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
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.
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.
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 best thing you can do for your baby is to look after yourself. That way, you will be better equipped to handle the challenges that face you and your family. Help is at hand from many sources - family, friends and the healthcare team in the special care baby unit - so don't be afraid to ask for what you need.
The neonatal intensive care unit (NICU)/special care baby unit (SCBU)/neonatal unit becomes the centre of the universe for parents of premature babies, so it's important to familiarise yourself with the way it operates.
The first few days after giving birth to your premature baby can pass in a daze. Here's what to expect...
If your baby is very young and very sick, he may need to be transferred to another hospital with specialist facilities. This might be done before he is born or just afterwards.
Whatever your premature baby's birth was like, it will have taken a lot out of you, so try to rest and gather your strength for the days ahead. The medical team will assess your baby's health and start treating him if necessary.
Skin-to-skin contact with your premature baby is a wonderful way for you both to bond. It also provides health benefits.
The healthcare team will cater for your baby's medical needs, but she needs you too. As you get to know your premature baby, you will begin to work out what she needs.
Your premature baby's diet will be carefully balanced to suit their tiny digestive system while meeting the needs of their growing body.
Positioning your premature baby correctly can make them feel secure, improve their breathing ability, strengthen their muscles and reduce the risk of cot death.
You may be asked if you would consider taking part in research into premature birth. We explain what this might involve.
We answer some of your questions about your premature baby's time in the hospital and neonatal unit.
You're bound to feel anxious if your premature baby needs surgery, but try to focus on the positive: the operation is likely to help improve your baby's chances.
During their stay in the baby unit, your baby will have all kinds of checks to monitor their progress.
If your premature baby has any of the conditions below, ask the healthcare team to explain anything that you don’t understand.
Babies born prematurely are more likely to have problems with their eyesight and hearing, but in most cases treatment is successful.
It's worrying if you discover that your baby has a heart problem, but most defects are treatable and some do not even need treatment.
- 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/
ℹLast reviewed on April 1st, 2014. Next review date April 1st, 2017.