Premature Delivery and Mechanical Ventilation

Premature delivery is a global problem. Roughly 15 million infants are born prematurely every year around the world. Although preterm birth rates in the U.S. have dropped in the last decade, almost 1 in 10 babies are born prematurely. (1) (2)

Babies who do survive can have breathing problems. Mechanical ventilators in infants are meant to assist with breathing and keep the child on the path to recovery. Here is a detailed outline of what mechanical ventilation looks like after premature delivery. 

Why Would a Premature Baby Need a Ventilator?

A 2021 study shows that all babies born at 28 weeks or sooner require some type of respiratory support, 22% of which is non-invasive. Among infants born after 28-31 weeks, 10.2% did not need ventilatory support. Whereas 42% required non-invasive breathing support. (3)

Premature babies have decreased functional residual capacity due to their immature respiratory tract and possible chronic lung ailments. The respiratory distress needs to be managed so that the baby will overcome this challenge. That’s where early intervention can help. 

A ventilator is meant to provide breathing support in immature or sick babies. Right after being born prematurely, their body is incapable of breathing well enough to support their system. As a result, they need adequate support to get the oxygen in and carbon dioxide out. 

This bedside machine is attached to a breathing tube and inserted into the trachea (windpipe) of the infant. The device can then be adjusted based on the patient’s needs, ailments, X-rays, and blood gas measurements. Only a healthcare expert can make the necessary ventilator adjustments. (4)

What Is Mechanical Ventilation Used For?

Premature babies with breathing troubles need proper support to get back on track. If this happens, medical experts will work with the parents to ensure that the newborn gets the best quality care. Breathing conditions can occur in different ways. Some are more impactful than others. Here are some of the most prominent ones that require breathing support.

Neonatal RDS 

In the U.S., respiratory distress syndrome is estimated to affect 20,000 to 30,000 babies annually. This lung injury causes fluid leakage into the lungs, becoming difficult for the patient to establish a proper breathing pattern. (5)

This kind of lung injury is linked to high mortality rates. So, supportive therapies and mechanical ventilation are the cornerstones of treatment. In premature babies, this syndrome could develop if the lungs lack surfactant. This is a substance found in completely developed lungs. 

Neonatal RDS might also happen as a result of congenital lung development problems. Other RDS risk factors include:

– Diabetic mother

– A sibling who previously had RDS

– Induction of labor

– Cesarean delivery

– Decreased blood flow to the baby during delivery

– Giving birth to twins or more

It develops in infants born before 37 to 39 weeks most of the time. The sooner the baby is born, the bigger the odds of experiencing this syndrome after birth. This is an uncommon ailment in infants born full-term. (6)

So, how can mechanical ventilation help with neonatal RDS? Conventional ventilatory support tends to rely on synchronized and volume-targeted ventilation. The goal is to ensure proper gas exchange, CO2 excretion, and adequate oxygenation. (7)

Bronchopulmonary Dysplasia (BPD)

Some infants born prematurely have lung damage, also referred to as BPD. This problem can manifest if the lungs need more time to develop completely, and additional oxygen is necessary to assist them with breathing. Infants can be more prone to BPD if they: (8)

– Had to be resuscitated

– Are born very small or have a low birth weight

– Required mechanical ventilation

This chronic lung disease is typically recorded in premature babies who need oxygen therapy and mechanical ventilation to curb respiratory distress. Their delicate lung tissues have been damaged, which has led to this medical situation. (9)

If an infant requires mechanical ventilation, healthcare experts will do their best to decrease BPD risk. They are trained in providing gentle ventilation so that the baby will reap the benefits and recuperate properly.

Apnoea of Prematurity (AOP)

Apnoea of prematurity happens when a prematurely born infant stops breathing for a certain time. This could be the result of brain immaturity or muscle weakness that has held the airway completely open. In some cases, extra stress on the premature baby, such as plummeting blood count, lung issues, heart problems, or poor oxygen levels, can worsen the apnoea. (10)

AOP incidence rate depends on the birth weight and age, happening in 7% of infants born 34 to 35 weeks of gestation. And 15% at 32 to 33 weeks gestation. Among babies lighter than 1,500g, the incidence varies from 25% to 50%. Whereas in those weighing less than 1,000g, it can reach a staggering 80%. (11)

Treating this condition comes down to adequate ventilation and oxygenation. Physical stimulation can help. But, mechanical ventilation, supplemental oxygen, and CPAP (continuous positive airway pressure) may be necessary. Only a qualified healthcare expert can identify the best form of treatment.

How Long Can a Baby Live on a Ventilator?

Preterm infants have no or little surfactant in their lungs. Without proper intervention, they could lose their life from respiratory failure. The frequency of surfactant deficiency can vary from 25% at 32 weeks gestation to 60% at 28 weeks and 100% at 24 weeks. (12)

Treating lung problems starts with the use of breathing tubes and breathing machines. The baby’s time on ventilation can be anywhere from a couple of days to around six weeks. But, the duration is based on their health problems and gestation at birth. 

When the newborn is ready to come off the mechanical ventilator, they are extubated. Meaning that the breathing tube is taken out, and either a CPAP is used or additional oxygen is placed over their head. Ultimately, doctors will use a nasal cannula to deliver supplemental oxygen. This is a small hose placed under the nose. 

What Has to Happen For the Baby to Return Home?

Preterm babies get discharged from the hospital when their condition is stable. Doctors will check their weight growth rate and ensure that the newborn is recovering properly. The baby can return home at about 37 weeks gestational age most of the time. But, if the newborn struggled with a serious respiratory issue, then expect to wait longer. Talk to a specialist to know how well your baby is recovering and how soon they can get discharged. 


When a baby born too soon develops severe breathing problems, that’s when mechanical ventilation becomes a key treatment strategy. It can feel overwhelming and stressful to see a baby ventilated. But, this is to keep them stable and restore adequate lung function. Doctors will do their best to ensure that the process goes well and the baby makes a full recovery. Don’t be afraid to ask the medical staff questions during the whole process to keep your mind at ease.