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The Stepping Stones Group - Opportunities - November 2023

What respiratory complications are associated with prematurity

November 1, 2023

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Question

What respiratory complications are associated with prematurity?

Answer

Respiratory distress syndrome (RDS) can occur in preterm infants. There is also a higher incidence of bronchopulmonary dysplasia (BPD) and apnea of prematurity. A surfactant deficiency causes respiratory distress syndrome. Surfactant is a mix of fat and proteins made in the lungs and coats the alveoli to keep the lungs from sticking together when the baby exhales.

BPD is synonymous with chronic lung disease. There are specific criteria for that particular respiratory complication that go along with how long the infant depended on oxygen. Essentially, bronchopulmonary dysplasia is more of a chronic problem that occurs due to treatment for respiratory distress syndrome. 

Apnea of prematurity is the cessation of breathing. It occurs in about 25% of preterm infants. The incidence increases with a decrease in gestational age. So, apnea of prematurity is seen more often in an infant at 30 weeks than in an infant born at 34 weeks.

There are several ways that respiratory complications impact an infant in the long term. A study reported that bronchopulmonary dysplasia was associated with adverse neurodevelopmental outcomes at nine and 12 months, and was more prominent in preterm infants with a BPD diagnosis versus those without it (Lin et al., 2017). There were greater adverse neurodevelopmental problems at nine and 12 months in that population with the BPD.

A second study reported that preterm infants with BPD have well-documented feeding difficulties (Mizuno et a., 2007). Even in the absence of BPD,  a baby with RSD trying to feed is similar to climbing 15 flights of stairs as fast as you can carrying a big, heavy backpack on your back, and when you get to the very top, you have to chug water while trying to keep your body temperature from exploding.  It's no surprise that they have so many feeding difficulties. It's very difficult to suck, swallow, and breathe when you can't breathe in the first place.

A third study found that when preterm infants with BPD were compared to healthy preterm infants without BPD, those with BPD had higher respiratory rates, larger decreases in their oxygen saturations, and lower performance on sucking measures (Barlow, 2009). This means their sucking is not as efficient. That is likely due to difficulty latching and sucking when their respiratory rate is too rapid, and they're having problems keeping their stats up. So, it makes sense that it is difficult, and that can have a long-term impact.

This ATE is an excerpt from the course, Overview of Prematurity and Associated Conditions, presented by Rhonda Mattingly, Ed.D, CCC-SLP.


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