It can be overwhelming to see your newborn connected to machines in the Neonatal Intensive Care Unit (NICU). A ventilator is a common form of life support that helps your baby breathe when they cannot do so on their own. It works by gently pushing air and oxygen into the lungs through a small tube, giving your baby’s body the time it needs to heal and develop.
The primary function of the ventilator is to ensure your baby receives enough oxygen and removes carbon dioxide, a process called gas exchange. Without adequate gas exchange, the level of oxygen in the blood can become too low, and carbon dioxide can become too high. The NICU team constantly monitors these levels to provide the precise amount of support your baby needs.
Medical Reasons for Ventilator Support
Several medical conditions can prevent a newborn from breathing effectively, requiring ventilator support.
- Respiratory Distress Syndrome (RDS): Common in premature infants, RDS occurs because underdeveloped lungs do not produce enough surfactant. This substance keeps the tiny air sacs in the lungs from collapsing. Without sufficient surfactant, the lungs can’t expand properly, requiring ventilator assistance to keep them open and deliver oxygen.
- Meconium Aspiration Syndrome: This happens when a baby inhales a mixture of meconium (the baby’s first stool) and amniotic fluid around the time of birth. This substance can block airways and cause inflammation and damage to lung tissue. A ventilator helps support breathing while the lungs recover.
- Persistent Pulmonary Hypertension of the Newborn (PPHN): This is a circulatory issue where a newborn’s circulation system doesn’t adapt to breathing outside the womb. Blood pressure in the lungs remains high, shunting blood away from the lungs and leading to low oxygen levels. A ventilator is used to deliver high concentrations of oxygen to help relax the lung’s blood vessels.
- Severe Infections: Conditions like pneumonia or sepsis can impair a baby’s ability to breathe. An infection can cause inflammation in the lungs, filling the air sacs with fluid and making it difficult for oxygen to enter the bloodstream. Ventilator support is provided to manage breathing while antibiotics and other treatments combat the infection.
The Ventilator and the NICU Environment
The NICU can be intimidating with its unfamiliar equipment and sounds. The ventilator is a bedside machine connected to your baby by an endotracheal (ET) tube, a flexible tube placed through the baby’s mouth or nose and into their windpipe. This tube is secured to stay in position, and the ventilator delivers warmed, humidified air with a specific amount of oxygen to the lungs.
The machine makes gentle puffing sounds as it delivers breaths, and you will hear various beeps and alarms. While these sounds can be alarming, they are a normal part of the NICU. The alarms are safety features that alert the nursing staff to any changes in your baby’s condition or the machine’s function, and they are trained to respond immediately.
Your baby will also be connected to several other monitors that provide constant information about their well-being. These include small sensors on the chest that track heart and breathing rates, and a probe wrapped around a hand or foot to measure oxygen saturation. These monitors provide a continuous, real-time picture of your baby’s stability, allowing the medical team to provide precise care.
The Weaning Process
The journey to breathing independently is a gradual process known as “weaning.” This involves slowly decreasing the amount of support the ventilator provides, allowing the baby’s own respiratory muscles to take on more of the work. The NICU team manages this process carefully, making changes only when the baby shows signs of stability and increased strength.
Weaning begins by reducing the ventilator’s settings, such as the number of breaths it delivers per minute or the amount of pressure it uses. As the baby demonstrates the ability to initiate more of their own breaths and maintain good oxygen levels, the support is further reduced. The pace is individualized and depends on the baby’s specific medical condition and overall progress.
As part of the weaning process, the medical team may conduct spontaneous breathing trials. During these trials, the baby is allowed to breathe on their own through the endotracheal tube for short periods while being closely monitored. Successfully completing these trials is a strong indicator that the baby is ready for extubation, which is the removal of the breathing tube.
Parental Interaction and Bonding
Even when your baby is on a ventilator, there are many ways you can connect and bond. Your presence and touch are comforting and contribute to your baby’s development. The NICU staff will guide you on how to interact safely, such as through gentle touch by holding your baby’s hand or placing a hand on their body.
Your baby became familiar with your voice in the womb, and hearing you talk, read, or sing can be incredibly soothing. This auditory stimulation is important for their brain development and helps them feel secure in the unfamiliar NICU. Simply telling your baby about your day can create a meaningful connection.
When your baby is medically stable, the team may encourage “kangaroo care,” which involves holding your baby skin-to-skin on your chest. Research shows that skin-to-skin contact helps regulate a baby’s heart rate, breathing, and temperature, and can promote better sleep. This practice is also beneficial for parents, as it can increase feelings of closeness and confidence.
If you plan to breastfeed, providing breast milk is another way to be actively involved in your baby’s care. Breast milk can be given through a feeding tube and provides important antibodies and nutrients that help protect your baby from infection. The NICU team can provide support and equipment to help you pump and store your milk.
Recovery After Extubation
The removal of the breathing tube, or extubation, marks a major step forward, but your baby’s respiratory journey is not over. After the tube is removed, your baby will be monitored closely to ensure they can continue to breathe effectively on their own. It is common for babies to need some form of less invasive respiratory support during this transitional period.
Often, babies will be placed on Continuous Positive Airway Pressure (CPAP) or receive oxygen through a nasal cannula. A CPAP machine delivers a gentle, continuous flow of air through small prongs in the baby’s nose to help keep the air sacs open. A nasal cannula is a smaller tube that sits under the nose to deliver oxygen, providing support while allowing more freedom of movement.
The medical team is prepared for the possibility that a baby may struggle after extubation and need to be reintubated. This is not a step backward but an indication that the baby’s lungs need more time to strengthen. The care team will assess your baby’s work of breathing and oxygen levels to determine the best course of action.