood supply, the tissue may die. When the tissue dies, it leaves fluid in its place. This fluid appears as a small fluid collection called a cyst.

The cysts themselves are not a problem, but they represent brain tissue that has died and been replaced by fluid. PVL is the appearance of these cysts on an ultrasound, CT, or MRI scan of the head. The brain tissue that has been lost is important to the control of muscle movements in the legs and sometimes in the arms. PVL is often associated with cerebral palsy and other developmental problems.

Persistent fetal circulation
An obstetrician who has subspecialized in the care of pregnant women and unborn babies. If you have a complicated pregnancy or one at high risk of having complications, you may be referred to one of these physicians. They are often the specialists who perform the level 2 or detailed ultrasound examination.

Persistent fetal circulationThe circulation of blood in the fetus is somewhat different from that of the baby after birth. This transition from fetal to neonatal circulation is one of the major physiologic changes after delivery. Before birth, the lungs are collapsed and the blood pressure in the lungs is quite high. This results in a very low blood flow through the lungs. After delivery, the lungs expand the and the blood pressure in the lungs decreases.

In some babies, although the lungs expand the blood vessels in the lungs remain constricted resulting in persistently high blood pressure in the lungs. This reduces the amount of blood that the infant can pump through the lungs. This decreased blood flow through the lungs after birth is called persistent fetal circulation because it is a persistence of the pattern of blood flow normally seen prior to birth during the fetal period.

Infections, malformations of the lung or diaphragm, and lung immaturity can all cause persistent fetal circulation. This is a very serious, although infrequent, newborn problem. Several new treatments for persistent fetal circulation have been developed in the past few years and have increased survival of infants with this problem.

Pertussis
Highly contagious infection of the respiratory tract and lungs caused by Bordetella pertussis. Pertussis 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. Infants are particularly prone to severe infections. 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.

Phenylketonuria
A congenital defect in the metabolism of the amino acid, phenylalanine. Individuals with phenylketonuria (PKU) lack an enzyme, phenylalanine hydroxylase. This enzyme breaks down phenylalanine, a normally occuring amino acid. Failure to metabolize phenylalanine results in its accumulation causing severe brain injury and mental retardation.

Infants with PKU who receive early treatment of dietary restriction of phenylalanine, have a much better outcome than those who are not treated. Hence, early treatment is essential.

Children with PKU appear normal at birth and the obvious signs of the disease may not appear until brain damage has already occurred. Therefore, virtually all infants in the U.S. are tested for PKU at birth. You should ask your pediatrician for the results of this test at your first newborn check-up.

Phototherapy
Ligth therapy to treat jaundice. Certain types of light chemically change bilirubin- the cause of jaundice to a form that is much easier for the body to eliminate. Shining light on the skin of infants effectively reduces the amount of bilirubin in the baby's system. Light therapy us usually used for only a few days. As the baby's liver increases its effectiveness in removing all forms of bilirubin, the light therapy is no longer needed.

Phototherapy may sometimes be given at home if the infant is otherwise ready to be discharged.

Pitocin®
Synthetic formulation of a hormone, oxytocin, that stimulates uterine contractions and is used to induce labor or delivery. Pitocin® is a commonly used drug during labor.

Pituitary gland
A hormone-producing gland at the base of the skull. It produces hormones regulating many aspects of body function. One of the areas it regulates is ovary and testicular function. Two important pituitary hormones influencing reproduction are follicle-stimulating hormone and luteinizing hormone.

Placenta
Organ within the uterus that provides communication between mother and fetus through the umbilical cord. The placenta enables oxygen and nutrients to pass from the maternal blood to the fetus and carbon dioxide and waste products to pass from the fetus to the mother. It is disk shaped and at term weighs around 500 grams.

Placenta accreta
Abnormally deep growth of the placenta into the uterus. Placenta accreta prevents the normal placental separation from the uterus and often causes severe uterine bleeding after delivery.

Placenta previa
The placenta is abnormally positioned in the uterus near the cervix. Only when the placenta is so close to the cervix that it can get pulled away from the uterine wall can it cause problems. As the cervix starts to dilate in the third trimester, the placenta becomes disrupted and separates from the uterine wall, resulting in vaginal bleeding. If you experience any vaginal bleeding, report this to your doctor immediately. Sometimes a low lying placenta can be seen on the ultrasound and not cause any problems or move slightly farther up the uterus during pregnancy so it is not as low lying.

Pneumogram
Recording of heart rate, breathing rate, blood oxygen saturation, and air movement in and out of the lungs during sleep, often called a sleep study. It is used to identify abnormal breathing patterns and their consequences. Almost all premature infants and some full- term infants have breathing patterns that are less regular than those seen in older infants.

Polio
Polio is caused by a virus that enters the body through the intestinal tract and can extend into the blood stream. From the blood it enters, infects, and destroys the nerve cells of the spinal cord and brain stem (lower part of the brain). Paralysis and even death can result. Polio was a common, devastating disease causing life-long suffering until an effective vaccine was made widely available in the 1950s. Since then the number of polio cases has plummeted. The only polio seen now in the U.S. is associated with the oral, live virus vaccine.

Polio Vaccine
Oral Polio Vaccine (OPV)OPV contains a weakened but live version of the real polio virus. Polio vaccine virus is easily killed by a normal person's immune system and stimulates excellent immunity. However, in some children with weakened immune systems the oral vaccine can actually cause polio. This occurs in about one out of every 500,000 to 750,000 doses.

Inactivated Polio Vaccine (IPV)IPV contains killed polio virus. It stimulates immunity almost as well as the live virus but cannot cause real polio disease. Using IPV instead of OPV should prevent the 8-9 cases of vaccine-associated polio that occur each year. The inactivated vaccine must be given by injection. To reduce the risk of vaccine-associated polio, IPV is now the recommendation for starting polio immunizations.

Who Is at Risk?All non-immune children are susceptible to polio. Although there is no polio in the Western Hemisphere, it does exist in other parts of the world and has been brought to the U.S. before by visitors and immigrants. Until polio is eliminated worldwide, it is important to maintain immunity among all children.

Vaccine EffectivenessJust two doses of either the oral, live virus or the injected, killed virus vaccine stimulate immunity in more than 90% of recipients. Three doses stimulate immunity in almost 99% of recipients. Injected vaccine may prevent the rare cases of polio infection caused by giving the oral vaccine to someone with a weakened immune system.

When to Check with Your DoctorYou should check with your doctor or nurse practitioner before your child receives OPV (They may still be able to take the IPV) if he, a family household member, or other close contact:

Has a weakened immune system. Is taking long-term steroid medicine. Has cancer. Has AIDS or HIV infection. Is pregnant.

Additionally, if your child has ever experienced:A serious allergic reaction to previous OPV, he should not receive OPV. A serious allergic reaction to previous IPV, he should not receive IPV. A serious allergic reaction to streptomycin, polymixin B, or neomycin, he should not receive IPV.

Mild, Common ReactionsSoreness at the site of injection with IPV.

Rare, Severe Reactions ·Oral vaccine (OPV) ·Vaccine-associated polio in first time recipients (1 per 750,000 doses). ·Rarely, serious allergic reactions. ·Injected vaccine (IPV) ·IPV may not offer quite as much protection during a polio outbreak. ·Serious, allergic reactions are possible but have not been proven so far.

You Must Give PermissionYou must give permission. This web site information is no substitute for talking with your child's clinic personnel and reading their information sheet before your child is vaccinated. Make certain you understand the benefits and risks before you sign the permission form. You may request a copy of the permission form you are asked to sign. You may also have a copy of the vaccine package insert which has complete information on the vaccine.

What To Do If There Is a Serious Reaction 1.Call a doctor and get your child to a doctor immediately (call 911). 2.Write down what happened with the date and time of occurrence. 3.Ask your doctor, nurse, or health department to file a Vaccine Adverse Event Report form or call (800) 822-7967. 4.The National Vaccine Injury Compensation Program makes payments for persons thought to be injured by vaccines. For more information call (800)338-2382.

Polyhydramnios
Too much amniotic fluid. It may lead to enlargement of the uterus, which can, in turn, result in preterm labor.

Polyp
A growth or benign tumor developing on the inside surface of an organ such as the large bowel or uterus. Polyps in the uterus can cause irregular or heavy menstrual bleeding.

Post partum
Occuring after childbirth, or delivery.

Postnatal care
Care given to a mother after she has given birth. Usually this refers to the care given before she is released from the hospital, but can extend past discharge.

Postpartum depression
Depression occurring after delivery of a baby. Also called "baby blues."

Pre-eclampsia
A condition of hypertension, albuminuria, and edema.

Pregnancy-induced hypertension (PIH)
High blood pressure brought on by pregnancy, especially in the last three months.

Premature baby
A baby born three or more weeks before the due date. The duration of a pregnancy is measured by gestational age. Gestational age equals the amount of time elapsed since the first day of the last menstrual period. A normal gestation lasts 40 weeks or 279 days. If delivery occurs before 37 weeks gestation, the baby is considered prematurely born. About 11% of all babies are born prematurely by this definition.

Irregular menstrual periods or first trimester vaginal bleeding can confuse gestational age estimates. To improve the accuracy of gestational age estimates, somedoctors use an ultrasound examination before about 20 weeks gestation. Ultrasound findings help your doctor to confirm or correct the gestational age estimate.

Birth weight can also indicate whether a baby is born prematurely. Babies born with a weight of less than 2500 grams (about 5 ½ pounds) are considered low-birth-weight babies. Generally, infants with a birth weight less than 2500 grams are premature. However, babies can be premature but weigh more than 2500 grams at birth. They can also be born at term and weigh less than 2500 grams. There is no perfect system for categorizing infants and both measurements, birth weight and gestational age, are used.

Many premature deliveries occur close to term (see below) and these infants generally do well. Infants born more prematurely than 32 weeks gestation routinely require lengthy stays in a Special Care Nursery. These infants are also at risk for long term problems. The risk of complications accelerates as gestational age decreases. Children born 16 weeks prematurely have many-fold more complications than those born 8 weeks prematurely.

Premature labor
Onset of labor before 37 completed weeks of pregnancy. Tocolytic agents are widely used today to treat premature labor and permit pregnancy to proceed and so that the fetus can gain in size and maturity before delivery.

Premature rupture of the membranes
Rupture of the amniotic sac before labor begins. This causes a woman to lose her amniotic fluid (bag of water). Labor usually starts soon after rupture of the amniotic membranes, even if the rupture occurs before term.

Prenatal care
Care given to a woman during pregnancy to help ensure the best possible outcome for both mother and baby. Prenatal care should begin as soon as pregnancy is discovered and continue up until delivery. Prenatal visits with your doctor become more frequent as you get closer to delivery.

Prenatal tests
Tests done before birth to monitor the pregnancy and health of the fetus. Examples are ultrasonography, amniocentisis, and routine blood work. Many of these tests are screening tests that are designed to identify women at higher than normal risk of having a complicated pregnancy. Although they may give abnormal test results, it does not mean that there is something wrong with your pregnancy or fetus. It only means you have increased risk and additional definitive tests are needed.

Preterm labor
Onset of labor before 37 completed weeks of pregnancy. Tocolytic agents (medications used to inhibit labor) are widely used today to treat preterm labor and permit pregnancy to proceed so the fetus can gain in size and maturity before delivery.

Primapara
The name given to a woman who has given birth to one child, regardless of whether the child was living at birth, or was one of a multiple births.

Primary teeth
Deciduous teeth. These are the first teeth to emerge and usually appear at about 6-8 months of age. Some children have primary teeth that erupt later than 8 months.

Primigravida
The name given to a woman who is pregnant for the first time.

Progesterone
A female hormone produced by the ovary in the corpus luteum following ovulation. Progesterone prepares the uterine lining for implantation and contributes to maintaining pregnancy in the first weeks after implantation. Some scientific reports suggest some women have repeated miscarriages because they do not produce enough progesterone. However, progesterone supplementation in women with naturally low levels has not consistently been effective in preventing miscarriages.

Prolactin
A pituitary hormone important to milk production.

Prolapsed cord
Positioning of the umbilical cord ahead of the baby's presenting part during labor and delivery. When this occurs, the baby's body puts pressure on the umbilical cord which is caught between the baby and the mother's birth canal. This pressure can seriously reduce or altogether stop the blood flow through the umbilical cord.

Unless the pressure is removed through either delivery of the infant or repositioning of the infant, derious problems occur. Prolapsed umbilical cord offurs more commonly with breech than with vertex presentation.

Prolonged labor
Labor which takes an abnormally long length of time. The usual length of time in labor is longer in primiparous women and varies considerably among individuals.

Prongs
Two flexible tubes inserted into a baby's nose and extended from a cannula. They are used to give more oxygen to the baby.

Prostaglandins
A class of chemicals produced by the prostate gland and other parts of the body. They can have varied and powerful effects on the body. The chemicals were first discovered in the prostate gland, hence their name. Prostaglandins are sometimes used to induce labor or soften the cervix to induce labor.

Prozac®
One of several medications used to treat depression. Other similar medications are Zoloft® and Paxil®. These medications come from a class of medications, serotonin-specific reuptake inhibitors. They have been very effective in treating depression with fewer side effects than previously used drugs.

There have been no conclusive studies showing adverse effects of these medications on babies even when the medication is given throughout pregnancy. No conclusion can be drawn at this time about these drugs' safety except to say that they have been used extensively with no obvious problems.

As with any medication, the risks and benefits of Prozac® and similar medications should be discussed with your doctor.

Puerperium
The period of confinement during and just after labor. Technically, the meaning includes the 6 subsequent weeks after delivery. During this time the reproductive tract returns anatomically to its nonpregnant state. Within 2 weeks the uterus has descended into the pelvic cavity. After about 4 weeks it has returned to the prepregnancy size.

Pyloric stenosis
Narrowing of the pylorus (outlet) from the stomach to the small intestine. It occurs when the pyloric muscle thickens and constricts the outlet. The reason for this muscle thickening is unknown. About one in 4,000 infants are affected. It causes forceful vomiting. Surgery is needed.

Quickening
The first recongnizable movements of the fetus in utero, appearing usually from the sixteenth to the eighteenth week of pregnancy.

Racial differences affecting health
Race affects incidence of prematurity, risk of complications, certain illnesses, and survival. For example, African-American babies have a higher rate of preterm delivery, higher rate of survival, and lower risk of chronic lung disease than Caucasian babies do.

Reproductive endocrinologist
A specialist in the hormonal disorders affecting reproduction.

Respiratory distress syndrome (RDS)
Respiratory problems due to lung immaturity. Respiratory distress is a much more inclusive term meaning simply that the child is having problems breathing. Respiratory distress syndrome is a specific condiont that causes respiratory distress in newborn babies due to the absence of surfactant in the lungs.

The lungs do not completely mature until 33-37 weeks gestation. In prematurely born infants with immature lungs, there is a deficiency of surfactant. Without surfactant, the alveoli (or air sacs) collapse during exhalation. These collapsed air sacs can only be reopened with increased work of breathing. Severe cases require ventilators and breathing tubes.

Surfactant medication can be instilled into the lungs and serves as a replacement for natural surfactant until the baby starts to manufacture her own, natural surfactant.

Respiratory syncytial virus (RSV)
The most common cause of bronchiolitis in young children. Bronchiolitis is an infection of the bronchial tubes that causes rapid breathing, coughing, wheezing and sometimes, even respiratory failure, especially in the first two years of life. RSV infection and bronchiolitis is a particular risk for infants with chronic lung problems and those born prematurely.

The RSV season is usually from October to March and seems to start somewhat earlier in the southern states. RSV is spread by contact with secretions from an infected person. This can occur through an infected sibling, contact at a childcare facility or other areas where children interact.

Children at highest risk for RSV bronchiolitis should receive a special gamma globulin that reduces the severity of RSV infection. There is no good treatment for infection once it has started. A vaccine is being studied, but is not yet available.

Reticulocyte count
Blood test measuring the percentage of newly made red blood cells. The reticulocyte count measures the ability to make new red blood cells to replace those lost through laboratory sampling, bleeding or normal cell turnover.

Retinopathy of prematurity (ROP)
Scars and abnormal growth of the blood vessels in the retina of the eye. The retina is the layer of cells in the back of the eye. Think of it as the photographic film of the mind. Images captured on the retina are sent to the brain for processing. The retina does not mature until close to term (40 weeks gestation). The blood supply grows into the retina from the optic nerve during the second trimester. The optic nerve is near the center of the retina. The blood vessels grow out from the center to the edges of the eye, but they do not completely reach the far sides of the eye until close to term.

When babies are born very prematurely, the normal growth of blood vessels into the retina is altered. Instead of the normal, orderly growth of the blood vessels, a distinct line forms beyond which the blood vessels seem unable to pass at first. As the process progresses, blood vessels begin growing in an abnormal process that can eventually damage the retina and other structures in the eye. These abnormally growing vessels can eventually lead to disruption of the retina and the loss of eye function.

Fortunately, severe ROP is unusual and mostly found in extremely premature infants. Routine exams for ROP will be given to premature infants at risk starting at about the 5th or 6th week after birth. If severe ROP develops, there are treatments that can reduce or prevent the loss of vision.

Retrolental fibroplasia (RLF)
An old name for retinopathy of prematurity.

Rh incompatibility
An incompatibilty of blood types. Blood types are commmonly characterized by the ABO typing system and the Rh system. An incompatiblity between the mother and fetus in either of these systems can result in maternal antibodies crossing the placenta and destroying fetal red blood cells. The Rh system more often causes serious problems than the ABO system.

Individuals are either Rh-positive (red blood cells carry the Rh antigen) or Rh-negative. When a Rh-negative woman is pregnant with a Rh-positive fetus (Rh-positivity inherited from the father), the mother can produce antibodies against the Rh portion of the fetal red blood cells. These antibodies attack the fetal red blood cells and destroy them. Loss of the fetal red blood cells causes elevated bilirubin, decreased red blood cell count and sometimes even heart failure in the fetus. The combination of these problems can be fatal.

There are ways to treat this problem before the baby is born. More effective than treatment is prevention of the problems. Women are exposed to Rh-positive red blood cells through a previous pregnancy, miscarriage or a mismatched blood transfusion. If a Rh-negative mother has been exposed to Rh-positive red blood cells, she should receive Rho-GAM, a special immunoglobulin that destroys the Rh-positive red blood cells before they can stimulate the woman to produce antibodies against Rh-positive cells.

Room air
The air we normally breathe. It contains 21 percent oxygen. When supplemental oxygen is given for respiratory problems, it is in concentrations higher than 21 percent.

Rooming-in
An alternative rooming arrangement in postpartum units. with rooming-in the infant does not stay in the newborn nursery, but in the mother's room during her hospital stay.

Rooting reflex
An instinctive reflex in newborn infants that causes them to turn their head to the side when their cheek is stroked. This reflex helps infants learn how to eat. By gently stroking the cheek, your baby will turn his or her head toward you with an open mouth ready to feed.

Roseola infantum
Also called baby measles. A contagious disease caused by a virus. It is most common in babies and young children. Roseola begins as with a fever to 102-105ºF and is often accompanied by a loss of appetite, cough, runny nose, diarrhea, and malaise. Almost immediately after the fever disappears a spotty pink rash develops on the trunk and spreads to the arms and neck. This rash fades after about 24 hrs, as opposed to measles which has a longer lasting rash and is a much more serious.

Rubella
German measles. A viral infection with a rash that looks similar to that of measles. After the 2-3 week incubation period, a slight fever, swollen lymph glands, sore throat, aching bones, and a light rash develop. The rash begins on the face and spreads to the rest of the body.

Typically, this infection is mild. Its significance resides in its ability to cause birth defects in women who are infected during pregnancy, especially in the first 3 months of pregnancy.

Salpingectomy
Surgery to remove the fallopian tubes.

Salpingitis
Inflammation of the fallopian tubes, usually due to infection. This inflammation commonly occurs in pelvic inflammatory diseases.

Sats
Slang term for blood oxygen saturation.

Separation anxiety
Anxiety prompted by separation of the infant from his mother. The first round of separation anxiety usually begins at around 9 months of age but can start as early as 6 months or as late as 1 year. The next episode of separation anxiety occurs at 10-18 months. For some infants this passes quickly and for others it lasts 6 months or more. This is a normal phase of the child's development.

SIDS (Sudden infant death syndrome)
The unexplained death of an apparently healthy infant. SIDS or sudden infant death syndrome is a parent's worst fear. An apparently healthy infant, usually less than 12 months old, with no obvious previous or present illness is laid in bed for sleep and never awakens. Examination of the infant's medical history, home, and even an autopsy do not reveal the cause of death in true SIDS cases. This nightmare occurs in about 1 out of every 1000 births. SIDS has been the leading cause of death among infants 1 to 11 months old. Fortunately, the number of SIDS deaths has been falling over the past few years.

Infants at increased risk for SIDS are those younger than 6 months of age, those born prematurely, males, and twins or triplets. Although parents can't control these factors, research suggests there are risk factors for SIDS that parents can control.

Factors that parents can alter to reduce the risk of SIDS are:

Singleton
Refers to a single baby versus twins or triplets.

Small for gestational age (SGA)
Children who are below the 10th percentile (smaller than 90% of other infants) are considered small for gestational age (SGA). Being small for gestational age has several names, each with a slightly different implication. Some of these:

There are many causes of being SGA, and your baby's doctor should search for an explanation. This is important because some problems cause reduced growth in childhood as well. A partial list of factors that can contribute to being SGA are:

SGA babies have more problems in the newborn period such as low blood sugar and too many red blood cells. SGA babies also have a higher risk than AGA infants for being small throughout life and for having delayed development. The later in pregnancy that the fetus' growth slowed down, the more likely that catch-up growth will occur.

Social worker
Trained professional who helps coordinate social services available to families and also helps families understand and use their insurance coverage. They can help families access services available through governmental and private agencies. Many social workers also act as counselors for parents undergoing personal or family stress while their loved one is in a hospital.

Solids
Refers to solid foods. Most babies can start on solid foods at about 4-6 months regardless of whether they are bottle or breastfed. Introduce solids one at a time and wait a week before adding another new food. This gives you time to determine if your baby will have a reaction to the new food. Rice cereal, strained vegetables, and meats all make good beginner foods. Be careful not to give your baby any food that requires chewing or that could get caught in your baby's throat.

Sonogram
Another name for an ultrasound examination. See ultrasound

Spina Bifida
A developmental anomaly characterized by a defect in the bony encasement of the spinal cord. AS a consequence the nerves of the spinal cord are exposed and often damaged. This results in bladder control problems and difficutly coordinating movements of the legs. The degree to which this anomaly impairs function depends on where in the spinal cord it occurs. The higher the lesion is on the spinal cord, the more likely there is to be significant sensory and muscle dysfunction.

Taking adequate amounts of folic acid can reduce the risk of this birth defect.

Step-down unit
Patients are transferred from intensive care to this unit to continue their recovery after they are no longer acutely ill.

Stepping reflex
A reflexive movement of the leg seen in newborn infants. This lasts until about two months of age. It can be demonstrated by holding the baby in an upright position on a flat surface he or she will lift one leg in the air, then step with the other foot and "walk". Most, but not all babies exhibit this reflex. Your baby can not support his own weight at this stage of development and should never be expected to bear weight at this age.

Stillbirth
Also called fetal death. The death of a fetus while still in the uterus is defined as the birth of an infant having none of the signs of life (respiration, heart beat, voluntary movement). The leading causes of stillbirths are hemorrhage-mostly due to placental abruption, often secondary to pregnancy induced hypertension. The rate of this is about 3/1000 live births. Most occur before term and over half occur before 28 weeks.

Stranger anxiety
See separation anxiety.

Stretch marks
Also called striae distensae. Stretch marks are caused by stretched or torn areas of skin. They are quite common during pregnancy and appear most often on the abdomen, buttocks, breasts, and hips. After pregnancy they may fade and take on a normal skin color, but they never go completely away.

Surfactant
A medication used to help infants suffering from or at great risk of respiratory distress syndrome. Surfactant is a soapy material inside the lungs of adults and mature infants that helps the lung to function. Without surfactant, the air sacs tend to collapse on exhalation. Lung surfactant production is one of the last systems to mature in an infant. Prematurely born infants often lack adequate surfactant production and this causes them significant breathing problems.

Surfactant obtained from cows has been shown to be safe and effective in treating respiratory distress due to surfactant deficiency. The use of surfactant to treat respiratory problems in newborn infants is one of the most important medical advances in pediatrics in the past decade.

Synchronized ventilation
Process allowing the ventilator "breaths" to happen at the same time the patient is trying to breathe. It supports or matches the patient's breathing.

Synchronizer
Small, soft sensor attached to the infant's abdomen and certain types of ventilators that tell the ventilator when the infant is taking a breath. It helps to match ventilator support with the infant's own breathing efforts. When the baby starts to take a breath, the synchronizer triggers the ventilator to provide a ventilator breath to the infant. Other types of ventilators use sensors near the breathing tube to sense when the child is breathing in.

Temperature probe
Plastic-coated wire placed on the patient's skin and covered with adhesive plastic. The probe measures the body temperature and may regulate the amount of heat needed from a heat source, such as an overhead warmer.

Terbutaline
A medication used to treat asthma which is also used during pregnancy to reduce uterine contractions. Although not approved by the FDA for use as a muscle relaxant it is commonly used to treat premature labor.

Tertiary
Level three, usually referring to a tertiary hospital. These hospitals are major medical centers providing specialty and subspecialty care such as neonatal intensive care units. If your child is born with problems he or she will likely be transferred to an NICU at one of these hospitals, if there is not an NICU in the hospital where you deliver.

Make arrangements with your doctor ahead of time, so that if there are problems with your newborn, you know where your baby might be transferred. If you have had a complicated pregnancy you should consider delivering in a hospital with subspecialty capability for newborns. Otherwise, your baby may require an emergency transport to another hospital.

Thrush
Yeast (Candida) infection of the mouth. This occurs most often in newborns, but can also affect older babies who are taking antibiotics. Thrush resembles patches of cottage cheese on the inside of the cheek, tongue, and the roof of the mouth. This is rarely a dangerous infection, but can be uncomfortable for the infant. It is treated with mycostatin, a medicine given orally. Some resistant cases require additional medicine.

Tocolytic
Drug used to stop or slow down uterine contractions during preterm labor.

Tonic neck reflex
A newborn reflex that resembles a fencing position. When your infant's head is turned to the side, one arm will straighten, the opposite arm will bend, and often one knee will significantly bend. You won't see this if your baby is crying and this reaction usually disappears between 5 to 7 months of age. Infants vary in the degree to which this reflex is obvious.

Toxoplasmosis
A protozoal infection acquired from coming in contact with infected cat feces or more rarely,raw, infected meat. Although this is a mild infection in healthy adults, it can cause serious problems for the fetus. Toxoplasma can cross the placenta and cause miscarriage, compromised fetal growth, or other problems. If you acquire the infection before you become pregnant, there is little to worry about. You will have antibody to the infection, are unlikely to become reinfected and are very unlikely to have an affected child. Blood tests can determine whether you have had toxoplasma infection in the past.

However, if a woman acquires toxoplasma infection for the first time during her pregnancy, her symptoms will still be mild but her unborn infant may be significantly affected. Toxoplasma can severely damage a child's developing nervous system. Unfortunately, this infection may not be obvious at birth. It may appear later as learning disabilities, impaired vision, or developmental delay.

There is treatment for this infection, but it is not nearly as effective as prevention. Pregnant women should never have contact with a cat's litter box. Even after petting your cat, you should probably wash your hands.

Tracheoesophageal fistula
An abnormal opening between the trachea (windpipe) and the esophagus that forms during the fourth week after conception. When the baby tries to eat food may enter the lungs, causing choking and coughing. The baby may not be able to swallow saliva or food. Tracheoesophageal fistula is usually discovered soon after birth. Babies (slightly more males than females) are born with this condition in about 1 out of every 2,500 births. The survival rate is nearly 90 percent.

Transfusion
Treatment for anemia in which red blood cells are given by vein into the baby's circulation.

Transient tachypnea of the newborn (TTNB)
Fast breathing that slowly becomes normal. It is thought to be caused by slow or delayed reabsorption of fetal lung fluid. Before birth the lungs are filled with fluid. Some of this fluid is squeezed out as the infant travels through the birth canal, while the baby must absorb the rest during the first minutes to hours outside of the womb. In babies with TTNB, excess lung fluid reduces the lung function. TTNB is more common in babies delivered by cesarean delivery and in those who are slightly preterm.

Transverse lie
Usually referring to the position of the fetus within the uterus. Sometimes babies will become positioned horizontally across the uterus, instead of the vertical position with the head or buttocks pointing toward the cervix. Usually the fetus will orient himself properly before labor. If the baby cannot be properly oriented, a C-section may be needed.

Trimester
A third of a pregnancy. Trimesters divide pregnancy into three 13-week periods. The development and potential problems of pregnancy and the fetus vary by trimester. For example, in the first trimester your baby's heart and other organs are formed. In the third trimester your baby prepares for birth by rapidly gaining weight, vernix, and maturing vital organs such as the lungs.

Tuberculosis
A serious, bacterial infection caused by Mycobacterium tuberculosis. There are 1.3 million cases and 450,000 deaths a year from TB in the U.S. Worldwide, it is a major cause of death and disability. Tuberculosis is uncommon during pregnancy, occurring in about 1/10,000 pregnant women. It is more common in certain high risk groups such as those who are HIV-positive, foreign born persons from countries with a high prevalence, IV drug users, alcoholics, those living with someone who has tuberculosis, etc. There is a skin test that will identify those infected. It is not recommended for all women, but only those at high risk.

Tuberculosis can cause problems in the fetus such as low birthweight, however, pregnant women may also have a slightly higher risk of complications from therapy.

Tylenol®
See acetaminophen.

Ultrasound
Imaging of body parts using sound waves. Ultrasound uses sound waves that are above the range of human hearing to create an image of organs within the body. Sound waves are reflected off internal body structures and back to the ultrasound machine. The reflected sound waves are analyzed by computer and turned into pictures. This method of imaging results in less clear pictures than xrays, CAT scans or MRI. However, there is no radiation risk with ultrasound and no confirmed adverse effects on the fetus or mother from diagnostic ultrasound examinations in pregnancy.

There are different types of ultrasound exams. They are differentiated by the purpose for which they are done and the level of detail obtained.

Ultrasound can measure fetal size, the amount of amniotic fluid, estimate fetal gestational age, identify multiple fetuses, some fetal abnormalities such as microcephaly or Down Syndrome, and locate the location of the placenta. Although an ultrasound can usually determine gender of your baby, many families do not want to know this informatin before delivery and some ultrasound centers have a policy of not revealing the gender.

Umbilical arterial catheter (UAC)
Catheter (small tube) placed in a belly button artery. It is used to check blood pressure, draw blood samples and give fluids.

Umbilical cord
The baby's lifeline from the mother during pregnancy. The umbilical cord is formed during the fifth week of gestation and connects the fetus' circulation with the mother's placenta. Through this vascular structure, the fetus receives nutrients, such as oxygen, glucose, and protein. . When the baby is born the cord is about 2 feet long and 1/2 inch thick.

The umbilical cord is clamped and cut shortly after birth. It will turn black within the first few days and should protrude about an inch or less. It will fall off within about 2-3 weeks. It is important to care for the umbilical stump to ensure proper healing. Fold diapers below the stump to expose it to air and keep it dry. Cleaning should be with a cotton swab and alcohol. The ideal time to do this is just after changing a diaper. If you notice that the skin around the stump has turned red or if the cord is oozing, call your doctor.

Umbilical hernia
A hernia at the umbilicus (See hernia.). Hernias are a protrusion of tissue through an abnormal opening. Normally, the abdominal wall is formed by two sheets of muscle that run along both sides of the abdomen. When these sheets of muscle incompletely fuse, it permits part of the bowel to protrude up through the muscle sheets at the level of the umbilicus or belly button. As the infant grows, the muscle layers increase and gradually fuse eliminating the hernia. This is one of the few hernias which often resolves on its own. Occasionally, surgical correction is required.

Umbilical venous catheter (UVC)
Catheter (small tube) placed in the belly button vein. It is used to give the infant fluids and medications.

Umbilicus
Belly button. This is the scar where babies were attached to the umbilical cord when they were in the womb.

Uterus
Also called the womb. The uterus is the organ that houses and protects the fetus during pregnancy. The uterus grows and expands with your baby's growth. Your doctor will measure this growth during prenatal visits. The uterus also helps the fetus leave the womb through contractions. It will take several weeks to months after delivery for your uterus to regain a normal shape and size following delivery.

Vaccine
See immunization.

Vacuum extraction
The application of a suction cup to the head for helping deliver the infant. This technique performs a similar function as forceps and helps the baby to descend through the birth canal. The vacuum extractor has a soft plastic cup attached to a tube and suction pump. The cup is inserted into the birth canal and attached to the baby's head by suction. Increasing the suction causes a vacuum an the handle of the cup can be used to pull the baby out of the birth canal. The vacuum extractor is more gentle and less damaging to the mother's soft tissue than forceps. However, there are risks with the vacuum extraction. Excessive suction or traction can cause injury to the mother or baby. There is also a limit on the number of pulls that should be made with the suction device attached.

Vaginal birth
Delivery of the infant through the birth canal, of which the vagina is a major component. The alternative method would be an operative delivery (cesarean section).

Vaginal birth after cesarean (VBAC)
A vaginal delivery after a previous cesarean delivery. One of the most common reasons for cesarean sections is the presence of a uterine scar from a previous cesarean section. A previous uterine scar can tear or open up during a hard labor with a subsequent pregnancy. For many years it was thought that once a cesarean, always a cesarean. This is not so. If the incision from the previous cesarean section has been performed low on the uterus, the scar is often sufficiently strong to withstand labor.

The advantages of a VBAC are decreased risk of surgical complications and a shorter recovery period. However, a VBAC is not possible for everyone. The type of incision previously made is one important determinant. For example, if you had a classical incision through the uterus, which is high up on the uterus, an attempted vaginal birth would not be a good idea because there of the risk of uterine rupture during labor. Multiple fetuses, medical complications such as high blood pressure or abnormal fetal position may all require a cesarean section and prevent a VBAC trial. If a VBAC is attempted you will need fetal monitoring and IV in case a section becomes necessary.The risk of uterine rupture is low, but if it occurs, the consequences can be severe for both the mother and the baby

Varicella
The medical name for chicken pox. 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 scaring 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.

Varicose veins
Dilation of veins, usually in the legs, due to rupturing of the small valves in veins that keep blood from pooling in the vein. Many pregnant women experience distended, enlarged veins on their legs. The enlarging uterus puts pressure on the major veins of the pelvis slowing the blood flow through them and causing back pressure on the other veins such as those of the leg. This is also the reason that hemorrhoids sometimes occur during pregnancy. The severity of varicose veins varies from person to person and may be inherited. Some women hardly notice their varicose veins and for others they are painful requiring treatment. Treatment includes wearing support hose, elevation of the legs above the heart, resting, wearing flat shoes, not crossing your legs, and staying off your feet as much as possible.These all aid circulation in the legs which ultimately is the only thing that will help varicose veins. Although they might not disappear after pregnancy they should get better.

Vasa previa
A rare condition in which the baby is coming down the birth canal with the umbilical cord first. This is a dangerous condition since the umbilical vessels often become pinched off as they are compressed between the baby and the walls of the birth canal or the vessels may be ruptured.

Ventilator
A machine that assists adults or children to breathe. This most often refers to newborn infants who sometimes have breathing problems so severe that they need help from a breathing machine. If your baby was born with lung problems or didn't breathe on his own he may be connected to a ventilator. Lung immaturity in prematurely born infants is the most common reason for a newborn to require a ventilator.

Vernix
Also called vernix caseosa. A cheesy, white substance covering a baby's skin at birth. The vernix is secreted by the sebaceous oil glands around the 20th week to protect the baby's skin from the amniotic fluid. Without the vernix, the baby would have very wrinkled skin from the constant exposure to the watery amniotic fluid. The amount of vernix present decreases toward the end of gestation. Remaining vernix is washed off after birth. The loss of vernix may cause the skin to peel during the first week after birth.

Vertex presentation
Vertex presentation position of the baby in the uterus, in which the baby's head enters the birth canal first. This is the most common and desirable position for birth.

Very low birth weight (VLBW)
A birthweight of less than 1,500 grams. Babies with such a low birth weight are almost always very prematurely born. About 1.3 percent of all births result in babies with a birth weight of less than 1,500 grams.

Viable
Able to survive. Refers to the condition of a newborn.

Vital signs monitor
Machine measuring and displaying heart rate, breathing rate, and blood pressure on a computer screen. If these vital signs become abnormal, an alarm usually sounds.

Warmer
Bed for a sick baby--usually undressed except for a diaper. Radiant heaters above the bed keep the baby warm. A warmer allows maximum access to a sick baby.

Web
Blockage of the lumen (internal canal) of the bowel. The blockage occurs when a film of membranous tissue grows into the center of the intestine. Webs are commonly seen in the duodenum, where the small bowel and the stomach meet. This would be called a duodenal web. A web also may be seen in the larynx (voice box).

Well-child care
Ongoing health care for normal babies. The goal is to detect potential problems early and to give advice on prevention of accidents and illness. The first well-child exam will take place about 1 to 2 weeks after delivery. Additional visits and exams should occur at 2 months, then at 4, 6, 9, 12, 15, 18, 24 and 36 months. Then child should also be examined before kindergarten and before junior high school.

During the first exam, the doctor or nurse practitioner will ask about the baby's sleeping and eating; measure weight, length, and head circumference; check vision and hearing; and perform a general physical exam. The doctor will check the heart, abdomen, hips, arms, feet, spine, eyes, ears, nose, mouth, throat, thyroid and lymph glands, soft spots on the baby's head, breathing and lung function, skin, genitalia, reflexes, and behavior.

Later visits include immunizations, discussions of normal childcare issues, and a brief physical exam. This is your chance to ask questions about your child's health and development. If you have concerns, they should be mentioned at this time. It is a good idea to take notes and ask questions so you can share what you learn with other family members.

Whooping cough
See pertussis.

Zygote
The name for the fertilized ovum during the first two weeks after conception. After this stage, the fertilized ovum is called an embryo.