Health Problems in Premature Babies

Airway and Breathing Problems

Premature babies often stop breathing for brief periods. What this condition is called depends on the length of the pause in the breathing and whether the pause is accompanied by changes in the heart rate and skin colour.

Periodic Breathing.

Periodic breathing is a pattern in which the baby briefly pauses in breathing, usually lasting 5 to 10 seconds and then resumes regular breathing. Babies who have periodic breathing always resume breathing on their own and never show any changes in heart rate or skin colour. Periodic breathing is a common pattern in premature babies, which may last for many weeks, and no treatment is required.

Apnoea of Prematurity

Any pause in breathing that lasts 20 seconds or longer or a pause of any length that is accompanied by changes in heart rate and/or skin colour is known as apnoea of prematurity. This is one of the most common problems of premature babies and is related to the immaturity of the babies' central nervous and respiratory systems. As these systems mature apnoea of prematurity disappears.

Management of Apnoea of Prematurity:

• The nurse may gently rub the baby's foot to stimulate respirations
• Giving extra oxygen either by blowing the oxygen near the babies face or gently pumping into babies lungs with an oxygen bag and facemask.
• Medication to stimulate breathing, usually caffeine.
• Giving extra oxygen by continuous positive airway pressure (CPAP) or
• 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). Large pockets of air can compress the lungs making breathing difficult. If this occurs the doctor may pass a small drain through the chest wall to allow the air escape. Often this has to be done, as an emergency so staff may not be able to discuss this with you until afterwards.

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. It is not clear why some babies develop BPD and some do not. 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)

When the heart or blood vessels near the heart don't develop normally during pregnancy, the baby is born with a congenital heart defect.
Approximately five to seven out of every 1,000 infants have some type of heart problem at birth. Congenital heart disease, or congenital heart defects, may be so minor that they cause no symptoms, or so severe that they can be fatal. However a great deal of progress has been made in recent years in the treatment of congenital heart defects.

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 and is the most common disease of the lungs that affects premature babies. The earlier a baby is born the more likely he or she is to have RDS and the more severe the disease is likely to be. The lungs mature at different rates from one baby to the next. 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)

Respiratory Distress Syndrome may worsen over the first 48 hours until your baby starts to produce surfactant and the lungs stabilise and begin to recover.

Artificial surfactant is now available and may be used to prevent or treat RDS¹.

The doctor administers the surfactant into the babies lungs through a tube placed in the baby's windpipe.

RDS may also be treated by using, continuous positive airway pressure (CPAP), or ventilation.

Transient Tachypnea of the Newborn (TTNB)

While your baby is in the womb the lungs are filled with fluid. Much of this fluid will be squeezed out of the chest as the baby passes through the birth canal. The remaining fluid is absorbed by the baby's circulatory system in the first few hours after birth. Transient Tachypnoea of the Newborn or Wet Lung develops when there is a delay in reabsorption of this lung fluid after birth. This results in rapid breathing which gradually improves over the first few hours or days and does not recur . 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.