Premature delivery, also known as preterm birth, is a major concern worldwide. It refers to the birth of an infant before completing the full term of pregnancy, which is considered to be 37 to 42 weeks.

When a baby is born prematurely, it can have various consequences on their respiratory system. This article will discuss the respiratory consequences of premature delivery and their impact on the well-being of these newborns.

Underdeveloped Lungs

One of the primary consequences of premature delivery is underdeveloped lungs. The lungs of a fetus typically mature during the final months of pregnancy, and premature birth disrupts this natural development process.

As a result, premature infants often have underdeveloped alveoli, which are essential for efficient gas exchange. This hampers their ability to breathe properly and can lead to various complications.

Respiratory Distress Syndrome (RDS)

Respiratory Distress Syndrome (RDS) is a common respiratory consequence observed in premature infants. It occurs due to a lack of a substance called surfactant in the underdeveloped lungs.

Surfactant is responsible for reducing surface tension in the alveoli, allowing them to remain open and function effectively. In the absence of surfactant, the alveoli collapse, leading to breathing difficulties and inadequate oxygenation.

Apnea of Prematurity

Another respiratory consequence seen in premature babies is Apnea of Prematurity. Apnea refers to a pause in breathing that lasts for more than 20 seconds.

Premature infants are prone to experiencing apnea due to the immaturity of their respiratory centers in the brain. These apneic episodes can further compromise oxygenation and require medical intervention, such as stimulation or respiratory support, to restart breathing.

Chronic Lung Disease (CLD)

Chronic Lung Disease (CLD), or bronchopulmonary dysplasia, is a long-term respiratory consequence of premature delivery. It primarily affects premature infants who required mechanical ventilation and oxygen therapy for an extended period.

CLD results from lung injury caused by oxygen toxicity, mechanical ventilation, and inflammation. The damaged lungs become scarred and stiff, leading to persistent breathing difficulties even after the baby is discharged from the hospital.

Asthma and Wheezing

Studies have shown that premature infants are at a higher risk of developing asthma and wheezing later in life.

The reasons behind this association are not yet fully understood, but it is believed to be linked to the underdeveloped lungs and disrupted lung growth. Premature babies may have ongoing airway inflammation and increased airway reactivity, making them more susceptible to respiratory conditions like asthma and wheezing.

Pulmonary Hypertension

Pulmonary Hypertension (PH) is a condition characterized by high blood pressure in the lungs. Premature infants are at an increased risk of developing PH due to the underdeveloped blood vessels in their lungs.

The combination of underdeveloped lungs, impaired blood vessel formation, and reduced production of nitric oxide (a vasodilator) contributes to increased pulmonary vascular resistance and leads to PH. This condition further complicates their respiratory status and requires specialized medical management.

Respiratory Infections

Premature infants are more vulnerable to respiratory infections compared to full-term babies. Their underdeveloped immune systems and respiratory immaturity make them susceptible to various pathogens.

Respiratory syncytial virus (RSV) is a common viral infection that can cause severe respiratory distress in premature babies. Additionally, premature infants are at a higher risk of contracting pneumonia and other respiratory illnesses, which can significantly impact their overall health and well-being.

Neonatal Respiratory Distress Syndrome (NRDS)

Neonatal Respiratory Distress Syndrome (NRDS) is primarily associated with premature delivery. It refers to respiratory distress in the first few hours after birth and is particularly seen in infants born before 34 weeks of gestation.

NRDS is caused by the lack of surfactant in the underdeveloped lungs, leading to significant respiratory compromise. Prompt medical intervention, such as surfactant replacement therapy and respiratory support, is crucial in managing NRDS and preventing further complications.

Apnea-Bradycardia Episodes

Apnea-Bradycardia episodes, commonly referred to as “spell episodes,” are a significant concern in premature infants. These episodes involve a combination of apnea (pauses in breathing) and bradycardia (drop in heart rate).

Apnea-Bradycardia episodes can further compromise oxygenation and circulation in these vulnerable babies. Close monitoring and intervention with respiratory support or stimulation are necessary to prevent adverse outcomes associated with these episodes.

Prevention and Management

Prevention and management strategies play a crucial role in mitigating the respiratory consequences of premature delivery.

Prenatal care, including progesterone administration, has shown promising results in reducing the incidence of premature birth and subsequent respiratory issues. In the neonatal period, respiratory support in the form of ventilation, oxygen therapy, and surfactant replacement therapy is essential.

Close monitoring, infection prevention, and proper nutrition also contribute to the overall management of respiratory consequences in premature infants.