Possible Health Problems in Premature Babies

AIRWAY AND BREATHING PROBLEMS

• Apnea and Bradycardia
• Transient Tachypnea of the Newborn (TTN)
• Respiratory Distress Syndrome (RDS)
• Air Leaks
• Bronchopulmonary Dysplasia (BPD)/Chronic Lung Disease (CLD)

Apnea and Bradycardia

Any pause in breathing that lasts more than 20 seconds is known as apnea, which may cause your baby to become a pale or blue colour. In addition, the baby may become limp and the heart rate may slow down, which is known as bradycardia. Apnea and bradycardia occur mostly in ELBW and VLBW premature babies if the part of the brain which controls breathing is not fully developed. Apnea improves and disappears as premature babies get older.

Treatments for apnea include:

• Rocking or stimulating the baby
• Medication to stimulate breathing
• Giving extra oxygen by continuous positive airway pressure (CPAP)
• Placing the baby on a ventilator (in more severe cases)

Transient Tachypnea of the Newborn (TTN)

Rapid breathing that gradually improves over the first few hours or days and does not recur is called TTN. TTN occurs because fluid in the newborn's lungs is not easily absorbed in premature babies. The symptoms of TTN resemble those of respiratory distress syndrome (RDS). Treatment consists of extra oxygen provided to the baby by an oxygen hood or continuous positive airway pressure (CPAP).

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.

Symptoms of RDS include:

• Rapid breathing/difficulty breathing
• Pulling in the ribs and centre of the chest with each breath (retractions)
• Flaring of the nostrils
• A grunting sound (most severe cases)

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

Air Leaks

An air leak from a baby's lung can occur when some of the alveoli (breathing sacs) break and air leaks 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 that can occur is called pulmonary interstitial emphysema (PIE) which happens when air leaks into the lung tissue itself.

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

Babies who have complicated lung problems with respiratory distress syndrome (RDS) or babies who are very tiny and need oxygen and a ventilator may get BPD/CLD. In babies with these conditions, not enough oxygen reaches the baby's healthy lung tissues.

A ventilator can cause these problems when waste products of the oxygen damage the air sacs in the baby's lungs. There are several reasons why a baby develops BPD/CLD including lung injury and inflammation of the lungs after being on a ventilator for a long time, infection, prolonged oxygen use and inadequate nutrition.

Symptoms of BPD/CLD include:

• Rapid, difficult and shallow breathing
• Wheezing
• Pulling in of the ribs and centre of the chest with each breath

Usually, BPD/CLD is diagnosed if the baby still needs extra oxygen one month before the original due date. 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, most babies with BPD/CLD usually outgrow their lung problems.