Respiratory Support for Premature Babies

Breathing difficulties are one of the most common health problems in premature babies. Fortunately, advancements in technology have allowed most preterm babies to achieve full health with the use of breathing support systems in neonatal intensive care units (NICUs).

Causes of Breathing Difficulties in Preterm Infants

Breathing difficulties develop in premature babies because their lungs don't have the chance to reach full maturity in the womb. As a result, they can experience any number of complications resulting from an immature respiratory system.

Among the most commonly seen conditions:

• Respiratory distress syndrome (RDS) is a disorder caused by the lack of surfactant in the lungs. These are the substances that allow the muscles of the lung to smoothly expand and contract. Without it, breathing becomes impaired.
• Bronchopulmonary dysplasia, a chronic lung disease, is commonly seen in preemies who weigh less than 2.2 pounds (one kilogram) at birth. It can be caused by the long-term use of oxygen and mechanical respiration.
• Apnea is a condition characterized by prolonged pauses in breathing that lead to an abnormal slowing of the heart rate (bradycardia). Apnea is usually caused by immaturity in the part of the brain that controls involuntary respiration.

Faced with those common respiratory illnesses, NICUs are trained and equipped to provide respiratory assistance to premature babies until they are able to fully breathe on their own.

Types of Breathing Support for Preterm Babies

Many different types of respiratory support are available in the NICU, depending on the level of assistance a baby needs. Among them:

• Nasal cannula is one of the least invasive forms of respiratory support. A nasal cannula is a thin plastic tube that delivers oxygen directly into the nostrils. This type of system is indicated in babies who can breathe on their own but need additional airflow to either keep the lungs open or maintain a consistent level of oxygen in the blood.
• Continuous positive airway pressure (CPAP) is a type of respiratory support that blows a constant flow of air into the baby's lungs through a mask or a nasal cannula. The main goal of CPAP therapy is to keep the premature lungs properly inflated. While the air pressure is higher than a standard nasal cannula, CPAP is only used for babies who can breathe on their own.
• Mechanical ventilation is used for premature babies who are too weak to breathe on their own. The ventilator provides a mixture of oxygen and air which is pumped through a tube into the windpipe and then drawn out, replicating the natural pattern of breathing. With most mechanical ventilators, babies can still breathe on their own.

Preventing Breathing Difficulties

To prevent RDS, doctors will typically provide a steroid such as betamethasone to women in premature labor. The medication, if given before delivery, can speed up the production of surfactant and help mature the baby's lungs. The surfactant can be also given to the baby after birth.

Although premature babies who lack surfactant will usually require a ventilator, the use of surfactant greatly decreases the amount of time needed for respiratory support.