The neonatal professionals of the Neonatal Intensive Care Program
at Paoli Hospital use a variety of special procedures to alleviate
breathing and respiratory problems in premature babies and seriously ill
The heart and lungs interact in the exchange of fresh oxygen and waste
carbon dioxide in the circulation of blood throughout the body. In
premature and high-risk babies, the lungs may need help to function on
their own. Here are some of the breathing problems that we
commonly deal with in the Neonatal Intensive Care Unit (NICU).
Sometimes babies stop breathing for short periods—a condition called
apnea—and an associated slowing of the heart rate, known as bradycardia,
may also occur. This is common to premature babies but is usually
outgrown. Medication, such as theophylline or caffeine, may be given to
stimulate the baby’s breathing to prevent apnea. Prior to discharge,
infants with apnea are evaluated to determine their need for home
Babies in the NICU may be unable to cough up their own mucus, so a
nurse or respiratory therapist will suction it out for them. This is
done using a very small catheter that is connected to wall
suction and passed into the infant's mouth or nostrils, or through
a breathing tube in the throat. Since the procedure also sucks out some
air along with the mucus, the infant may become dusky in color and is
given additional oxygen or breathes with a ventilator bag.
Increased Oxygen Requirement
The normal oxygen concentration in a room is 21 percent. If an infant
needs a higher level of oxygen, this can be delivered several
Relatively low oxygen levels can be administered by small
catheters placed inside the baby’s nostrils.
Higher levels (greater than 30 percent) can be given by means of
an oxygen hood. This is a clear plastic tent placed over the
If an infant has a major oxygen requirement, continuous
positive airway pressure (CPAP) therapy provides a constant flow
of air and oxygen under pressure through special nasal prongs to
help stabilize the air sacs in the lungs.
If the infant’s respiratory problems are even more severe, the
baby is placed on a ventilator to help the lungs regulate oxygen
and carbon dioxide levels in the blood. For this purpose, a
breathing tube is inserted into the windpipe through the mouth
or the nose. The ventilator is connected to this tube. Babies
cannot cry with the tube in place, but as they improve, it is
removed and their ability to cry returns. They then progress to
CPAP or an oxygen hood for ongoing oxygen therapy.
Some babies may experience a pneumothorax, which is the collection
of air or gas in the space around the lungs caused by an air leak. This
buildup of air puts pressure on the lung and can result in a collapsed
lung. To treat it, a chest tube is introduced through the chest wall
into the space around the affected lung. It is connected to a special
suction chamber that removes the air around the collapsed lung. This
allows the lung to re-inflate. The air leak usually heals within two or
three days, and the tube can then be removed.
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Paoli, PA 19301
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