Child Health Seth Stratton | 5 years ago

Inside the NICU: Stronger Lungs Make Stronger Babies

Respiratory therapists at Levine Children’s Hospital use specialized technology to prevent chronic lung disease in premature babies.

Compared to babies delivered full-term, babies born prematurely have to work extra hard to be healthy and grow. And underdeveloped lungs are one of the most common challenges these babies face. Because of their limited lung capacity, premature babies have a high risk for developing severe breathing problems, or respiratory failure, and a variety of other short- and long-term issues throughout their lives.

Determined to find a better way

For the last 40 years, two of the most common methods used to help premature babies overcome breathing difficulties have been invasive ventilation and intubation. The first helps patients using a mechanical breathing device while the second helps open airways by putting a flexible plastic tube into the windpipe. While these techniques have helped babies survive, they come at a cost. The lungs of premature babies are prone to injury and both techniques can lead to trauma and an increased risk for lung disease. Carolinas HealthCare System’s Levine Children’s Hospital created a respiratory taskforce to find a way to help babies with tiny lungs breathe better with fewer side effects. Led by Shelia Ball, BSRT RRT NPS RCP, a respiratory therapist, and Thomas Kueser, MD, a neonatologist, the taskforce quickly found an alternative option they could build upon. Known as noninvasive ventilation, it helps prevent the intubation of premature babies. It also provides greater respiratory support and has more long-term success than intubation. With noninvasive ventilation, doctors help babies breathe through the nose instead of using a tracheal tube (in the throat) and a respirator.

Team rethinks current technology

Healthcare facilities already use noninvasive technology to detect when a baby breathes by measuring a change in pressure or volume, but the team at Levine Children’s Hospital uses a different technique. The team uses a special noninvasive technology that detects the electrical activity of a baby’s breath by measuring the signal the brain sends to the lungs. When breathing is disrupted – or when apnea is detected – the electrical activity triggers the ventilator to give the baby “back-up breaths” without a tube in their windpipe. Once the baby begins to breathe again, the machine no longer provides the back-up breaths. “This technology works faster, it’s more accurate and it allows us to support the baby immediately – breath by breath – and deliver exactly what they need to maintain respiratory health,” says Ball. “Levine Children’s Hospital has used this technology for about two years because it’s so common for premature babies to forget to breathe. Called apnea, it affects roughly one in four premature babies, so the technology has a huge impact on our tiniest patients and helps prevent the need for intubation and mechanical ventilation, which can lead to lung injury.”

Research receives national recognition

Ball and her team collected data on the noninvasive technique and submitted their research to the American Respiratory Care Foundation. They monitored 57 patients, all from the neonatal intensive care (NICU) unit at Levine Children’s Hospital. “Our ultimate goal was to reduce intubation rates, and we did,” says Ball. “The rates went from 73 percent to 19 percent. We want to provide the best for these tiny giants. They are the ultimate fighters and we just want to give them enough support so they can go out and conquer the world.” In October, Ball received a national award from the American Respiratory Care Foundation and she was invited to present her work at its national conference in San Antonio. “Neonatal medicine has come a long way and the field continues to improve with every infant who comes through our NICU doors,” says Dr. Kueser. “Levine Children’s Hospital was the first hospital in the region to use this form of noninvasive ventilation as part of our goal to reduce the number of babies with chronic lung disease. And this technology has proved to do just that.”