Newborns that struggle to breathe shortly after birth may have a breathing condition. There are many types of breathing problems that affect newborns, such as transient tachypnea of the newborn, neonatal respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), meconium aspiration syndrome, persistent pulmonary hypertension of the newborn, pneumonia, and apnea.

The type of breathing condition that a newborn has depends on the cause. Premature birth, especially before 32 weeks of pregnancy, commonly leads to respiratory distress syndrome in newborns. Bronchopulmonary dysplasia (BPD) is when a baby born prematurely continues to require oxygen after reaching what would have been their 36th week of gestation.

If your healthcare provider is concerned that you may give birth several weeks before your due date, they may give you medicines called corticosteroids to help decrease the risk of breathing disorders for your newborn. After the baby is born, a provider will watch them closely for any symptoms of a breathing disorder, such as irregular breathing, grunting, or a bluish tint to the baby’s skin.

If your baby has any of these symptoms, providers must act quickly to find out what is wrong and begin treatment to help them breathe. Breathing support using a nasal continuous positive airway pressure (nCPAP) device is very common. Often, newborn breathing conditions can be treated if they are found early. Most babies improve gradually in the days, weeks, and months that follow, when they get the right treatment and supervision.

An extraordinary sequence of events must take place before a baby can cry out for the first time. Infant development researchers refer to the moments that surround this milestone as the "transition to extrauterine life." Indeed. The baby is delivered, still attached by its lifeline, the umbilical cord, to the remarkable but temporary organ, the placenta, that has sustained the fetus and met all of its physiological needs. Within seconds after this connection has been abruptly broken, the baby must breathe on her own for the first time so that her circulatory system can deliver oxygen to all of the tissues throughout her body. Though this dramatic shift seems nothing short of miraculous, the great majority of babies leap across this transition with nothing more than a loud cry of recognition.

Lung development proceeds in five main stages, the earliest taking place in the embryo between three to seven weeks gestation, explains Susan Tucker Blackburn, in Maternal, Fetal, & Neonatal Physiology. Rudimentary fetal breathing movements also start early in gestation and steadily grow in strength and frequency. Lung development throughout gestation will be stimulated by the mechanical stretching caused by these movements. The fifth stage, which involves the maturation of the tiny air sacs called alveoli, extends from 36 weeks gestation through 2 years. These alveoli are the site of gas exchange, but only about 15% are mature by birth.

The diameters of the alveoli double in size as they mature. According to Blackburn, at birth there are 20-70 million alveoli and pre-alveolar air sacs; by 6 months, between 85% and 90% of alveoli are formed; and by 8 years the child's alveoli capacity has expanded to 300 million. In all of these stages, nutrients are critical for the growth and development of not just respiratory tissue, but also the bone, cartilage, and muscle tissue that will form the ribcage to house the lungs. This connection between bone growth and respiratory development will continue through childhood.

The substance called surfactant is a critical part of healthy respiratory function. It is a lipoprotein that is responsible for maintaining the gas exchange capacity of the lungs. It also plays a role as a pathogen barrier and inflammatory mediator in immune function.

We know that a healthy gut is critical for a healthy immune system in an infant. But immunity is hardly confined to the gut. One of the most obvious indicators parents can use to judge the overall immune health of a baby is the presence of respiratory infections. Respiratory illness is the leading cause of hospitalization among young children. And when it is severe enough to require hospitalization, respiratory illness can dramatically increase the risk of childhood asthma.

There are a number of factors, including nutriention, that are important in respiratory immunity. While vitamin D is most often associated with its role as a critical part of healthy bone growth, researchers know that it also plays a key part in the regulation of innate immunity. There is increasing evidence that pathways that involve the vitamin may be involved in several autoimmune diseases, from rheumatoid arthritis to possibly even multiple sclerosis, and that understanding these mechanisms may shed light on treatment possibilities.

Another group of nutrients that researchers believe are involved in respiratory immune health are the lipids known as LCPUFAs (long-chain polyunsaturated fatty acids). LCPUFAs are important structural and functional components of immune cells and have multiple roles, from regulating inflammation to signaling the production of specialized immune cells.

Different conditions can cause a baby to have trouble breathing shortly after birth.

Transient tachypnea of the newborn (TTN)

Transient tachypnea of the newborn (TTN) is the most commonly diagnosed breathing condition in newborns.

Before a baby is born, their lungs are filled with fluid. In most babies, this fluid goes away shortly after birth, but sometimes it does not go away as quickly as it should. This causes TTN., Your baby may be at higher risk for TTN if you have diabetes, asthma, or a cesarean delivery (c-section) without going into labor. With the right treatment, TTN usually gets better by the time the baby is 3 days old.

Respiratory distress syndrome (RDS)

Respiratory distress syndrome affects most babies who are born before 32 weeks of pregnancy. This is because newborns born prematurely are not able to make enough surfactant. Surfactant is a foamy substance that keeps the lungs fully expanded so that newborns can breathe in air once they are born. It also keeps the lungs open so when the baby breathes out, the lungs do not collapse. Without it, the lungs collapse and the newborn must work harder to breathe. Respiratory distress syndrome, also known as lung disease of prematurity, may develop over time into a more serious and persistent condition called bronchopulmonary dysplasia (BPD) that requires oxygen, a ventilator, or medicines to help with breathing.

Persistent pulmonary hypertension of the newborn (PPHN)

Persistent pulmonary hypertension of the newborn (PPHN) causes high pressure in the blood vessels of a newborn’s lungs, which makes it hard for them to take oxygen into the blood from air they breathe in. This leads to breathing difficulty and fast breathing rate.

For most babies, after taking their first few breaths after birth, air rushes into the lungs, bringing in oxygen that helps the blood vessels in the lungs relax. This helps blood to flow easily. When blood flows through the lungs, it picks up oxygen that is needed throughout the body. In newborns with PPHN, the blood vessels in the lungs do not relax in response to the oxygen in air, and blood cannot easily move past the air pockets in the lungs to pick up oxygen as it flows by. Depending on how severe the tightness of the blood vessels is and what is causing PPHN, your child may need short-term intensive medical support and medicines. Long-term effects of PPHN include decreased ability to exercise and other disabilities such as poor lung and heart function, as well as learning difficulties.

Pneumonia

Pneumonia is an infection of the lung caused by bacteria, viruses, or fungi. Newborns may experience symptoms that range from mild to serious depending on the cause and how quickly treatment is started.

Apnea

Apnea is when a baby stops breathing for several seconds at a time. This can cause a baby’s heart to beat more slowly (bradycardia) and they can turn pale or a bluish color (cyanotic). There are many causes of apnea, and, in some babies, providers cannot find an exact cause. In that case, the baby may need to be placed on a monitoring device that alerts about every event, even short pauses that get better on their own. Talk to your baby’s provider to find out how long your baby needs to be monitored. Most often, apnea is a temporary condition that will get better over time.

There are certain factors that may raise the risk that your newborn will have a breathing condition:

• Premature delivery: This is the most common. Babies born several weeks before their due date usually have lungs that are not fully developed. This can cause problems with breathing.
• Problems with the baby’s heart or lung development include congenital heart or lung disorders.
• Diabetes in the mother: Uncontrolled diabetes before pregnancy or developing diabetes during pregnancy (called gestational diabetes) can raise the risk of the baby having respiratory distress syndrome when born.

When a baby is born, they go from living in the womb to living in the outside world. This requires many changes to occur in their body, especially in the lungs. To breathe outside the womb, a newborn’s lungs must adapt immediately after birth.

• In the womb, the lungs of a fetus are filled with fluid. Instead of the fetus “breathing,” blood that flows through the placenta supplies oxygen and other nutrients to the fetus.
• The lungs are usually not fully formed until week 36 of pregnancy.
• When a baby is born, hormonal changes and labor itself stops a baby’s lungs from producing fluid. When a newborn takes their first breaths, the air they breathe into the lungs squeezes out any remaining fluid and blood can flow to the lungs. In addition, newborn lungs make a foamy substance called surfactant that helps their lungs remain expanded even when the baby breathes out.

Problems in development

The changes that a baby’s lungs undergo during birth require many complex processes. Problems with any of these steps can cause a newborn to have a breathing condition. For example:

• When a newborn does not produce enough surfactant, they can develop respiratory distress syndrome (RDS). This can either be due to premature birth or changes (mutations) in gene that control surfactant production.
• When a baby’s lungs do not reabsorb enough fluid during labor and delivery, they can develop transient tachypnea of the newborn (TTN).
• When blood cannot flow into the vessels of the lungs to get oxygen, a baby may have a condition called persistent pulmonary hypertension of the newborn (PPHN).

Other problems

Other things can happen in the womb, during birth, or soon after birth that can cause a newborn to have difficulty breathing.

• Infections: bacteria or viruses can cause infections before or after birth that can lead to pneumonia or sepsis.
• Meconium aspiration: Meconium is the first stool that a fetus produces and sometimes it can get into the fluid that surrounds a baby (called amniotic fluid) before birth. If a baby inhales the fluid, called aspiration, it can get into the lungs. This can block the airway and cause lung inflammation, which can lead to breathing problems in a newborn. This is sometimes called “meconium aspiration syndrome.”
• Complications from treatments: Treatments for breathing conditions, especially if mechanical ventilation is needed, can cause air to leak out of the lungs and get stuck between the lungs and the chest wall. This is called a pneumothorax, or a collapsed lung.

Symptoms of newborn breathing conditions usually happen at birth or within the first few hours that follow. Common warning signs include:

• Irregular breathing or heart rate (fast or slow)
• Grunting
• Flaring of the nostrils with each breath
• Bluish tone to a baby’s skin and lips
• Pulling inward of the muscles between the ribs when breathing

If your baby shows signs of distress, your child’s provider will do tests to help diagnose a newborn breathing condition.

When a newborn has difficulty breathing, healthcare providers must act quickly to find out what is wrong. Many types of newborn breathing conditions can be treated if they are discovered early.

There are many ways for a provider to find out whether a newborn has a breathing condition.

• A physical examination can help find any symptoms of breathing trouble.
• Lung imaging tests, such as chest X-rays, show how well the lungs expand and if the size or function of the heart is affected by the condition. X-rays are used to diagnose most types of newborn breathing conditions.
• Skin sensors check the levels of oxygen and carbon dioxide in the blood.
• Heart tests such as an echocardiogram can check for a possible congenital heart defect.
• Blood tests look for an infection.

Treatment for newborns with breathing conditions usually begins as soon as a baby is born. Most newborns who show symptoms of a breathing condition are quickly moved to a neonatal intensive care unit (NICU). There, they receive around-the-clock care from healthcare professionals who specialize in treating premature newborns. Treatments will depend on the type of breathing condition but can include any of the following.

Breathing support

Breathing support, such as oxygen therapy, is used to help newborns breathe until their lungs can make enough surfactant on their own. Many babies receive breathing support from a nasal continuous positive airway pressure (nCPAP) device that gently pushes air into the lungs through prongs placed in their nostrils.

In serious cases, nCPAP is unable to support breathing. When this happens, a mechanical ventilator can help your baby breathe. A ventilator is a machine that takes over the work of breathing and is a form of life support. The machine connects to a breathing tube that runs through a newborn’s mouth or nose and into the windpipe. Babies that require ventilation are more likely to develop bronchopulmonary dysplasia. They may also develop complications from the breathing tube or ventilator, such as an airway or lung injury.

Other supportive treatments

Besides breathing support, your child may need one or more of the following treatments.

• Surfactant replacement therapy can be used if a newborn struggles to breathe despite the use of nCPAP. Sometimes, giving an infant surfactant requires the use of a breathing tube. If so, because of the possible complications, your baby’s provider will help you consider the risks and benefits of the procedure.
• Antibiotics can help treat breathing problems that are caused by a bacterial infection, like pneumonia.
• Caffeine treatment is still being studied, but for many infants, it reduces the need for mechanical ventilation and lowers the risk of bronchopulmonary dysplasia, especially in newborns who have apnea.
• Fluids and nutrients can help prevent malnutrition and promote growth. Nutrition is critical to the growth and development of the lungs.

The best way to prevent breathing conditions in newborns is to lower the risk of giving birth too early in pregnancy. Not smoking and not consuming alcohol, as well as having healthy eating habits, can lower the chance of premature birth.

Sometimes premature birth is due to another condition or circumstance that is outside of your control. If your provider thinks that your baby is at risk of being born too early, they can give you medicine called corticosteroid, which help your baby’s lungs mature and produce surfactant.

If your baby is born several weeks prematurely, there are still ways that doctors can prevent breathing conditions. Though continuous positive airway pressure (CPAP) is typically used as a treatment for breathing problems, it can also be used before symptoms begin to prevent breathing problems in newborns who are born early.