A baby is fully formed by its 13th week of gestation and spends the remaining 27 weeks growing and maturing. For the premature baby, the major complication they will face is the fact that they are born before their body is mature enough to live outside the protected environment of their mother’s womb.. The most common and the most life-threatening problem is the immaturity of its lungs.

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During its time in the Uterus a baby’s lungs have no work to perform. They are filled with fluid and are deflated. The growing baby gains its oxygen from its mother. Normally at birth, with the baby’s first breath the fluid is expelled and the lungs inflate and start their lifetime of work. Being born prematurely, the lungs haven’t matured enough to allow this normal draining and inflation. The premature baby will be able to get some oxygen to their lungs but not sufficient for their needs. This will cause them to breathe quicker and work harder while their body tries to get sufficient oxygen. This problem is called “wet lung” or “transient tachypnoea”.

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Our lungs are made up of tiny air sacks (alveoli) that take in the oxygen and deliver it to the blood that flows through the lungs. The oxygen rich blood is then circulated back to the lungs to be pumped through the body. Each of the air sacks has a substance called ‘surfactant’. This substance is vital for the process of breathing. The ‘surfactant’ holds the alveoli open and makesbreathing easy. Without enough surfactant the alveoli collapse with each breath. In a full term pregnancy, the baby’s lungs are not mature enough to fully able to function before the 35th or 36 week. In a preterm birth before the 35 week, the majority of baby’s will need some sort of help to get enough oxygen into their system.

Some babies born before 35 weeks, especially those who have had a stressful time in utero have lungs that have matured early and need no or little assistance with breathing.

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Respiratory Distress Syndrome (RDS)
Babies who have problems with breathing are said to have Respiratory Distress Syndrome or RDS. RDS in premature babies can be anywhere from mild,(where the baby only needs a little help to get its breathing and lungs right), to very severe (where the baby might be on a ventilator for a long time and end up with lung damage) RDS is also one of the main cause of death in extremely premature babies.

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There are a number of ways your doctor will be able to help your baby breathe and these range from a ventilator doing all the breathing for the baby to nasal cannulas (or prongs) giving a whiff of oxygen.

If the mother goes into premature labour and there is time before the delivery, an injection of corticosteroids may be given to help speed up the maturing of the lungs. Soon after birth the doctors can give the baby a special preparation of surfactant.

Long term, most premature babies will recover well from lung problems. Before the majority go home they will be totally weaned of any oxygen needs. However for a small group, lung damage can occur and these babies can be more susceptible to frequent chest respiratory infections and have problems with Asthma or similar breathing problems.

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APNOEA
The other problem a premature baby may have with breathing is an episode called an apnoea. The breathing centre in a prems brain is still developing and quite simply they forget to breathe. In most cases an alarm will sound and the nurse will simply tap on the isolet or the baby and he will start breathing automatically. The episode usually only last a few seconds and it is something the great majority of prems will grow out of before they go home. In a small amount of prems, they are still rarely having apnoeas when they are ready for discharge and the baby will be send home with an apnoea monitor. If this happens to you, talk to your doctor and nurses about why and how to properly use it and what to do if it alarms.

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Ventilator
If your baby is struggling with breathing, one help the doctors can give is to put him on a ventilator. Many premature babies especially those born before about 30 weeks and some babies born after 30 weeks will need the extra help of the ventilator. A ventilator is basically a machine that can breathe for your baby.

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The Neonatologist that sees your baby straight after birth may decide that your baby will need extra help with breathing or it may be a few days later that your baby starts to struggle with breathing that he is placed on a ventilator. The first thing the doctor will have to do is intubated (a special tube is inserted into the windpipe via the mouth or the nose) your baby. This tube can then be attached to the ventilator.

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For most prem parents the first view of their little on is after she has been attached to the ventilator and it can be a scary sight. Ask your doctor or nurse to explain what the ventilator is doing for your baby. In some cases it will be doing all the breathing. In other cases it may be supplementing your baby’s breathing. For a baby born extremely premature it may by weeks before you baby comes off the ventilator. But even while on the ventilator the doctors will be gradually weaning him off of it. They will change the pressures, volume or timing of the machine until it is basically your baby doing most of the breathing and the ventilator only kicking in at times.

Some babies will have trouble weaning from the ventilator but doctors will usually only remove a baby from the ventilator after they are sure that he will breathe adequately on his own or with the help of CPAP. If your baby develops an infection or needs some surgery, often they will be put back onto the ventilator for a time. This can be very distressing to a parent who has waited weeks for the freedom from the ventilator but usually once the baby starts to recover he will loose

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CPAP
Continuous Positive Air Pressure.
Your baby may progress from his time on a ventilator he may be put on CPAP. (see pap) With CPAP a short plastic tube is run through the nose to the back of the throat. A mixture of Oxygen and air is fed into this tube under pressure and is used to keep the baby’s lungs partly inflated. With CPAP your baby does the breathing, and the CPAP just helps to make it less work for him. CPAP is a positive step forward for the prem. You could look at CPAP as training the lungs in how to do their job. For some babies this is a short couple of days for others it may be a few weeks.

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Head Box
Some prems will have the ability to breathe by themselves but they are not getting the oxygen into their system that they need. To give this prem the concentrated oxygen he needs doctors may use a head box. This is simply a round or square box placed over the baby’s head and shoulders and it has a concentrated level of oxygen fed into it. Some parents find that the moist air fogs up the box and they can not see their baby’s face but it usually is only for a short period of time till the baby’s oxygen levels pickup.

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Isolet Oxygen
A baby still in the isolet may receive extra oxygen needed by a tube fed into the isolet. This baby doesn’t need the concentrated oxygen that a baby with a head box does but still needs a little extra oxygen. The isolet will have an oxygen monitor, monitoring the levels of oxygen inside and most will have sleeves over the side access holes to stop the oxygen levels decreasing too quickly when the doors of these holes are open.

The prem with head box or isolet oxygen can usually be taken out of the isolet for cuddles but will need to its oxygen close by. In some cases this is done with a funnel or simply a tube pointed so that the oxygen is wafting over the baby’s face.

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Nasal cannula
The final step in the path to breathing independently is a nasal cannula. This is a small set of nasal prongs attached to an oxygen line. The prongs are set up that they blow oxygen into your baby’s nostrils and provide extra oxygen the baby needs. In some cases the baby’s have trouble giving up this final support and some babies will go home with the nasal cannula and an oxygen bottle. If this is your baby’s case, the medical staff will show you how to deal with home oxygen and you will be asked to come back at regular intervals to have your baby’s oxygen levels tested.

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The primary aim of PIPA is to provide practical and emotional support to the parents and families of premature infants. However we do not offer professional advice. We are parents of preterm baby’s and not medical staff. We do offer understanding, support, encouragement and friendship.