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Breathing support for premature babies

Some premature babies having breathing problems they are born. If this happens, the hospital staff will work with you to make sure they have the best care.

The information below describes the main types of breathing problems premature babies can have. Find out more about the types of breathing support on the baby unit. The healthcare team will explain which type of breathing support your baby needs and why.  

Breathing conditions

Newborn respiratory distress syndrome (NRDS)

Newborn respiratory distress syndrome causes breathing problems, especially in premature babies. It happens when the baby’s lungs haven’t developed enough to be able to take in enough oxygen. 

Babies in the womb start to produce a substance called surfactant, which helps to keep the lungs inflated and stops them collapsing at the end of each breath. Most babies’ lungs have produced enough surfactant by 34 weeks of pregnancy. But if your baby is born prematurely, they may not have enough surfactant to breathe without help.

Babies with NRDS may: 

  • have blue skin, lips, tongue or nail beds
  • have shallow, rapid breathing
  • flare their nostrils
  • make a grunting sound when they breathe.

If your baby has NRDS, the healthcare team may put a small amount of surfactant into their lungs through a thin tube that goes down the windpipe. After the treatment, they will keep a close eye on how well your baby is breathing and give them any help they need using the breathing support systems described above.

If you’re at risk of giving birth before 34 weeks of pregnancy, your healthcare team may offer you steroid injections to help your baby’s lungs develop.  

You can read more about newborn respiratory distress syndrome.

Bronchopulmonary dysplasia (BPD), also known as chronic lung disease (CLD)

Some premature babies develop lung damage, called BPD. This happens when the baby’s lungs haven’t had time to develop properly and they needs extra oxygen for at least 28 days after birth to help them breathe. 

Babies may be more likely to develop BPD if they: 

  • are very premature
  • have a low birth weight
  • are small for their age
  • need to be resuscitated after birth
  • need mechanical ventilation.

If your baby needs ventilation, the healthcare team will do everything they can to reduce the risk of BPD. They will use the most gentle ventilation possible to make sure your baby gets enough oxygen.  

Some babies at high risk of BPD may be given steroids during their neonatal stay to help them breathe independently without ventilatory support.  If the healthcare team think steroids may help your baby, they will talk to you about the benefits and risks. The dose and timing of these steroids will vary from unit to unit and will depend on your baby’s medical situation.

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

Apnoea of prematurity

Sounds like 'ap-nee-ya'. This is a common condition where a baby may pause their breathing for a variable amount of time. Some babies may have apnoea together with bradycardia (a slow heart beat) or cyanosis (see below). 

The healthcare team may recommend caffeine treatment to help reduce or treat apnoea. As your baby gets older, they are less likely to have apnoea. 

Cyanosis

This is when a baby’s skin, lips, tongue or nail beds have a blue tinge if there’s not enough oxygen in their blood.   

Recession

Babies who are having trouble breathing may suck in their chest with each breath. When this happens, you may notice a dip between or underneath the ribs. This is recession. 

Tachypnoea

Sounds like ‘tack-ip-knee-a’. This means rapid breathing. 

What does this mean for my baby?

If your baby has any of these breathing conditions, the hospital staff will work with you to make sure they have the best possible care. 

Don’t be afraid to ask the staff any questions you need to that will help you understand what is happening. This will help you make informed decisions about your baby’s care. Be involved with as much, or as little, as you feel comfortable with.

Find out more about your role in caring for your premature baby.

Wyllie J, Ainsworth S, Tinnion R (2015) Resuscitation Council Guideline: Resuscitation and support of transition of babies at birth. www.resus.org.uk/resuscitation-guidelines/resuscitation-and-support-of-transition-of-babies-at-birth/

Sweet DG et al (2019) European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2019 Update. Neonatology 2019; 115(4): 432–450.

NHS. Newborn respiratory distress syndrome. https://www.nhs.uk/conditions/neonatal-respiratory-distress-syndrome/ (Page last reviewed: 19 March 2021. Next review due: 29 March 2024)
  
Pammi M (2020) Premature newborn care. BMJ Best Practice. https://bestpractice.bmj.com/topics/en-gb/671/pdf/671/Premature%20newborn%20care.pdf

NICE (2019) Specialist neonatal respiratory care for babies born preterm. NICE guideline 124. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/ng124
  
Doyle LW et al (2017) (> 7 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants. Cochrane Database of Systematic Reviews 2017; Issue 10. Art. No.: CD001145. DOI: 10.1002/14651858.CD001145.pub4.

Ballout RA et al. (2017) Body positioning for spontaneously breathing preterm infants with apnoea. Cochrane Database of Systematic Reviews 2017; Issue 1. Art. No.: CD004951. DOI: 10.1002/14651858.CD004951.pub3.

MSD Manual. Apnea of Prematurity. https://www.msdmanuals.com/professional/pediatrics/respiratory-problems-in-neonates/apnea-of-prematurity (Page last reviewed: October 2019)
  
Moschino L et al. (2020) Caffeine in preterm infants: where are we in 2020? ERJ Open Res. 2020; 6(1): 00330-2019.

Macdonald S, Johnson G (2017) Maye’s Midwifery 15th edition. Elsevier, London.

Baston H, Durward H (2017) Examination of the newborn: a practical guide 3rd edition. Routledge, Oxon.