Respitatory Support for Premature Babies in the NICU

Nasal Cannulas, CPAP, and Ventilators

A newborn with a nasal cannula.
A newborn with a nasal cannula. Matt Carr/Getty Images

Breathing difficulties are one of the most common health problems encountered by premature babies. Fortunately, due to advancements in medicine and technology, most premature babies will achieve full health with the assistance of varying levels of breathing support in the neonatal intensive care unit (NICU).

Causes of Breathing Difficulties in Preemies:

Because their lungs don't have the chance to reach full maturity in the womb, premature babies may be born with breathing problems caused by one or more of the following:

  • An immature respiratory system
  • Respiratory Distress Syndrome, due to a lack of surfactant in the lungs, a substance that allows the muscles of the lung to expand and contract smoothly. When a woman is in premature labor, medication can be given before delivery to speed up production of surfactant and help prevent RDS. Surfactant can be given to the baby after birth, as well, if needed. Although most premature babies who lack surfactant will require a breathing machine, or ventilator, for a while, the use of surfactant has greatly decreased the amount of time they spend on the ventilator.
  • Bronchopulmonary dysplasia, a chronic lung disease more common in preemies, especially those who weigh less than 1,000 grams (2.2 pounds) at birth
  • Apnea, prolonged pauses in breathing that may cause the heart rate to decrease, usually caused by immaturity in the area of the brain that controls the drive to breathe

    Fortunately, neonatal intensive care units (NICUs) are staffed and equipped to provide the breathing assistance and monitoring premature babies need until they are able to breathe optimally on their own. Breathing assistance provided in the NICU can be one of the most important treatments a premature baby receives.

    Types of Breathing Support in the NICU

    Many different types of respiratory support are available in the NIUC, depending on the level of help a baby needs. These include:

    • Nasal Cannula: One of the least invasive forms of respiratory support, a nasal cannula is a thin plastic tube that delivers oxygen directly into the nostrils. With a nasal cannula, the baby breathes on his or her own, but needs additional airflow to keep the lungs open or additional oxygen to maintain good oxygen saturations.
    • CPAP: Continuous positive airway pressure, or CPAP, is a type of respiratory support that blows a constant airflow into a baby's lungs through a mask or via a nasal cannula in order to help keep the lungs inflated. The air pressure is higher than with a nasal cannula, but the baby is still breathing on his or her own.
    • Mechanical Ventilation: A baby who is very premature or weak may need the assistance of a ventilator, which can help the lungs do the work of breathing. A ventilator provides a mixture of air and oxygen into the baby through a tube in his or her windpipe, and then draws it out. This replicates a natural pattern of breathing. With most ventilators, a baby can still take his or her own breaths, but the ventilator will greatly assist.

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