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 newborns.
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 monitoring.
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 ways:
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 infant’s head.
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 reinflate. The air leak usually heals within two or three days, and the tube can then be removed.
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