Seeing your baby in the Neonatal Intensive Care Unit (NICU) connected to tubes and monitors can be overwhelming. For many families, a common sight is the use of oxygen to support their infant’s breathing. This intervention is a standard part of care for many newborns, especially those born prematurely or with health challenges. Medical teams use carefully controlled oxygen as a bridge, supporting a baby’s lungs as they mature and develop the ability to breathe sufficiently on their own.
Conditions Requiring Oxygen Support in the NICU
Several conditions may lead to a newborn needing breathing support. One of the most common reasons, particularly for premature infants, is Respiratory Distress Syndrome (RDS). Babies born before their lungs are fully developed may not produce enough surfactant, a substance that keeps the tiny air sacs in the lungs from collapsing. Without enough surfactant, each breath is a significant effort, and the baby struggles to get enough oxygen.
Another condition is Transient Tachypnea of the Newborn (TTN), a period of rapid breathing that occurs shortly after birth. It is caused by leftover fluid in the lungs, and while temporary, infants with TTN may require supplemental oxygen as their lungs clear the fluid.
A less common condition is Persistent Pulmonary Hypertension of the Newborn (PPHN). In PPHN, a baby’s circulatory system does not adapt correctly after birth, causing blood to bypass the lungs and limit oxygen absorption. These infants require oxygen support to help relax the blood vessels in the lungs and improve blood flow.
Methods of Delivering Oxygen
The way oxygen is provided depends on how much support an infant needs. The least invasive method is a nasal cannula, which consists of small plastic prongs that sit inside the baby’s nostrils. This approach delivers a higher concentration of oxygen and is used for babies who can breathe on their own but need extra help, allowing for easier feeding and comforting.
For infants needing more substantial support, a Continuous Positive Airway Pressure (CPAP) machine may be used. CPAP delivers lightly pressurized air, often with added oxygen, through a mask or nasal prongs. This constant pressure helps keep the air sacs in the lungs open between breaths, making breathing easier.
When a baby is unable to breathe effectively on their own, a mechanical ventilator is required. This involves placing a breathing tube into the baby’s windpipe, which connects to a machine that takes over the work of breathing. This is the most intensive form of respiratory support.
Monitoring Oxygen Saturation Levels
Parents in the NICU become familiar with the pulse oximeter. This small device, often wrapped around a baby’s hand or foot, is a non-invasive tool that continuously measures oxygen saturation levels in the blood (SpO2). This constant monitoring allows the medical team to make immediate adjustments to a baby’s oxygen support as needed.
The numbers on the monitor can be a source of anxiety, but it is helpful to understand the goals. For many premature infants, the target oxygen saturation level is not 100%, but a range, often between 90% and 95%. The care team carefully calibrates the oxygen support to keep the baby within this safe and effective range.
The alarms from the monitor can be startling but do not always signal an emergency. These alarms are sensitive and alert nurses to even minor changes, such as a baby’s movement temporarily affecting the probe’s reading. Staff are trained to assess the situation quickly, and often a simple repositioning of the baby or sensor is all that is needed.
Potential Complications of Oxygen Therapy
While oxygen is a necessary treatment, its use requires a delicate balance to avoid potential complications. The NICU team’s goal is to use the lowest effective amount of oxygen for the shortest time possible. Prolonged exposure to high concentrations of supplemental oxygen can contribute to specific health issues, particularly in very premature infants.
One of the primary concerns is Bronchopulmonary Dysplasia (BPD), a form of chronic lung disease. BPD can develop when an infant requires long-term use of a mechanical ventilator and extra oxygen, which can lead to inflammation and scarring in the lung tissues. This makes the lungs stiff and less efficient at exchanging gas.
Another complication is Retinopathy of Prematurity (ROP), an eye disease that affects the development of the retina’s blood vessels in premature babies. Exposure to high levels of oxygen can disrupt their normal growth. In most cases, ROP is mild and resolves on its own, but severe cases can lead to vision problems if not treated.
The Weaning Process
The journey toward breathing independently is a gradual one, known as weaning. This process involves slowly reducing a baby’s oxygen support as their lungs mature and they grow stronger. The medical team assesses a baby’s readiness for the next step by observing their breathing rate, oxygen saturation levels, and overall comfort.
Weaning is a step-down process that often mirrors how support was initiated, moving from more invasive to less invasive methods. A baby may transition from a ventilator to CPAP, then to a nasal cannula before breathing entirely on their own. Each step is a milestone, though it is common for the process to have forward and backward steps.
In some situations, particularly for infants with BPD, a baby may be ready for discharge but still require a small amount of oxygen. In these cases, parents are trained to manage home oxygen equipment. This allows the baby to continue growing at home while giving their lungs more time to heal.