Lung Disease in Premature Infants
Nabta • May 29, 2022 • 5 min read
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.
Apnea
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.
Infections
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
Sources:
- 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
- Pediatrics
- Apr 2003;111(4 Pt 1):914-7. March of Dimes
- Common Conditions Treated in the NICU.
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Can Exercise Help to Relieve Postnatal Depression?
Exercise help to relieve postnatal depression after the birth of a baby, called [postnatal or postpartum depression](https://nabtahealth.com/what-is-postnatal-depression/) ([PND](https://nabtahealth.com/glossary/pnd/)), is common. Thought to affect between 10 and 20% of new mothers, some of the main symptoms are frequent crying, a feeling of listlessness and tiredness, and an inability to fully bond with their baby. The reasons why some women are more susceptible to [PND](https://nabtahealth.com/glossary/pnd/) than others have not been fully established, but with many reporting that they had unrealistic expectations of what being a mother would feel like and others struggling with low self esteem due to an altered body shape, perhaps the high proportion of women diagnosed with [PND](https://nabtahealth.com/glossary/pnd/) is unsurprising. The vast array of physico-chemical and hormonal changes that occur during pregnancy and beyond probably play a role, however the exact mechanisms and contributing factors are still unclear. #### **The problem** Despite its high prevalence and the long-term health risks it poses, not just to the mother, but also her baby… despite the fact that it can impact a woman’s relationship with her husband, her friends and other family members… despite the fact that in its most severe form, it can [lead](https://nabtahealth.com/glossary/lead/) to suicidal thoughts… despite all of this, and more, current treatment options are limited to say the least. Postnatal health and weight management is important. Following pregnancy, many women are left with excess weight and reduced fitness, at a time when being fit and healthy is vital. The problem is that whilst this is widely known, there are no universal guidelines to support and instruct women on how to maximise their health and fitness post-childbirth. #### **So, can exercise help?** Let’s consider the literature first. There have been a significant number of studies demonstrating that regular exercise is beneficial for the general population. There have even been studies showing the importance of mothers-to-be maintaining a good level of overall fitness throughout their pregnancies. In the general population, physical activity has been shown to reduce stress, anxiety and depression; it has an important role in the promotion of good mental health. The National Institute for Health and Clinical Excellence (NICE) in the UK recommends that for adults with mild/moderate depression a structured group physical activity programme should form part of their ‘facilitated self-help’. The NICE guidelines on the management of [PND](https://nabtahealth.com/glossary/pnd/) make no specific mention of physical activity being used as an adjuvant tool, although they do refer people to the section of facilitated self help under the guidelines for clinical depression. An older version of the NICE guidelines did indicate that moderate exercise could benefit women with [PND](https://nabtahealth.com/glossary/pnd/), but newer versions seem to have removed this statement. Perhaps, this is unsurprising. Literature searches and meta analyses are fairly inconclusive. Data on the benefits of exercise for women struggling after childbirth is conflicting and positive associations are weak. There is a need for more robust, longer-term studies. Without the evidence to support it, few health institutes will be prepared to list the undertaking of physical activity as a viable treatment option. 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But, this is a topic I feel quite passionately about. I do believe exercise can improve a negative mindset, I am a great advocate of group exercise programmes and this is why. I never had clinically diagnosed [PND](https://nabtahealth.com/glossary/pnd/), but, like many women, I struggled after giving birth; I missed my independence and I found it a very socially isolating experience. In many ways, the second time round was easier, we knew what we were letting ourselves in for; life had changed significantly with our first baby. how much difference would another one really make (the absolute naivety of that statement is a topic for another time!)? What was difficult with round two, was that we had recently moved overseas; we moved when I was 12 weeks pregnant. And so, I found myself living in a different country, with no family, few meaningful friendships, a husband that worked, a toddler and a newborn. I still would not say I was depressed; I did not struggle in the way that some women do, but I was lonely and that can have a big impact on a person’s quality of life. I lived for the weekends, when my husband was home, but by then was too irritable and tired to make the most of it. Things changed hugely for me when I found a postnatal exercise class to join. I could take the baby and nobody minded if I had to stop part way through and breastfeed, but the main thing was, it was something for me; the focus being on me, and not on the baby. Sure, he got to come along, have a change of scene, stare at himself in a mirror and dribble over other baby’s toys; so you could say we both benefitted. I made friends, like-minded women, who were in a very similar position to me; I got fitter and felt better about my own body; I improved my energy levels and, ultimately, improved the relationship I had with my husband and my children. So, yes, I will take on board what the science says, I will not guarantee physical activity as the best and only way of relieving the symptoms of [PND](https://nabtahealth.com/glossary/pnd/). But, I will suggest that if you are struggling, find a type of exercise that works for you, with or without baby (there is no shame in having a break sometimes), and go for it. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#463f272a2a270628272432272e23272a322e6825292b) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * “1 Guidance: Depression in Adults: Recognition and Management: Guidance.” NICE, [https://www.nice.org.uk/guidance/cg90/chapter/1-Guidance#step-2-recognised-depression-persistent-subthreshold-depressive-symptoms-or-mild-to-moderate](https://www.nice.org.uk/guidance/cg90/chapter/1-Guidance#step-2-recognised-depression-persistent-subthreshold-depressive-symptoms-or-mild-to-moderate). * “1 Recommendations: Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance: Guidance.” NICE, [https://www.nice.org.uk/guidance/cg192/chapter/1-Recommendations](https://www.nice.org.uk/guidance/cg192/chapter/1-Recommendations). * Carter, Tim, et al. “The Effectiveness of Exercise-Based Interventions for Preventing or Treating Postpartum Depression: a Systematic Review and Meta-Analysis.” _Archives of Womens Mental Health_, vol. 22, no. 1, Feb. 2019, pp. 37–53., doi:10.1007/s00737-018-0869-3. * Daley, Amanda J, et al. “The Effectiveness of Exercise as a Treatment for Postnatal Depression: Study Protocol.” _BMC Pregnancy and Childbirth_, vol. 12, no. 1, 9 June 2012, doi:10.1186/1471-2393-12-45. * Saligheh, Maryam, et al. “The Relationship between Postnatal Depression, [Sociodemographic](https://nabtahealth.com/glossary/sociodemographic/) Factors, Levels of Partner Support, and Levels of Physical Activity.” _Frontiers in Psychology_, vol. 5, 14 July 2014, doi:10.3389/fpsyg.2014.00597.
Getting started with Nabta Health; Your 101 Guide to Maternal Health
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Feeling Overwhelmed? Learn 3 Tools to Help
* The first step is to admit that you are feeling overwhelmed. * It’s important to involve your whole self (mind & body) in order to get the most effective results when overcoming overwhelm. * Tools and techniques you can use include breathing exercises, writing lists, and learning to say no. Yes, we’re still overwhelmed. No, we don’t just need to learn to relax. In our series of articles about career development and returning to work after maternity leave or a break, we explore the topic of how to deal with feeling overwhelmed. For more advice on how to get back into your career, sign up for a course with [Get Unstuck Career Coaching on the Nabta Health Women’s Shop](https://nabtahealth.com/product/back-to-work-online-career-coaching/). The 4 part ‘get back to work’ course includes a session on Using Emotional Intelligence as a Foundation for Career Development. By the end of the program, participants have the tools and confidence they need to approach job opportunities. Recognising overwhelm, and learning how to overcome feeling overwhelmed are crucial to tackling new challenges such as [work](https://www.getunstuckcareercoaching.com/post/getting-back-to-work-after-pregnancy), with confidence. #### Feeling constantly overwhelmed With everything that’s happened in the last year, the effects of the pandemic are still very real and will continue to affect us for some time. One of those effects is this feeling of constant overwhelm. Overwhelm of emotions, change, information, grief, and the unknown that is ultimately scraping away at our overall well-being. We mustn’t forget that our well-being is always important and just because time has passed since the beginning of the pandemic doesn’t mean that it’s gotten any easier to manage. We all know, rationally, the things we can do to help: eat healthier, exercise, get quality sleep. But it can be hard to do these things when you’re stuck in overwhelm. So, let’s look at some practical things you can start doing today that may help you get started. First of all, if you find yourself feeling this way a lot, you’re not alone. It can be difficult to admit but there are more of us feeling overwhelmed than not. Second, there are some things that you can try that might give you a little breathing room. You’ll notice that a couple of the things I mention below have to do with your body and I believe it’s important to involve your whole self (mind & body) in order to get the most effective results. #### How to overcome feeling overwhelmed ##### 1 **Breathe** More specifically, breathe in for 7 seconds and breathe out for 11 seconds. And repeat for at least 1 minute. You can also breathe in for 4 and out for 8, the idea is that you’re breathing out for a longer period of time than you’re breathing in. This method of breathing activates your parasympathetic nervous system, slows your heart rate down, and allows your body to slow down. I first learned about this technique during a hypnobirthing course I did when I was pregnant and have sworn by it ever since. ##### 2 **Make a list** Write it down using a pen and paper. Make a list of everything that is on your to-do list, everything that is causing the overwhelm. A great technique that I follow was created by [Ryder Carroll, the author, and creator of the Bullet Journal.](https://bulletjournal.com/pages/about) He says to create 3 columns and in the first one write down all the things that you’re currently working on, in the second column make a list of everything you should be working on, and in the third column list everything you want to be working on. Spend time on this exercise, don’t rush it. Each thing can be written down as a bullet point in short form. This method allows you to see your mental inventory. Then you want to look at this inventory you’ve created and ask yourself, for each bullet point, 1) Does this matter? (not just to you but maybe someone you care about) And 2) Is this vital? (to your housing, loans, job, etc.) Any point on your list that you answer with a “No” to both of these questions, can then come off your list. You should be left with only things that matter and/or are vital to you. “Everything else is a distraction,” says Carroll. He also mentions that it’s more beneficial to do this using a pen and paper so that you can be more mindful and present (rather than typing it on your phone or computer). ##### 3 **Learn to say “no”** And then keep practicing until it becomes a natural way for you to prioritize the tasks, people, and situations that you know won’t cause you unnecessary stress. Just like the mental inventory exercise above, notice what activities you’re doing that make you counter-productive and take up a lot of energy, which ones can you stop doing today? 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To learn more about how to build your emotional strength and apply this in a work context, consider using a [career coach.](https://nabtahealth.com/product/back-to-work-online-career-coaching/) You’ll gain the tools you’ll need and you will develop self awareness and social awareness, self management skills and relationship management skills. Get Unstuck’s session on [Using Emotional Intelligence as a Foundation for Career Development](https://nabtahealth.com/product/back-to-work-online-career-coaching/) is a great one for learning practical techniques for building confidence when returning to work. Reviewed by the Nabta Editorial Team