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)


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:


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.


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


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.


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


  1. ADAM Medical Encylopedia (accessed Sept 2011) Bronchopulmonary dysplasia, PubMed Health,
  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,
Hide details

Last reviewed on April 1st, 2014. Next review date April 1st, 2017.

Was this information useful?

Yes No


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

    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
    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.
    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?

Add new comment