When a baby is intubated, a flexible plastic tube (endotracheal tube or ETT) is placed into their windpipe (trachea) to help them breathe. This tube provides a pathway for air and oxygen to reach the lungs, often connecting to a ventilator. Intubation is a supportive measure, ensuring adequate oxygen supply and carbon dioxide removal.
Reasons for Intubation
Babies may require intubation for various medical reasons, primarily involving compromised breathing. Respiratory Distress Syndrome (RDS) is common in premature infants whose lungs lack sufficient surfactant, a substance that keeps tiny air sacs open. Without enough surfactant, these air sacs collapse, making breathing difficult.
Another reason is apnea, particularly in premature infants, where a baby stops breathing for periods, often due to immature brain respiratory control centers. Severe infections like sepsis can overwhelm a baby’s body, including their respiratory system, leading to a need for breathing support. In such cases, intubation ensures the baby receives adequate oxygen.
Intubation is also performed during surgical procedures requiring general anesthesia to protect the airway. Neurological conditions affecting the brain or nerves that control breathing, such as those causing muscle weakness or airway obstruction, may also necessitate intubation. Any severe illness or trauma that weakens a baby’s ability to maintain sufficient breathing can also lead to intubation.
The Intubation Procedure and Initial Care
Baby intubation is a precise procedure performed by trained medical professionals, such as neonatologists or anesthesiologists. Before the procedure, the medical team assesses the baby’s condition and prepares necessary equipment, including a laryngoscope and appropriately sized endotracheal tubes. If not an immediate emergency, medication for sedation and pain management may be given for comfort.
During the procedure, the baby is positioned on their back, often with a small roll under their shoulders to align the airway. The clinician inserts a laryngoscope to visualize the vocal cords, then guides the ETT through the vocal cords into the trachea. This process is usually quick. Once in place, the ETT connects to a ventilator, which assists or takes over the baby’s breathing.
Immediately after intubation, the medical team confirms the tube’s correct placement. This involves listening for equal breath sounds in both lungs and checking for exhaled carbon dioxide, which indicates the tube is in the airway rather than the esophagus. A chest X-ray is then taken to confirm the precise depth of the tube within the trachea, ideally positioned between the first and second thoracic vertebrae (T1-T2), about 1 cm above the carina. The ETT is then secured to prevent accidental displacement, often with tape or a specialized device, and the baby’s vital signs are continuously monitored in a Neonatal Intensive Care Unit (NICU).
Ongoing Support and Recovery
Once a baby is intubated, continuous monitoring is in place to ensure their stability and progress. Medical staff closely observe various parameters, including heart rate, respiratory rate, oxygen saturation levels, and blood pressure. These readings help the team adjust ventilator settings and provide personalized care.
Medications are administered to keep the baby comfortable and to address any underlying medical conditions. Sedatives, such as fentanyl or midazolam, are often used to minimize discomfort and prevent the baby from “fighting” the ventilator, while other medications like antibiotics may be given if an infection is suspected. Babies who are intubated cannot feed orally, so they receive nutritional support through intravenous (IV) fluids or feeding tubes that deliver breast milk or formula directly to their stomach. These feeding methods ensure adequate calories, protein, fats, and electrolytes for growth and development.
As the baby’s condition improves, the medical team begins the weaning process, gradually reducing the ventilator’s support. This involves decreasing the pressure and rate provided by the machine, encouraging the baby to breathe more on their own. The goal is to reach a point where the baby can maintain adequate oxygenation and carbon dioxide removal independently, at which point the ETT can be removed, a process called extubation.
After extubation, the baby is closely monitored for any signs of respiratory distress. They may receive less invasive breathing support, such as continuous positive airway pressure (CPAP) or high-flow nasal cannula, to help their lungs adjust. While temporary hoarseness or mild throat irritation is common after tube removal, usually resolving within a day or two, medical staff also watch for potential complications like post-extubation laryngitis. Throughout this recovery, parental involvement, including gentle touch and bonding, plays a significant role in the baby’s emotional well-being and overall progress.