why do premature babies have difficulty breathing

Another common respiratory problem of premature babies is called apnea of prematurity. This occurs when the baby stops breathing. It often causes the heart rate and oxygen level in the blood to drop. Apnea occurs in almost of babies who are born before 28 weeks gestation. Itвs much less common in older premature babies, especially those born at 34 weeks or later. Apnea usually does not happen immediately after birth. It occurs more commonly at 1 to 2 days of age and sometimes is not obvious until after a baby has been weaned from a ventilator. There are two main causes of apnea in premature infants. The baby forgets to breathe, simply because the nervous system is immature. This is called central apnea. The baby tries to breathe, but the airway collapses. Air canвt flow in and out of the lungs. This is called obstructive apnea. Premature babies frequently have mixed apnea, which is a combination of central and obstructive apnea. A baby who is at risk for apnea needs to be connected to a monitor that records the heart rate, the breathing rate, and the oxygen level in the blood. If any of these rates fall below normal levels, an alarm sounds, alerting the hospital staff that the baby is having an episode of apnea. The staff then stimulates the baby, usually by gently rubbing the baby s chest or back. The baby begins to breathe again.

Occasionally, a baby requires assistance with a bag and mask to begin breathing again. Central apnea can be treated with a medication called, or with caffeine. Both of these drugs stimulate the baby s immature respiratory system and reduce the number of episodes of apnea. If they don t, or if the episodes are severe enough to require the staff to frequently stimulate the baby s breathing with a bag and mask, the baby may need to be put on a ventilator. This will be the case until the nervous system matures. Babies with purely obstructive apnea often need to be connected to a ventilator through an endotracheal tube to keep the airways open. Apnea of prematurity usually resolves by the time a baby is 40 to 44 weeks of age. This includes the number of weeks of pregnancy plus the number of weeks since the baby s birth. Sometimes, itвs resolved as early as 34 to 35 weeks. But occasionally, apnea persists and the baby requires long-term therapy. Parents may need to give their baby aminophylline or caffeine, and use an apnea monitor at home. In that case, parents are trained to use the monitor and to give CPR to stimulate breathing. Babies are not sent home on a monitor unless they are otherwise stable and are having only rare episodes of apnea in a 24-hour period.
A baby needs a fully developed set of lungs in order to breathe well on her own and to provide enough oxygen for her bodyвs tissues.

A premature babyвs lungs may be underdeveloped, causing difficulty with breathing and putting the baby at risk of developing complications. Extra care must be given to the baby born prematurely to sustain her with enough oxygen for her body, while her lungs continue to develop as she grows. Babies develop lungs before they are born, but while still in the womb they do not breathe air. The lungs begin as tiny buds that lengthen into the branches of the airways by 16 weeks gestation. By 28 weeks gestation, tiny sacs known as alveoli are developing and surfactant is excreted. Surfactant lubricates the lung tissue and promotes elasticity for better oxygen exchange after delivery. As soon as a baby is born, he begins to breathe the air around him. The air travels down into the lungs, where it is dispersed into the alveoli, which are located at the outer edges of the lung tissue. They are surrounded by blood vessels. The membranes of the alveoli are extremely thin to allow oxygen particles to transfer into the blood vessels. Alternatively, carbon dioxide in the bloodstream crosses back into the alveoli where it is sent out of the body when a baby exhales. Because surfactant production occurs later in pregnancy, babies that are born prematurely may have less, causing breathing difficulty after birth.

Treatment of this condition involves helping a baby to breathe using oxygen and a ventilator. A physician may give artificial surfactant directly into the lungs after birth to help with breathing as a baby continues to grow. Artificial surfactant is an important treatment, because if a baby is born before her lungs have fully developed, she will not continue to produce surfactant after birth. Many premature babies receive oxygen through a ventilator, which delivers a set number of breaths each minute to help with breathing. Long-term ventilator use while a babyвs lungs are developing can cause damage to the fragile tissues, resulting in scarring and decreased elasticity. This condition is known as bronchopulmonary dysplasia (BPD), and can lead to long-term conditions such as increased susceptibility to infections or the development of asthma. According to the American Pregnancy Association, most babies have mature lung tissue by approximately 36 weeks gestation. If a mother goes into preterm labor before 36 weeks, there is a risk of having a baby with immature lung tissue. Some physicians give mothers a steroid injection, which can help promote lung development in a fetus before birth. Steroid injections are typically only given when delivery of a preterm baby is imminent.

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