DIAGNOSIS

After your premature baby is moved to the NICU, he or she may undergo a number of
tests. Some are ongoing, while others may be performed only if the NICU staff suspects
a particular complication.

Diagnosis of Premature Infants

 Obstetric history and postnatal physical parameters
 Fetal ultrasonography
 Screening tests for complications
When periods are regular and recorded contemporaneously, the menstrual history is
relatively reliable for establishing gestational age. Ultrasonographic measurements of
the fetus in the 1st trimester give the most accurate estimate of gestational age.
Ultrasonographic estimates are less accurate later in pregnancy; 2nd and 3rd trimester
ultrasonographic results should rarely be used to revise those done during the 1st
trimester. After delivery, newborn physical examination findings also allow clinicians to
estimate gestational age, which can be confirmed by the new Ballard score.

Along with appropriate testing for any identified problems or disorders, routine
evaluations include pulse oximetry, complete blood count, electrolytes, bilirubin level,
blood culture, serum calcium, alkaline phosphatase, and phosphorus levels (to screen
for osteopenia of prematurity), hearing evaluation, cranial ultrasonography (to screen for
intraventricular hemorrhage and periventricular leukomalacia), and screening by an
ophthalmologist for retinopathy of prematurity. Weight, length, and head circumference
should be plotted on an appropriate growth chart at weekly intervals.

As with older neonates, routine newborn screening tests are done at 24 to 48 hours of
age. Unlike full-term infants, premature infants, especially extremely preterm infants,
have a high rate of false-positives (1). Mild elevations of several amino acids and
abnormal acylcarnitine profiles are common and slight elevations of 17-
hydroxyprogesterone levels and low thyroxine (T4) levels (typically with normal thyroid-
stimulating hormone levels) are often present. Extremely preterm infants and very
preterm infants are at risk of a delayed presentation of congenital hypothyroidism and
should be periodically screened.

X-rays, often obtained for other reasons, may provide evidence of osteopenia and/or
unsuspected fractures. DXA scanning and quantitative ultrasonography scanning may
detect osteopenia but are not n widespread use.
LABORATORY EXAMINATION

Possible tests for your premature baby may include:

Examination Analysis
Your baby's breathing and heart rate are monitored on a continuous basis. Blood pressure readings are
Breathing and heart done frequently, too.
rate monitor.

The NICU team carefully tracks how much fluid your baby takes in through feedings and intravenous
fluids and how much fluid your baby loses through wet or soiled diapers.
Fluid input and
output.

Blood samples are collected through a heel stick or a needle inserted into a vein to monitor a number of
critical substances, including calcium, glucose and bilirubin levels in your baby's blood. A blood sample
may also be analyzed to measure the red blood cell count and check for anemia or assess for an
infection.
Blood tests.
If your baby's doctor anticipates that several blood samples will be needed, the NICU staff may insert a
central umbilical intravenous (IV) line, to avoid having to stick your baby with a needle each time blood is
needed.
 This test is an ultrasound of the heart to check for problems with your baby's heart function. Much like a
Echocardiogram fetal ultrasound, an electrocardiogram uses sound waves to produce moving images on a display
monitor.

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

An ophthalmologist (eye doctor) may examine your baby's eyes and vision to check for problems with
Eye exam the retina (retinopathy of prematurity)