NICU – Weaning off the Nasal Canula!

Finally.

I had been looking forward to this day the most. Even more so than the discharge day. Writing about it months later still gives me a scratch in the heart.

photo credit: istock

D. needed oxygen support for 52 days. I was so scared that she was not able to come out of it. According to the doctors she just needed a “little support”. She was indeed not in a bad condition in terms of the flow and amount given they states. I, on the other hand, had my doubts: Why was it taking so long? How could they be so sure that it was coming out? Did we have to go home with an oxygen machine if it did not come out? I just wasn’t comfortable with the oxygen support and I needed it to be done as soon as possible.

Nasal canula for one prevented D. from breathing from the nose. Her mouth was open almost the entire time. It was painful at times to see her like that. There were times I thought she looked cute too.

Nasal canula was attached to a long, thick cable, which then got attached to HFNC machine. The cables were almost the same size and weight as D. Whenever she wanted to move her face from side to side, cables had to follow. You can imagine how uncomfortable it was.

I was also worried because based on what I read; her oxygen flow rate was higher than wanted according to the articles I read.

She was at 6.0 flow (lpm) for a while and the concentration of the gas (FiO2) was between 22-25%. Only at these rates, they were able to keep her Oxygen saturation above 90%.

A baby should have 98-100% oxygen saturation without oxygen support. If a baby cannot achieve this alone due to immature bodily systems, oxygen support will do the job until she grows up. Flow and FiO2 are controlled by the doctors to provide the baby ideal oxygen saturation.

Oxygen flow means the amount of oxygen delivered to the body in liters per minute. Usually flow rate above 6.0 lpm is considered high. For a baby to be able to breathe on her own, one of the requirements is that flow goes down to 1.0 lpm. (This is the minimum value HFNC machine provides)

FiO2 on the other hand should go down to 21% as this is the concentration of oxygen at room air.

the day before weaning off completely

When flow is 1.0 lpm and FiO2 is 21% and if the baby’s oxygen saturation levels are close 100%, then nasal canula is taken out.

Weaning of the HFNC requires gradual decrease of the flow by half a point every time there is decrease. On day 17th post-delivery, doctors tried to go down to 5.5 which impacted her need of oxygen concentration (FiO2 went up to 28%-30%). Our doctors decided it is better to keep the flow at a higher rate at 6.0 and oxygen concentration at a lower rate between 22%-25%. So, we went back up to 6.0 and gave her some more time at this rate.

On day 35, we tried 5.5 lpm again and this time around it worked. Next day it was 5.0, and the day after it was 4.5 lpm. It went down by 0.5 a point everyday until we reached 3.0 lpm. We spent a week at 3.0 lpm and spent another week to gradually go down and reach 1.0 lpm.

On day 53, we were FINALLY off the nasal canula.

Even after nasal canula came out and we went home, she did not close her mouth especially when she was awake until she was around 6 months old. I even checked with her doctor and he said it is not something out of ordinary.

She also had nose sensitivity until she was 19 months old. It might be just a normal baby reaction to be touched on the nose. I felt it was more like a reaction to her NICU days. Now she is wiping her nose herself😊

Long story short, weaning of the nasal canula requires time, patience and faith. Some preemies take longer than others. Some does not need support at all. It is important to understand your baby’s situation in detail and follow up with the doctors.

Worry. Don’t worry. You will eventually get there😊