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Treatment of breathing problems in premature babiesTTreatment of breathing problems in premature babiesTreatment of breathing problems in premature babiesEnglishNeonatology;RespiratoryPremature;Newborn (0-28 days);Baby (1-12 months)LungsRespiratory systemDrug treatment;Non-drug treatmentPrenatal Adult (19+)NA2009-10-31T04:00:00ZAndrew James, MBChB, MBI, FRACP, FRCPCJaques Belik, MD, FRCPC12.000000000000048.0000000000000600.000000000000Flat ContentHealth A-Z<p>Read about several ways in which treatment can improve breathing. The effectiveness of each will depend on the type and severity of the problem.</p><p>Since the lungs are the last major organ system to mature in the womb, breathing complications are common during the first few hours and days of a premature baby’s life. Depending on the type and severity of the problem, there are several ways in which treatment can improve breathing. For the most part, these methods attempt to enhance gas exchange in the lung and therefore increase oxygen delivery to the body.</p><h2>Key points</h2> <ul><li>Treatment for breathing problems depend on the severity of the condition and upon the severity of prematurity of the baby .</li> <li>Complications from treatment may occur, but the risks are generally well known and NICU staff pay close attention to prevent them.</li> <li>Monitoring and various assessments are done frequently or even continuously to determine the effectiveness of treatments.</li></ul>
Traitement des troubles respiratoires chez les bébés prématurésTTraitement des troubles respiratoires chez les bébés prématurésTreatment of breathing problems in premature babiesFrenchNeonatology;RespiratoryPremature;Newborn (0-28 days);Baby (1-12 months)LungsRespiratory systemDrug treatment;Non-drug treatmentPrenatal Adult (19+)NA2009-10-31T04:00:00ZAndrew James, MBChB, MBI, FRACP, FRCPCJaques Belik, MD, FRCPC12.000000000000048.0000000000000600.000000000000Flat ContentHealth A-Z<p>Lisez au sujet des différentes méthodes utilisées pour améliorer la respiration. L’efficacité de chacune dépend du type et de la gravité de la condition.<br></p><p>Puisque les poumons sont le dernier organe majeur à devenir matures dans l’utérus, les troubles respiratoires sont courants durant les premières heures et les premières journées de vie d’un bébé prématuré. Selon le type et la gravité de la condition, il y a plusieurs moyens par lesquels des traitements peuvent améliorer la respiration. En général, ces méthodes tentent d’améliorer l’échange gazeux dans les poumons et ainsi d'améliorer l’apport d’oxygène au corps.</p><h2>À retenir</h2> <ul><li>Le traitement des problèmes respiratoires dépend de la gravité du trouble et du degré de prématurité du bébé.</li> <li>Des complications à la suite d’un traitement peuvent survenir, mais les risques associés sont habituellement bien connus et le personnel de l’unité néonatale des soins intensifs tâchera de les éviter.</li> <li>Les effets des traitements sont évalués à intervalles réguliers ou même en continu.<br></li></ul>

 

 

Treatment of breathing problems in premature babies1835.00000000000Treatment of breathing problems in premature babiesTreatment of breathing problems in premature babiesTEnglishNeonatology;RespiratoryPremature;Newborn (0-28 days);Baby (1-12 months)LungsRespiratory systemDrug treatment;Non-drug treatmentPrenatal Adult (19+)NA2009-10-31T04:00:00ZAndrew James, MBChB, MBI, FRACP, FRCPCJaques Belik, MD, FRCPC12.000000000000048.0000000000000600.000000000000Flat ContentHealth A-Z<p>Read about several ways in which treatment can improve breathing. The effectiveness of each will depend on the type and severity of the problem.</p><p>Since the lungs are the last major organ system to mature in the womb, breathing complications are common during the first few hours and days of a premature baby’s life. Depending on the type and severity of the problem, there are several ways in which treatment can improve breathing. For the most part, these methods attempt to enhance gas exchange in the lung and therefore increase oxygen delivery to the body.</p><h2>Key points</h2> <ul><li>Treatment for breathing problems depend on the severity of the condition and upon the severity of prematurity of the baby .</li> <li>Complications from treatment may occur, but the risks are generally well known and NICU staff pay close attention to prevent them.</li> <li>Monitoring and various assessments are done frequently or even continuously to determine the effectiveness of treatments.</li></ul><p>In general terms, lung complications interfere with breathing, resulting in respiratory distress. Frequently, there is a lower oxygen level and higher carbon dioxide level in the blood. Lung complications may also interfere with the heart. The lungs and heart are dependent upon each other: the lungs providing the mechanism for gas exchange and the heart providing the mechanism by which oxygen is delivered to all regions of the body. Since the heart and lungs are interdependent in this way, problems with the function of the lungs can interfere with the physical action of the heart and vice versa. </p><p>That being said, the management or treatment of lung problems involves trying to achieve the correct amount of oxygen in the blood by improving the gas exchange that occurs within the lungs. Unfortunately, weakened, immature, or damaged lungs can only be pushed so far; at a certain point, the effort to improve the amount of oxygen in the blood by treating the lung can cause injury that may result in lung damage or make it worse. Treatment of the lungs must take into consideration the balance between the benefit of improving oxygen levels and the risk of creating lung damage, which may be permanent, in the process. </p><h2>Monitoring and assessment of treatment effectiveness<br></h2><p>The effect of treatments is assessed at frequent intervals. Since the goal is to improve the delivery of oxygen and remove carbon dioxide from the blood, which are the prime functions of the lungs, measurement of these blood gases will be frequent and more or less continuous. </p><p>In most cases, the amount of oxygen in the blood, called oxygen saturation, can be measured with a test called pulse oximetry, avoiding the repeated drawing of blood to determine levels of blood gases. In pulse oximetry, a long, thin wire is attached to a monitor. This wire connects to a sensor that is usually put over the baby’s finger or toe. The probe has a small red light on one side and a detector on the other side. The red light shines through the baby’s finger or toe and is “seen” by the detector on the other side. In this way, the detector can measure the amount of oxygen in the blood. </p><p>Carbon dioxide levels can also be monitored using a non-invasive monitor which has a special probe that sits on the surface of the skin. This probe can estimate the amount of carbon dioxide in the blood stream. </p><h2>Surfactant replacement therapy</h2><p>Surfactant, a naturally produced substance, is a kind of foamy, fatty liquid that acts like grease within the lungs. Without it, the air sacs open but have difficulty remaining open because they stick together. Surfactant allows the sacs to remain open. </p><p>Surfactant usually appears in the fetus’s lungs at about the 24th week of pregnancy and gradually builds up to its full level by the 37th week. If a premature baby is lacking surfactant, artificial surfactant may be given.</p><p>Surfactant is delivered using an artificial airway or breathing tube that is inserted into the trachea, or windpipe, either immediately at birth for extremely premature babies, or later once respiratory problems have revealed themselves. Surfactant is administered through the windpipe over the course of a few minutes. During this time, the baby will be turned and moved in an effort to distribute the surfactant to all parts of the lung. Depending on the severity of the lung condition, surfactant may be administered more than once.</p><p>Surfactant replacement therapy cannot begin until breathing has been stabilized, perhaps with mechanical ventilation, and the proper monitoring equipment has been set up.</p><h2>Treatment of the immature lung</h2><p>Extremely premature babies who have respiratory distress but show no specific reason for that distress may have an immature lung. If the baby does not respond to surfactant replacement therapy, this can be another indication of an immature lung. Although immature lungs may appear normal on X-ray, the alveoli, which are the small sacs lining the lung where gas exchange takes place, may not have developed or may not have developed enough. For this reason, surfactant may not improve breathing or not improve it by much. Babies suspected of having an immature lung may be given: </p><ul><li>surfactant replacement therapy </li><li>oxygen </li><li>continuous positive airway pressure (CPAP) or </li><li>mechanical ventilation </li></ul><h2>Treatment of respiratory distress syndrome<br></h2><p>Respiratory Distress S​yndrome (RDS) is characterized by surfactant deficiency in the premature baby’s lung. The condition is generally progressive in that the breathing difficulties experienced by the baby begin immediately at birth and worsen over time. The severity of RDS and its progression have to do with the maturity of the lung. As with most conditions affecting premature babies, the more premature the baby, the more likely RDS is to be severe. Treatment of RDS may include surfactant replacement therapy and supplemental oxygen delivered by one of these ventilation methods:</p><ul><li>continuous positive airway pressure (CPAP)</li><li>conventional mechanican ventilation (CMV)</li><li>high frequency oscillation (HFO)</li><li>high frequency jet ventilation (HFJV)</li></ul> <figure class="asset-c-80"><span class="asset-image-title">Respiratory distress syndrome X-ray before and after surfactant</span><img src="https://assets.aboutkidshealth.ca/akhassets/Respiratory_distress_surf_XRAY_MEDIMG_PHO_EN.png" alt="" /><figcaption class="asset-image-caption">The first X-ray was taken before surfactant was administered. The lungs look quite dense and white due to the collapse of the alveoli. The amount of air in the lungs is very small. The second X-ray was taken after the administration of surfactant. The lungs appear darker as they now contain more air.</figcaption> </figure> <h2>Treatment of chronic lung disease </h2><p>Chronic lung disease (CLD) comes as a result of lung injury. The likelihood of CLD occurring is influenced by events during pregnancy or birth, the degree of immaturity, the underlying lung condition, exposure of the lung to supplemental oxygen, the use of mechanical ventilation, and the presence of infection. The longer a baby needs supplemental oxygen and mechanical ventilation, the more likely it is that they will develop CLD. </p><p>About 50% of extremely premature babies who have respiratory distress syndrome (RDS) will have CLD to some degree. In many ways, CLD is the price to pay for surviving respiratory distress and other lung complications. Luckily, severe cases are rare and most babies grow to maturity without major long-term complications.As the lungs attempt to repair the damage associated with the RDS treatment, the force of the ventilator and the extra oxygen can interfere with the healing process. </p><p>The treatment goal with CLD is to maintain an acceptable oxygen level in the blood without causing further lung damage. </p><p>Babies with CLD may not be mechanically ventilated. If a baby with CLD is ventilated, because ventilation is partly to blame for the lung injury, babies with CLD will be weaned off mechanical ventilation as quickly as possible. In some cases, this may mean tolerating a higher level of carbon dioxide than normal. Called permissive hypercapnea, this approach is used to prevent further lung damage and encourage spontaneous breathing. </p><p>Babies with CLD may also be managed with one or more of the following approaches:</p><ul><li>diuretics, which are medications that encourage urination and therefore help maintain a proper fluid balance </li><li>bronchodilators, which may encourage the airways to stay open </li><li>steroids, which may decrease inflammation in the airways </li><li>mechanical ventilation </li><li>antibiotics, if there is suspected or proven infection in the lung </li></ul><h3>CLD and bronchopulmonary dysplasia</h3><p>The terms CLD and bronchopulmonary dysplasia (BPD) are at times used to describe the same lung condition, although there are differences. </p><p>Although in both conditions scar tissue has formed in the lungs, with BPD the fibrosis created by the scarring will generally not heal normally; this will cause the lung to become quite stiff. Additionally, babies with BPD are at a higher risk for heart problems, specifically cor pulmonale or a failure of the right ventricle of the heart. Thankfully, BPD is rare. </p><p>Although CLD cannot always be avoided through careful use of ventilation technologies, the damage caused, though similar to that of BPD, is not necessarily permanent. Babies with established CLD are often treated with supplemental oxygen and may sometimes go home needing oxygen for a few weeks or months. </p>Treatment of breathing problems in premature babies

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