Two Newborn Breathing Conditions That Can Lead to NICU Care

Parents of a premature baby expect that their baby is likely to require specialised care in a neonatal ICU. When a mother carries to term in what appears to be a healthy, normal pregnancy, it can come as a big shock when the baby suddenly requires admission to the neonatal ICU.

In this blog, we will have a look at two conditions which may occur in a full-term baby and lead to an ICU admission. The first condition is known as Persistent Foetal Circulation (PFC) and the second is Transient Tachypnea of the Newborn (TTN). 

Persistent Foetal Circulation (PFC) or Persistent Pulmonary Hypertension of the Newborn (PPHN)

During pregnancy – While baby is safely tucked up in the womb, it receives oxygen via Mom’s bloodstream. It is a remarkable exchange. The oxygen-rich blood travels through Mom’s arteries to the placenta. Baby and the placenta are connected by the umbilical cord. The umbilical cord acts as a conduit, allowing the oxygenated blood to travel from the placenta to the baby. Carbon dioxide is sent back through the umbilical cord to the placenta and then back to mom to be eliminated.

At birth– Once baby is born and the umbilical cord is cut, baby no longer has the safety net of the placenta and the tiny new lungs need to take over the job of breathing. It is a complicated process. As soon as baby is exposed to air, hormones in the lungs expel fluid, allowing the little lungs to open and for baby to take its first breath. As soon as this happens, pressure in the left side of the heart rises and a valve closes. Blood then flows to the lungs, picks up oxygen, returns to the left side of the heart and normal circulation begins.

But what if this doesn’t happen? There are times when the lungs don’t respond as they should after birth, as the term “persistent foetal circulation” suggests. The pressure in the arteries stays high, the valve in the heart doesn’t close and blood doesn’t flow to the lungs. This now becomes a medical emergency. Baby will lack oxygen, turn blue, struggle to breathe, have a rapid heart rate and become extremely distressed.

Can the baby be treated? It is critical that the medical staff recognise the signs and respond urgently to prevent damage to all of the baby’s organs. High-flow oxygen needs to be started immediately. Medications are used to balance the pH and to relax the lung vessels to allow for pressure to drop. In some cases, the baby may require mechanical ventilation.

What would cause this condition? The most common cause of PFC is birth stress. This could be a difficult labour where baby is deprived of oxygen (asphyxia), is ill (sepsis or pneumonia), swallows meconium or has physical issues like a hernia in the diaphragm.

Will my baby survive PFC? Most full-term babies with PFC survive. This is, of course, directly related to the available care at birth, to ensure that baby is properly supported until the lungs are able to respond correctly.

Transient Tachypnea of the Newborn (TTN)

Our second condition is not as serious as the PFC discussed above. Having said this, no parent wants their newborn to land in NICU instead of being safely in the arms of the parents. There are other names for the condition, like “wet lung” or “respiratory distress syndrome”.

As the name states, this is a “transient” or temporary state during which baby struggles to breathe normally and requires some medical intervention. The good news is that it does resolve within 24 to 72 hours.

During the pregnancy – A baby’s lungs are filled with foetal lung fluid during the pregnancy. This means that they are not breathing air, but practising “breathing” by inhaling and exhaling the fluid in the lungs. Oxygen is provided to the baby by mom via the umbilical cord.

At birth- During a natural birth (vaginal delivery), the foetal lung fluid is squeezed out, so that when baby takes its first breath, the fluid has drained, the blood vessels open and the lungs inflate, ready to accept oxygen from the heart. Unfortunately, many babies are born by caesarean section, without any form of labour taking place. The fluid in the lungs is then not expelled by the birth process. The baby is reliant on the fact that its first breath will expel the fluid and allow the breathing process to take place.

What happens if my baby’s lungs are still full of fluid at birth? If a baby doesn’t have the lungs cleared during birth, or if there is slow absorption of the fluid in the foetal lungs, then baby will struggle to get oxygen and begin to breathe faster to compensate. This rapid breathing (more than 60 breaths per minute) usually starts shortly after birth. Baby may display other features like flaring nostrils and making a grunting sound. You may notice the ribs pulling in when baby breathes. This is called retractions.

Can the condition be treated? A baby with TTN can be treated, but the method used depends on the severity of the respiratory distress. The doctor is likely to call for an X-ray of your baby’s chest to confirm the diagnosis. A blood test will be taken to establish oxygen levels in the blood. Oxygen may be given via a mask. Should baby need more than this, then the doctor may opt for a CPAP machine. This device provides a continuous flow of air to baby to keep the airways open and to provide oxygen. Baby may also need to be tube-fed during this time. A baby usually settles within 24 to 72 hours.   

What is a likely cause of this condition? The most likely cause is being born by caesarean section. The fluid present in the lungs isn’t adequately expelled, making breathing difficult. Premature babies are also at risk. If the mom herself has asthma or diabetes, the baby is at a higher risk for TTN. Statistics also show that boys are more susceptible to TTN.

Will my baby survive TTN? Once TTN is treated, a baby recovers easily and is not at risk of developing other respiratory problems. 

ALSO READ: Too Soon: What You Should Know About Premature Babies

Conclusion

The arrival of a healthy, term baby is what all parents wish for. Nothing short of a miracle takes place the minute a baby leaves its mother’s womb. So many incredible processes take place to ensure baby goes from the womb and into the parents’ arms without a hitch. Unfortunately, the process is complex and some of our babies may require support to make the transition from foetus to baby. Your healthcare professionals are at your side to assist in this incredible process. 

REFERENCES

• https://ajronline.org/doi/10.2214/ajr.128.5.781#:~:text=Abstract
• https://www.msdmanuals.com/professional/pediatrics/respiratory-problems-in-neonates/persistent-pulmonary-hypertension-of-the-newborn-pphn
• https://www.ncbi.nlm.nih.gov/books/NBK537354
• https://emedicine.medscape.com/article/976914-overview?form=fpf
• https://pmc.ncbi.nlm.nih.gov/articles/PMC2805987