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)

prembaby1

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 oxygen

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).

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), also known as chronic lung disease

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.

The baby unit

Caring for your baby

  • Mother holding baby to her chest.

    Kangaroo care

    Skin-to-skin contact with your premature baby is a wonderful way for you both to bond. It also provides health benefits.

  • Mother holding premature baby.

    Caring for your baby: your role

    You will play an important part in your premature baby's care, even while they are in the NICU.

  • Premature baby using feeding equipment.

    Feeding your premature baby

    Your premature baby's diet will be carefully balanced to suit their tiny digestive system while meeting the needs of their growing body.

  • Premature baby in incubator.

    Positioning your premature baby

    Positioning your premature baby correctly can make them feel secure, improve their breathing ability, strengthen their muscles and reduce the risk of cot death.

Treatment and medical support your baby may have

Sources

  1. ADAM Medical Encylopedia (accessed Sept 2011) Bronchopulmonary dysplasia, PubMed Health, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002079/
  2. 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
  3. Seger N, Soll R (2009) Animal derived surfactant extract for treatment of respiratory distress syndrome, Cochrane Library, Cochrane Neonatal Group, Wiley Online Library
  4. Speer CP (2011) Neonatal respiratory distress syndrome: an inflammatory disease?, Neonatology, Vol 99, No 4, p316-9
  5. ADAM Medical Encylopedia (accessed Sept 2011) Apnea of prematurity, PubMed Health, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004488/
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Last reviewed on April 1st, 2017. Next review date April 1st, 2020.

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Comments

  • By Ada (not verified) on 22 Sep 2018 - 04:21

    Hi
    I am Ada my baby was born at 29 weeks. She was on oxygen for 3 days after birth then oxygen was removed. Now she is 31 weeks back to Oxygen I hope my little girl is ok.

  • By Midwife @Tommys on 24 Sep 2018 - 12:44

    I hope so too Ada. We wish her all the best as she goes through the next few weeks. We hope that our information has given you some support and encouragement. Take care

  • By Venolen (not verified) on 29 Aug 2018 - 13:35

    Hi my wife went in to early labour at 29 weeks..she had to undergo an emergency c-section,,baby is only 13days only today..and they have oxygen on him to help with breathing. They say the machine is set on low so will there be a need to have oxygen at home wen baby gets discharged

  • By Midwife @Tommys on 31 Aug 2018 - 14:05

    Hi Venolen,
    They will not discharge the baby home until they are happy with their breathing, if the baby stills needs oxygen then they will stay in the hospital. The only exception would be if the baby has a long term condition where they will need oxygen however they would discuss this with you prior to discharge.
    I hope your wife and baby are doing well.
    Best wishes
    Tommy's midwife

  • By Lelo (not verified) on 11 Aug 2018 - 04:43

    My baby was born at 28 weeks and was breathing through oxygen till the 6th day she couldn't breath kept on breathing n stopping she was on machine that helps her to breath and have orange brownish urine with lil blood . What's wrong with my baby and what are her chances

  • By Midwife @Tommys on 13 Aug 2018 - 16:39

    I am sure that your baby is in the best hands. The baby doctors will be the best people to ask about her chances. Please don't be scared to ask. We wish you both all the best. Take care x

  • By christie (not verified) on 26 Jul 2018 - 15:04

    my baby girl was born 36 weeks with congenital anomaly. one ear seem fine but the other is partially missing. she has been on oxygen. we ran several tests which came out fine but she is still on oxygen 4days now. I'm so worried. she weighed 2.95kg at birth

  • By Midwife @Tommys on 27 Jul 2018 - 12:34

    Hi Christie,
    I am sorry to hear that your little girl is unwell and needing support, sounds like a confusing and difficult time at the moment. Please do be in touch with us if we can support you. I hope she is better soon.
    Best wishes
    Tommy's midwife

  • By Afifa Wasif (not verified) on 25 Jun 2018 - 21:11

    Hi,my son born in 27 weeks ,on ventilation than on cpap and now we take him home after 3 months in hospital he is in home vth 0.05 oxygen,frim the last 3 weeks his situation is same ,plz tell me when he can bretge on his own as his saturation level drops up to 86 to 87 without oxygen.

  • By Midwife @Tommys on 28 Jun 2018 - 10:35

    Thank you for your message and congratulations on the birth of your baby boy.
    Its difficult to say when he can breathe without oxygen as each baby is individual and some take longer than others before they are ready. I have attached 2 links with more information for you-

    https://www.tommys.org/pregnancy-information/pregnancy-complications/premature-birth/your-babys-time-hospital/breathing-support-premature-babies

    https://www.tommys.org/pregnancy-information/pregnancy-complications/premature-birth/taking-your-baby-home/helping-your-baby-breathe-home
    I appreciate that this is a difficult time for you and your family; please be guided by advice from your baby's hospital and community support teams as they will advise when he is ready to breathe without extra oxygen
    Take care
    Tommy's Midwife

  • By Anonymous (not verified) on 23 Jun 2018 - 21:43

    my daughter was born at 24 weeks 1 day
    she is now 29 weeks 6 days corrected age and she is still on the ventilator. Her tracheal tube was suctioned a it was blood tinged. The doctor decided to give her platelets and change the settings on her vent. Should I be worried? Has anyone gone through this and their baby recovered? Thanks

  • By Midwife @Tommys on 25 Jun 2018 - 16:15

    This is such a difficult time for any mother. I am sure that your baby is in safe hands and the doctors will do everything possible to ensure a healthy outcome. If she has low platelets she will be at increased risk of a bleed. A transfusion of platelets would decrease this risk. Please try to ask the nurse who is caring for your little one to explain what is happening and how long they expect her to be on the ventilator. We wish her and you all the best. Take care Tommy's midwives x

  • By Amna (not verified) on 9 Jun 2018 - 20:19

    Hi I Am Amna my baby boy born 34+week after he born the Dr take him in ventilator he take a life for only 6 days and he's gone he can't survive his life

  • By Midwife @Tommys on 11 Jun 2018 - 14:57

    So very sorry Amna. Please take good care of yourself. I hope you have the support of your family at this very distressing time. We at Tommy's wish you all the best. Tommy's midwives x

  • By Abdul Shahbaz a... (not verified) on 27 Mar 2018 - 20:10

    Hi everyone my baby birth in 32 weeks 5 days he is in the hospital on ventilator.and docter say every time one new things there is air in his lungs infection in the stomach now they tell me need blood transfusion .can any body having like this problem and how much it takes to recover a baby . Please advise iam two worried pray for my baby

  • By Midwife @Tommys on 28 Mar 2018 - 10:08

    Dear Abdul, I am sorry that your baby boy is unwell. I am sure that the doctors and nurses are caring perfectly for him. The ventilator will help him to breathe until he has cleared the lung infection and is able to do this on his own. We wish him all the best for a speedy recovery. Take good care of yourselves. Tommy's midwives

  • By Krunal Asher (not verified) on 10 Mar 2018 - 02:32

    Hi everyone.. My baby girl is experiencing breathing problems after birth and she is on ventilator right now.. Dr says we need to wait for 48-72 hrs..pls pray for her and let me know if neone has come across such an incident..

  • By Midwife @Tommys on 12 Mar 2018 - 10:32

    Hi Krunal, So sorry to hear that your baby girl is so unwell. We hope that she improves quickly and that you will be able to hold her in your arms very soon. Sending lots of love from Tommy's midwives.

  • By Khan (not verified) on 10 Feb 2018 - 17:33

    Born in 28 weeks only 1kg weight and doctor sugessting to put the baby on cpap machine,, what is u r opinion and how long it will take time to recover

  • By Midwife @Tommys on 14 Feb 2018 - 09:29

    Hi Khan.
    I am sorry to hear that baby arrived earlier than planned for you. I know that the Nurses and Dr's in NICU will be caring perfectly for little one. Continuous positive airway pressure (CPAP) therapy uses a machine to help a baby breathe more easily. A CPAP machine increases air pressure in the throat so the airway does not collapse when breathing in. It is a commonly used piece of equipment in the NICU. The best people to ask this question to, is the nurses and Dr's looking after baby as they will know the full medical factors and history of mum and baby. This will provide a much more detailed answer to your question. I am sorry that my answer does not immediately answer your question.
    Please take care and sending love to your little one.
    Sophie, Tommy's Midwife

  • By Srishti (not verified) on 25 Feb 2018 - 12:35

    My niece is in the same situation. What's the progress with your baby?

  • By Hafsa Alam (not verified) on 10 Feb 2018 - 17:00

    My sister's baby is born in 31 weeks and he is now hospitalise in a ventilator as he is dealing with breathing problem.... So what's the probability of him staying alive?

  • By Midwife @Tommys on 14 Feb 2018 - 09:24

    Hi Hafsa Alam
    I am so sorry to hear that your sisters baby was born prematurely. I hope that baby is doing well, i know the care will be amazing as NICU staff care so much for their little ones and work so hard to get them 100% healthy before they are discharged home. The best people to ask this question to, is the staff caring for your sisters baby. They will know the full medical history and be able to comment how baby is doing individually. I am sorry i am not able to fully answer your question.
    Please take good care of yourself
    Sophie,Tommy's Midwife

  • By Midwife @Tommys on 12 Sep 2017 - 12:34

    Hello,
    Thank you for posting. I'm sorry that your little boy has been born so early. You have a lot to deal with right now, both recovering from his birth and being a Mum to a very premature baby who will need to spend a long time in hospital.
    I am not able to answer this question but I think visiting the website Bliss- for babies born premature or sick might give you more information and you could also call them on 0808 801 0322
    http://www.bliss.org.uk/ventilation
    I hope that his condition as the next few days and weeks unfold will give you the opportunity to speak with his nurses and doctors and ask all the questions that you have as a new parent.
    We have a free Prematurity App that I hope might be useful to you.
    https://www.tommys.org/pregnancy-information/pregnancy-complications/premature-birth/free-app-parents-premature-babies
    With love and best wishes to you and your Family
    Anna-Tommy's Midwives

  • By Anonymous (not verified) on 12 Sep 2017 - 08:56

    My baby is born 23 weeks and now he is hospitalise in ventilator ....Due to problem in breathing...
    How much period he will have in ventilator?

  • By Anonymous (not verified) on 21 May 2018 - 12:25

    Until he can breathe his on his own.,ventilation is very helpful for pre rterm baby.,

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