Lung Disease in Premature Infants
Premature infants are at risk for a variety of lung problems and diseases, in part because infants can survive birth at earlier ages than ever before. According to the New England Journal of Medicine, infants today “consistently” survive birth at 23-26 weeks’ gestation. However, as a result, their lungs are less developed than a full term baby’s lungs, potentially leading to problems down the road. Here are a few conditions that premature babies may face both in the neonatal intensive care unit (NICU) and after discharge.
Respiratory distress syndrome (RDS)
Premature babies often lack adequate surfactant, a special substance inside the lungs that makes it easier to breathe by preventing the lungs from collapsing. This condition, known as respiratory distress syndrome (RDS), is the most common lung problem affecting premature babies. Premature babies (usually those born before 36 weeks’ gestation) with RDS generally require treatment with surfactant immediately after birth. This medication coats their air sacs and enables them to breathe easier. Some babies with RDS require more intervention. They may need a temporary ventilator or continuous positive airway pressure (CPAP), which offers adequate airway pressure until their lungs mature and get stronger.
Bronchopulmonary dysplasia (BPD)
Bronchopulmonary dysplasia can occur in premature infants who suffer from RDS. BPD is typically seen in premature infants born at or before 30 weeks gestation who need supplemental oxygen for a prolonged period of time. Infants with BPD have lung scarring and abnormal lung development. Fortunately, many babies outgrow BPD. However, others might need medications or lung treatments for years to come, including diuretics, inhaled steroids, and bronchodilators (a type of medicine that helps open up the lung passages to allow air to flow through more freely). According to the National Heart, Lung, and Blood Institute (NHLBI), between 5,000 and 10,000 new cases of BPD occur every year in the U.S.
Sometimes, premature babies have erratic breathing. In fact, even full-term healthy babies have moments when their breathing is uneven, referred to as periodic breathing. However, premature babies with infant apnea require close monitoring. The American Academy of Pediatrics (AAP) defines apnea as \"an unexplained episode of cessation of breathing for twenty seconds or longer, or a shorter respiratory pause associated with bradycardia (low heart rate), cyanosis (blue color to the skin), pallor (paleness), and/or marked hypotonia (baby becomes floppy).” While in the NICU, the baby may require CPAP or even an infant form of caffeine to stimulate the baby to breathe regularly. Premature babies with infant apnea will oftentimes go home from the NICU unit with monitoring equipment. Sensors located in a special vest will detect and monitor both breathing and heart rate, and an alarm will sound if either of these fall below a safe range.
Persistent pulmonary hypertension of the newborn (PPHN)
Premature infants can have high blood pressure in their lungs called persistent pulmonary hypertension of the newborn (PPHN). This condition most often occurs when babies aspirate meconium during labor. These infants are likely to require the use of mechanical ventilation until the condition resolves. They may require high-frequency ventilation, which is a specialized ventilator to help the lungs heal more quickly. They will also receive medication to help them breathe, including surfactant. PPHN can also occur in full term infants (approximately 2 per 1,000 babies) and is actually more common in full term infants than premature infants.
Lung infections can be dangerous for any baby but premature infants are at a much higher risk of complications from either viral or bacterial causes. Respiratory syncytial virus (RSV) is the most common cause of viral lung infections in premature babies. (RSV) can infect anyone, but is a cause for concern in premature infants because their lungs are weaker. Treatment is usually just supportive, including oxygen and IV fluids. Viral infections can sometimes be complicated by bacterial pneumonia. Newborns with pneumonia will likely require supplemental oxygen until they get over the insult to their already fragile lungs. IV antibiotics are also used to combat the infection.
Reviewed by Dr. Sara Connolly, December 2018
- American Lung Association
- Understanding Bronchopulmonary Dysplasia (BPD). Baraldi, E., and Filippone, M
- Chronic Disease after Premature Birth
- N Eng J Med 2007:1946-55. Centers for Disease Control and Prevention
- Respiratory syncytial virus (RSV). Committee on Fetus and Newborn
- American Academy of Pediatrics
- Apnea, sudden infant death syndrome, and home monitoring
- Apr 2003;111(4 Pt 1):914-7. March of Dimes
- Common Conditions Treated in the NICU.
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