Respiratory (or breathing) problems are the most common reasons for babies to be admitted to the NICU.

Full-term babies may exhibit respiratory distress in the immediate newborn period as the baby makes a transition from fluid-filled to air-filled lungs. The baby may take somewhat longer than usual to clear the fluid from the lungs, may draw extra amniotic fluid into the lungs with the first breaths, or may partially collapse one or both lungs with vigorous crying to expand the lungs. Also, it is possible for an infection to develop in the uterus during labor, which can then affect the baby and cause breathing difficulties once the baby is born. It is not always possible to immediately determine which of these problems is causing the respiratory distress.

Premature babies may have all of the same problems that full-term babies experience but, in addition, they may have lungs that have not fully matured and therefore are somewhat stiff and do not exchange oxygen and carbon dioxide as well as mature lungs.

Evaluation and treatment for these breathing problems is based on the degree and the suspected cause of the distress. The baby's doctor may request a chest X-ray to look at the baby's lungs; blood tests to evaluate the oxygen and carbon dioxide levels and to evaluate the blood counts for evidence of infection; and monitoring to assess heart rate, breathing rate and oxygen level.

If the baby's distress is mild and his color is good without extra oxygen, observation alone may be all that is needed. However, many of these babies will need extra oxygen.

Oxygen may be provided to a baby through an oxygen hood, which is placed over the head, or through prongs (also called cannulae), which fit into baby's nostrils and provide some pressure to help expand the baby's lungs. (This treatment is called CPAP.) Oxygen may also be provided through a ventilator (or breathing machine), which assists the baby withbreathing. If a ventilator is required, a flexible plastic tube (endotracheal tube or ETT) will be placed through the mouth and into the trachea (windpipe). This tube will then be connected to the ventilator. If such a tube is needed, the baby will make no noise with crying since this tube passes between the vocal cords.

If infection is suspected as a cause of the baby's respiratory distress, samples will be taken from blood and urine (and sometimes from other sites) to evaluate for infection, and the baby will be started on antibiotics, which will be given through an IV. If the baby is suspected of having immature lungs, medication may be given to compensate for the lack of surfactant in the lungs. If this medication is needed, it will be given directly into the lungs and therefore the baby will need to have an endotracheal tube in place and will be connected to a ventilator.

Although these are the most common respiratory problems in newborns, there are other less common causes of respiratory distress. Depending on the baby's course and preliminary evaluation, further evaluation or different types of treatment may be required.

© 2008 St. John's Mercy Health Care
615 S. New Ballas Rd., St. Louis, Missouri, 63141