Why do the lungs of a premature baby suffer?
The fetal lungs are formed until the very end of pregnancy, and in a child born much prematurely, the alveoli are not yet developed, and the surfactant that keeps them from collapsing is produced in insufficient quantities. Such a child requires oxygen and often artificial ventilation, but these vital measures additionally injure the delicate tissue: high concentrations of oxygen cause oxidative damage, and the pressure stretches the alveoli. The addition of infection and inflammation intensifies the process, and normal lung maturation is disrupted.
- Alveolar immaturity and surfactant deficiency
- Damaging effects of high oxygen concentrations
- Pressure injury from mechanical ventilation
- Inflammation and intrauterine infection
- Patent ductus arteriosus and fluid overload of the lungs
- Pulmonary vascular development disorder
Risk factors
The main factor is the degree of prematurity: the shorter the gestational age and birth weight, the higher the likelihood of the disease. The duration and severity of respiratory support, episodes of infection, including intrauterine, the presence of a patent ductus arteriosus, excessive fluid administration, and maternal smoking during pregnancy are all important. In boys, the disease is slightly more common. Modern approaches - prenatal prophylaxis, early administration of surfactant and gentle respiratory support regimens - significantly reduce the risk.
- Gestational age less than 32 weeks
- Very low birth weight
- Long-term artificial ventilation
- High oxygen concentrations
- Intrauterine and hospital infection
- Patent ductus arteriosus
- Maternal smoking during pregnancy
Symptoms
The main manifestation is a continuing need for additional oxygen and rapid breathing. The child has noticeable retractions of the yielding areas of the chest, flaring of the wings of the nose, whistling or groaning breathing. Feeding is difficult: the baby gets tired quickly, sweats, takes breaks, which is why he slowly gains weight. Children are susceptible to respiratory infections that are more severe than usual and often accompanied by obstruction. With a pronounced form, it is possible to increase pressure in the pulmonary artery with a load on the heart.
- Rapid breathing and shortness of breath
- Retraction of intercostal spaces
- Need for supplemental oxygen
- Wheezing and wheezing
- Difficulty feeding and fatigue
- Slow weight gain
- Frequent and severe respiratory infections
Diagnosis and observation
The diagnosis is made by a neonatologist based on prematurity, oxygen requirements and examination data. Pulse oximetry shows blood oxygen saturation at rest, during sleep and during feeding. X-ray reveals characteristic changes in the pulmonary pattern and areas of increased airiness, and computed tomography is used in severe cases. Echocardiography is needed to assess pressure in the pulmonary artery and the functioning of the right heart. After discharge, the child is regularly monitored, monitoring weight, breathing and development.
- Estimation of oxygen requirement at a certain age
- Pulse oximetry at rest, during sleep and during feeding
- Chest X-ray
- CT scan of the chest in severe cases
- Echocardiography to evaluate pulmonary hypertension
- Weight and height control
- Assessment of neuropsychological development
Treatment and life at home
Treatment is aimed at supporting breathing and creating conditions for the growth of healthy lung tissue. Oxygen is supplied in a volume sufficient for normal saturation, gradually reducing it as it improves. Nutrition should be high in calories, since breathing requires a lot of energy; breast milk is preferred. The doctor may prescribe inhaled drugs and diuretics, but only if indicated. At home, protection from infections and complete absence of tobacco smoke are critical, as well as timely vaccination on an individual schedule.
- Oxygen support based on saturation data
- High-calorie foods, preferably breast milk
- Inhalation therapy as prescribed by a doctor
- Strict smoking ban in the house
- Limiting contacts during the season of respiratory infections
- Vaccination according to a schedule agreed with the pediatrician
- Regular observation by a pulmonologist and monitoring of development