Updated April 2014, next review April 2017

Your premature baby's time in hospital

Breathing support for premature babies

Many premature babies need help with breathing for a while. This is known as ventilation.

Until your baby is born, her lungs are filled with a liquid that helps them grow and develop. During labour and birth this fluid is absorbed so that after birth she can take in the surrounding air. Premature babies are at high risk of developing breathing problems because their lungs are not yet mature enough to make this switch without some extra help.

The healthcare team will aim to use a ventilation (breathing) strategy that is as gentle as possible, because in some cases artificial breathing machines (ventilators) can cause lung problems such as bronchopulmonary dysplasia (see below).

Types of ventilation support on the baby unit

Mechanical ventilation through an endotracheal tube (intubation)

Premature baby getting oxygen through CPAP (continuous positive airway pressure)

A plastic tube is inserted through the nose or mouth into the windpipe and air or an air–oxygen mix is blown in and out of the lungs under pressure. The machine does most or all of the breathing for the baby.

Continuous positive airway pressure (CPAP)

Short prongs or a mask are positioned by the nostril or nose, and air or oxygen is blown in at a constant pressure. Your baby does all of her own breathing, but the machine helps keep the lungs open in between breaths.

Nasal prong oxygenPremature baby getting oxygen through a nasal prong

A pair of small prongs is used to deliver extra oxygen through the nostrils. This option is used when the baby does not need pressure to keep the lungs open, but needs a little extra oxygen to maintain sufficiently high oxygen levels in her bloodstream. A modified version of this is called Vapotherm, which allows higher levels of oxygen to be delivered through prongs, and works in a similar way to CPAP (above).

Incubator oxygen

It is possible to control the oxygen level in most incubators. This is another way of adjusting the amount of oxygen that your baby breathes.

Newborn respiratory distress syndrome (RDS)

Respiratory distress syndrome occurs commonly in premature babies because their lungs are structurally immature and they lack of a substance called surfactant. Surfactant is a lubricant that is produced by the lungs and covers the inner lining of the breathing sacs. In large enough quantities, surfactant prevents the lungs from collapsing at the end of each breath. Without surfactant, it is hard for the baby to take in oxygen, and this can result in a range of serious health problems.

To help prevent RDS, the team will put some surfactant into the baby's lungs in tiny quantities, through a tube that goes down the windpipe. After the treatment, they will keep a close eye on how well your baby is breathing and alter the support from whichever breathing machine is used as necessary.

Giving corticosteroids to the mother during pregnancy, and giving surfactant to the newborn baby, greatly reduces the risk of a range of lung and breathing-related conditions for the baby.

Breathing issues/problems in premature babies

Challenges your premature baby may face when taking in oxygen:

Apnoea

Pronounced 'ap-nee-ya', this is the term for episodes when a baby stops breathing. Premature babies will often stop breathing, or breathe very shallowly, for 5–10 seconds, before resuming normal breathing – this is known as periodic breathing.

True apnoea is defined as episodes that last more than 20 seconds. This often happens because the breathing centre of the brain has not yet matured. The healthcare team will probably recommend either caffeine treatment, which stimulates the breathing centre, or support with a ventilator. Studies suggest that most babies will have overcome apnoea by 37 to 40 weeks corrected age. However extremely premature babies may not achieve this until 43 weeks corrected age.

Bradycardia

During an episode of apnoea (see above), some babies' heart rates may drop (called bradycardia).

Cyanosis

This term refers to a bluish skin tone, caused by a lack of oxygen. This happens because blood that is low in oxygen is blue-purple, while oxygen-rich blood is bright red. In dark-skinned people, cyanosis may be more noticeable in the lips, tongue or nail beds.

Nasal flaring

If your baby's nostrils open widely or flare out, this could be a sign that she is having to work hard to breathe.

Recession

If your baby's airways aren't fully open she may suck in the centre of her chest to breathe. When this happens, you may notice a dip between the ribs.

Rapid breathing

This problem, known as tachypnoea, is often a sign of distress. Your baby's team will examine her and may carry out investigations to determine the cause and appropriate treatment.

Bronchopulmonary dysplasia (BPD)

This condition, formerly known as chronic lung disease of infancy, is the diagnosis given to babies who need extra oxygen at 36 weeks corrected age. The more premature the baby, the more common BPD is. It may be made worse by artificial ventilation, which may be used in the early weeks of life to improve the baby's chance of survival but can cause scarring or inflammation in the baby's lungs.

A baby with BPD may go home on oxygen and some will need to continue this therapy for several months, or even years. If this happens, you will be supported by specialist nurses in the community.


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Sources

ADAM Medical Encylopedia (accessed Sept 2011) Bronchopulmonary dysplasia, PubMed Health, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002079/

Rodriguez RJ, Martin RJ, Fanaroff AA (2002) Respiratory distress syndrome and its management ed. Fanaroff and Martin in 'Neonatal-perinatal medicine: Diseases of the fetus and infant', St. Louis, Mosby

Seger N, Soll R (2009) Animal derived surfactant extract for treatment of respiratory distress syndrome, Cochrane Library, Cochrane Neonatal Group, Wiley Online Library

Speer CP (2011) Neonatal respiratory distress syndrome: an inflammatory disease?, Neonatology, Vol 99, No 4, p316-9

ADAM Medical Encylopedia (accessed Sept 2011) Apnea of prematurity, PubMed Health, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004488/

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'The breathing was the biggest issue. It wasn't improving and they were anxious to get her off the breathing support as it was damaging her lungs. Then something happened – she turned a corner and graduated onto CPAP. And that very dark time passed. They said she'd probably have to go home on oxygen and I said, "I can't cope with that". But then two weeks later, she came off oxygen too, and was discharged. It was an incredibly quick turnaround at the end.'

DEBBIE

'She was on every ventilator known to man. She started on the oscillating ventilator, then went onto a conventional ventilator. Then she went onto CPAP, but always had to come off and go back onto the ventilator. It was very stressful, but every time she moved up, I felt like "Yay! Another promotion!"'

DIANE