If your baby has been taken into the NICU for breathing issues, this post contains a short primer on the different kinds of breathing support offered to babies. First, hugs - we understand how concerning it is to hear your baby is struggling to breathe. Your baby's team will be doing their best to get them back into shape as soon as possible.
Basics about oxygenation
The air around us in the world contains 21% oxygen. This is the minimum amount that all of us need to keep our blood oxygen levels in a good range. When babies are struggling to keep their blood oxygen levels in a good range, doctors can help them by upping the percentage of oxygen into the air that they breathe. Your doctor can adjust the percentage of oxygen from 21% (called “room air”) all the way up to 100%.
Your doctor can also help baby by adding pressure into the air, so it is easier to inflate the lungs. This is sometimes needed because lungs are not meant to deflate all the way; when this happens, they “collapse” and it’s hard to open them up again. This happens sometimes with younger babies, or even with older gestation babies when they don’t produce enough of a substance called “surfactant”. The surfactant coats the lungs and prevents them from collapsing.
Types of breathing support
The ventilator or "vent": Ventilators offer the highest kind of support. They are offered to babies who can't breathe on their own, usually because their brains are still immature or because they are otherwise too weak to sustain their own breathing. A baby who needs a vent will be “intubated”, which means they will get a tube placed into their windpipe. This tube will allow them to get air (usually mixed with oxygen) into and out of the lungs in a controlled manner.There are various types of vents, including the conventional ventilator, the jet, the oscillator, and NAVA. They differ in how they assist ventilation (for example, some give them frequent, smaller breaths, and some others give them fewer, bigger breaths), and sometimes each method will mean they will change how you will be able to interact with your baby. Some methods mean you will not be able to pick up or hold your baby for a while. Remember to ask your nurse what kind of vent they are in, and how it works.
Positive airway pressure (CPAP and BiPAP): This kind of support is used in babies who are able to sustain their own breathing, but who may need help with maintaining their lungs inflated. The little masks blow air into the lungs at a certain pressure; the CPAP machine maintains a constant pressure all the time, while BiPAP has two different pressures, one for breathing in and one for breathing out.
Nasal cannula (high flow or low flow): Nasal cannulas offer the lowest kind of respiratory support. When babies don't need additional pressure but still can benefit from a bit of help to maintain their blood oxygen levels, they will use these cannulas that deliver oxygen. In some cases, babies who are on low flow oxygen can be discharged home with it (in which case you'll have oxygen tanks at home until baby outgrows the need for additional support).
Is it possible to skip some kinds of respiratory support?
Yes, not all babies will need all of these, and if a baby is doing well, they may be able to move through them quickly or skip some altogether. Your baby's doctor will try to wean them considering their oxygen levels and their overall state.
I got steroids before my baby was born. Will they help?
Yes, steroids can help baby avoid the need for respiratory support. But even with steroids, some babies can need a little help at first. It depends on many factors like gestational age at birth, size, mode of delivery, other underlying conditions, etc. Babies who are near or at term and who don't have other health conditions will usually spring back very soon.
My baby was doing so well, but now they’ve had to take a step back. Why, what is going on?
Hugs, we’re so sorry. Remember that breathing is hard work for our littles! Sometimes they just need to rest a little after working so hard, and this step back will allow them to rest and recharge. It doesn’t mean that baby won’t be able to keep progressing.
If you feel like the numbers and settings in the machines are causing you stress, it’s okay to not watch them and to concentrate on your baby. Take your cues from the nurses and doctors - they see the big picture and know what back and forth is normal vs. when it is time to be concerned, and they will let you know.
I see they’re giving my baby support, but their oxygen saturation is not at 100%. Why aren’t they helping them more?
Good question! The NICU staff will want to aim for numbers closer to 95% rather than 100% if your baby was premature, as this can prevent a complication called retinopathy of prematurity (ROP), an eye condition.
Questions to ask your NICU staff
What kind of breathing support does my baby need?
Do you expect my baby to need this kind of support for a long time? What should I expect?
Can I hold my baby? What kind of interaction is okay?