Babies in the Neonatal Intensive Care Unit (NICU) will often require assistance with breathing. There are several methods of delivery for breathing support, depending on the specific needs of each baby.
Supplemental oxygen
Frequently, babies in the NICU with breathing difficulties will need some form of supplemental oxygen. There are several ways to provide oxygen, but the simplest and least invasive method is simply to provide a more oxygen-rich environment for the baby. The method chosen may depend on how much supplemental oxygen a baby needs.
High-flow nasal cannula
High-flow nasal cannula (HFNC) is a method of administering heated and humidified oxygen through a baby’s nose. It may be used as an alternative to non-invasive ventilation in some infants who need less pressure, oxygen and air flow than is provided by non-invasive ventilation methods.
Non-invasive ventilation
Continuous positive airway pressure
Continuous positive airway pressure (CPAP) is the delivery of air and oxygen that is warmed and humidified. It is delivered through the nose via a mask or prongs. This mixture of air and oxygen gas is gently blown, creating a slightly higher amount of pressure within the lungs. This pressure helps prevent the lungs from collapsing and makes breathing easier. The amount of oxygen given in the mixture with air can be adjusted to satisfy the oxygen needs of the baby’s body. The pressure delivered to the lungs can also be adjusted. The goal is to keep the lungs inflated without putting too much strain on the lungs themselves. As breathing and lung strength improve, the health-care team can wean a baby can off CPAP by slowly reducing the pressure and/or oxygen and assessing the baby’s breathing closely.
Nasal intermittent positive pressure ventilation
Nasal intermittent positive pressure ventilation (NIPPV) refers to delivery of air and oxygen through the nose via a mask or prongs at higher pressures than CPAP at a set rate. This mode is more effective than CPAP to deliver higher pressures, if needed, or to provide a breath in the event of an apnea, which is relatively common in preterm babies.
Conventional mechanical ventilation
Under normal circumstances, when someone takes a breath, the lungs expand, pulling air into the lungs. With conventional mechanical ventilation (CMV), the ventilator pushes a measured amount of air and oxygen into the lungs at a certain rate meant to mimic normal breathing. The rate, the volume of air (or pressure) and its oxygen content can all be adjusted for the individual baby. The lungs are like an elastic band: as the ventilator pushes a measured amount of air into the lungs, they stretch. At the end of the ventilator breath, the lungs stop stretching, then relax and recoil to their resting state.
Modern ventilators can sense when a baby is about to take a breath and synchronize ventilator breaths with the spontaneous breaths of the baby. In this way, CMV can be used to support breathing rather than replace it.
High-frequency oscillation
High-frequency oscillation (HFO) is another mode of achieving gas exchange. It is usually used for babies with significant lung disease. HFO puts pressure into the lungs, keeping them open, and then delivers very small volumes of air in and out of the lungs at a high rate. With the lungs always open, tiny volumes of air cycle through the lungs at 600 to 900 shakes, or oscillations, per minute. HFO has the advantage of reducing the strain and stretching on the lung because the lungs are not opening and closing. To wean a baby off HFO, the pressure or the tiny volume of air being shaken or oscillated is gradually lowered. As the carbon dioxide levels in the baby’s blood begin to rise as a result, their brain will encourage them to begin taking breaths.
High-frequency jet ventilation
High-frequency jet ventilation (HFJV) is similar to HFO, except that instead of oscillations to drive oxygen into the lungs, it uses something like the action of a tiny air gun. There is a steady, continuous flow of gas into the lungs that is interrupted very frequently by pulsatile jets of gas directed at right angles to the continuous flow of gas. Jets of gas enter the lung at high rates. HFJV is sometimes used for babies with air leaks or asymmetric or heterogenous lung disease, such as chronic lung disease or meconium aspiration syndrome.
