Some preemie babies are born with compromised airways due to immature lungs, and in such cases, many parents worry about the effects of resuscitation on preemie babies.
Preemie Babies Immature Lungs
When obstetricians have advanced warning that an infant is to be born prematurely it is possible to give the pregnant mom a shot of a drug named 'surfactant'. This is a steroid that, if given to the mother, is then passed to the unborn infant. It then aims to improve the strength and function of the immature lungs in preparation for early birth.
Dependant on the degree of prematurity the lungs of an infant born prior to 'term' will differ in terms of their development and function. In some cases, induction of labor or planned cesareans are put off as long as possible in an attempt to allow the lungs of the infant to mature. It is indeed the case that in the final few weeks of gestation the major organs develop to their fullest ability, and therefore every day, week and month counts.
Respiratory Support: Effects of Resuscitation on Preemie Babies
Until the moment a preemie baby enters the world, the neonatal or pediatric medical team will have no idea what degree of respiratory support the newborn will require. Some infants require simple oxygen supplementation, whereas others require full respiratory resuscitation, with supportive ventilation in the neonatal intensive care unit (NICU) for a period of time after delivery.
The act of resuscitation ensures that an infant will have all his necessary breathing functions performed for him. The administration of oxygen, suction to remove unwanted secretions, and ventilation to enable lung expansion is not uncommon during resuscitation, and it is no wonder parents, particularly those who may have witnessed the event, become concerned about the potential for long term harm to their precious infant.
In those infants who require resuscitation, it may take days, if not weeks to see the true effects of the preterm birth and any effects of resuscitation. In the unfortunate event that the preemie dies following delivery, it is likely that his or her organs, including the lungs, were not developed enough to survive life outside the womb. The effects of resuscitation attempts are unlikely to be detrimental to life. However, the inability to deliver an adequate amount of oxygen will ultimately lead to issues in the maintenance of oxygen levels in the early stages.
Preemies who have been resuscitated are likely to require oxygen and possible ventilatory support for days, and in some cases weeks, after the event. This support can only be of benefit, as if taken away too soon the infant may still be too fragile to support his own respiratory function, and in worst case scenarios a secondary 'respiratory arrest' may occur. The reason preemies are cared for in NICU's is to enable close monitoring by experts ensuring that the correct level of therapy is given at all times. A preemie infant cannot be deemed entirely 'safe and well' until such times as he is ready to go home. In the case of those born early, discharge home will not be allowed until breathing and feeding systems are entirely satisfactory.
Long-term Lung Problems
In some cases it is discovered that a preemie infant has a condition of the lungs which complicates the recovery phase. 'Bronchopulmonary Dysplasia' (BPD) is a lung condition which is not present at birth but develops as a result of chronic lung damage. It is seen in particular in preemies and those infants who have needed ventilatory support. 'Respiratory Distress Syndrome' (RDS) occurs when an infant, particularly those born at or before 34 weeks, requires oxygen support or ventilation for a prolonged period of time. If this becomes extensive, it is then deemed to be chronic, thus resulting in a diagnosis of BPD. Damage can indeed be caused by prolonged ventilation in infants, and the inflammation caused by the constant pressure of oxygen is what ultimately causes BPD.
In a way this is a 'Catch 22' situation as many infants need ventilation and oxygen, yet suffer the risk of long-term lung damage as a result. In the event of resuscitation, a preemie infant may automatically be ventilated to prevent death; therefore, the decision for the pediatrician is one which at the time goes without question.
The Onward Journey
When parents take home their precious newborn for the first time it can be a worrying experience. Having observed monitors, machines and alarms, the fear of separation from this equipment can be a worry. Some infants who have developed lung problems as a result of pre-term birth and the possible need for resuscitation may require long-term medical therapy to continue to improve the lung function. Treatments such as inhalers (bronchiodilators), fluid reducing drugs (diuretics) and steroids may be necessary to support the infant's ability to breath freely, and as a result he or she may well be at greater risk of acquiring respiratory infections.
It is important to remember that the effects of resuscitation on preemie babies can vary dramatically with a large number of infants requiring nothing more than a little oxygen before they begin the journey to being well developed and strong enough to go home. Those who develop complications are likely to do so not just because of the resuscitation event but because of the intensive treatment required as a direct consequence of pre-term birth and immature lungs.