Health Problems in Premature Babies

Airway and Breathing Problems

Apnoea and Bradycardia

Any pause in breathing that lasts more than 20 seconds is known as apnoea. This may cause your baby to become a pale purple or blue colour. In addition, the baby may become limp and his heart rate may slow down. This condition is known as bradycardia. Apnoea and bradycardia can occur in premature babies if the part of the brain which controls breathing is not fully developed. Apnoea improves and disappears as premature babies get older, but until then treatments include:

rocking or stimulating the baby
medication to stimulate breathing, usually caffeine.
giving extra oxygen by continuous positive airway pressure (CPAP)
placing the baby on a ventilator (in more severe cases)

Air Leaks

An air leak from a baby's lung can occur when some of the alveoli (breathing sacs) break causing air to leak into the space around the lungs. Air leaks happen mostly in premature babies or babies whose lungs are not fully developed.

Air might collect in the space between the lungs and the chest wall (a condition called a pneumothorax).

Air may also leak into the space in the chest which contains the heart and main blood vessels (this is called a pneumomediastinum).

Another condition which can occur is called pulmonary interstitial emphysema (PIE). This happens when air leaks into the lung tissue itself.

Bronchopulmonary Dysplasia (BPD) or Chronic Lung Disease (CLD)

Babies who have complicated lung problems with respiratory distress syndrome or babies who are very tiny and need oxygen and a respirator may get bronchopulmonary dysplasia or chronic lung disease.

This is because these infants' lungs are underdeveloped at birth and breathing oxygen and/ or being ventilated can affect the normal development of the lungs. If this happens, not enough oxygen may reach the baby's healthy lung tissues. Symptoms of BPD/CLD include:

rapid, difficult and shallow breathing
wheezing
crackling sound in the lungs

BPD/CLD develops in the first few weeks of life, and if severe, it can be life threatening Some babies with BPD/CLD may need extra oxygen for a long time after birth, even after they have returned home.

Treatment may include providing support to help the baby's breathing, nutrition with extra calories for growth, medication, and avoiding excess fluid in the baby's system. With time and ongoing care, babies with BPD/CLD usually outgrow their lung problems.

Congenital Heart Disease (CHD)

Approximately five to seven out of every 1,000 infants have some type of heart problem at birth1. Congenital heart disease, or congenital heart defects, may be so minor that they cause no symptoms, or so severe that they can be fatal.

Defects also vary widely in complexity, from a simple hole in the wall between two heart chambers to a complicated set of malformations, such as blood vessels in the wrong places and underdevelopment of one side of the heart.

Many heart problems can be detected using echocardiography, which causes sound waves to create a picture of your baby's heart.

If the heart is beating too slowly or quickly, medications can usually fix the problem before the heart starts to fail.

Infants with significant congenital heart disease will usually be assessed by a paediatric cardiologist.

Respiratory Distress Syndrome (RDS)

RDS is also known as hyaline membrane disease. This condition is common among premature infants whose lungs are not fully developed. Immature lungs do not produce enough surfactant – a soapy liquid that lines the small air sacs in the lungs and helps them to open and close. If these sacs do not expand easily, the lungs cannot take in air and get oxygen into the bloodstream. The symptoms of RDS include:

rapid breathing
pulling in the ribs and centre of the chest with each breath
flaring of the nostrils
a grunting sound (most severe cases)

Artificial surfactant is now available and may be used to prevent or treat RDS¹. RDS is also treated by giving the baby extra oxygen under an oxygen hood, continuous positive airway pressure (CPAP), a ventilator, or respirator.

Transient Tachypnea of the Newborn (TTNB)

Rapid breathing which gradually improves over the first few hours or days and does not recur is called transient tachypnea of the newborn (TTNB). TTNB occurs because fluid in the newborn's lungs is not easily absorbed in premature babies.

The symptoms of TTNB resemble those of respiratory distress syndrome (RDS) and the treatment is to give extra oxygen to the baby using an oxygen hood or continuous positive airway pressure (CPAP).

¹ D. Sweet et al. European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome. J Perinat Med 2007;35:175-86.