NICU – Breathing After Birth

Your baby taking his first breathe on her own is a magical moment if you are a preemie parent.

When a baby first comes into world, he takes his first breathe. His lungs are healthy. All is fine. Nothing to worry about. However, when you have a preemie born less than 32 weeks, their lungs are probably not developed as much. When they take their first breathe, level of oxygen produced might not be enough for their body and brain.

So, the very first thing your baby goes through is intubation. NICU team makes sure your baby is getting enough Oxygen to her bodily systems to survive. If doctors decide she is breathing fine on her own meaning oxygen level is high enough, then they will remove the tube and depending on the situation they will move your baby to CPAP (Continuous positive airway pressure) or HFNC (High Flow Nasal Canula). The order obviously depends on the extremity of the prematurity, but the order usually is intubation, CPAP and then HFNC.

Intubation is an invasive procedure, and it is scary. There is this huge tube on your baby’s extremely tiny face that goes through down the throat and into the airway for full breathing support. You basically cannot see your baby’s face because it is all covered. However, knowing she is able to breathe through the tube is relieving. It is not ideal to spend too much time intubated mainly because feeding happens through an IV, not from the mouth. However, there is so many other factors to your baby’s health. So it is a good idea to trust your NICU doctor. If they say it is fine, it should be fine as they consider a dozen of other reports/data points before they give you an idea.

Then there is CPAP. It is non-invasive and it is less scary. The tube does not go through the throat but sits on the nose. There is a screen where you observe your baby’s oxygen levels. You are able to tell whether your baby is breathing on her own or breathing through the machine. With CPAP, your baby starts feeding from the mouth or nose. Latest reports show that introducing breast/nipple also might be a good idea for some cases. Again, something to check with your doctor.

Then comes HFNC. If your baby is on HFNC now, it means she is breathing on her own but needs some support. It is a small nasal canula in your baby’s nose and that’s pretty much it.

As for us, D. stayed intubated for a day, and she was on CPAP for two days and then she was on nasal canula for a while (49 days). She was also put on caffeine medication which apparently improves lung function in preemies. Cheers to all the coffee I did not drink during my pregnancy.

We have not seen a single procedure when it was actually being performed. I have not seen how they intubated her, which I thought was the most scariest. NICU team was very careful with getting procedures done during no visit times so parents do not get agitated. However, we were always informed about the schedule of procedures.

Intubation and CPAP days went by so fast. Until I get a hold of it, we were already on nasal canula. However, we stayed on nasal canula longer than anticipated. She was doing very well initially, then due to anemia of prematurity (we believe) she needed more time on nasal canula.

First 30 days were fine. Last 19 days with nasal canula, I was on google searching for:

‘premature babies long stay in HFNC’

‘Ideal flow for HFNC’

‘HFNC 6.0 flow too high for a premature baby’

‘preemie discharged with a nasal canula’

‘HFNC vs chronic lung disease in preemies’

‘chronic lung disease preemies’

‘chronic lung disease affect on brain preemie’

And many more combination of keywords. Look, I know I shouldn’t have googled it blah blah blah, yet it gave me some sanity, some comfort. I read all the available reports out there. Some were promising, some were not so optimistic. I decided to get a second opinion from an NICU expert in my home country. This was an informal consultation just to get an idea. When I asked him about the duration of the stay in high flow nasal canula, he said chronic lung disease is so common in premature babies which resolve over time, how much time depends on the baby and the situation.

When I heard the word chronic, I lost it. I already had my doubts about staying on nasal canula for so long. With this new piece of information, I was sure that something was wrong. Next day, when I was in NICU, I openly asked our super emphatic doctor, whether D. is going to have chronic lung disease. I told him I got a second opinion as I knew he was a confident, brilliant doctor who wouldn’t have a problem with that. He said "it is true that chronic lung disease is common among premature babies, however, for your specific case, it is very unlikely to happen." He added "It is very normal for a 33-week-old infant to need some support on breathing but all other indicators are looking fine so I wouldn’t worry."

That was the day I stopped worrying over/googling HFNC and focused on PUMPING which I will tell more later.

Moral of the story I guess, ask questions to your doctors, ask them everyday if something is bothering you. If you are not satisfied, get a second opinion, third opinion. However, when you do it, make sure those doctors have access to all the information before giving you an opinion. Otherwise, I suggest make peace with your own team of doctors as they are on top your baby's medical history such as daily blood reports, feeding situation, weight-height-head circumference development, brain scans, heart echo and many more.

p.s. "do not google this stuff" they will suggest. I say google all you want. You are your baby's advocate during this process. Power of information will give you an opportunity to ask more educated questions about your baby’s health and be a better advocate.