New machine helps premature babies breathe easier

Almost half a million babies are born too early in the US every year and the cost of caring for them can reach into the millions of dollars.

Now something used to help adults with sleep apnea is helping preemies breathe easier.

Twins Dallon and Damon surprised and scared mom by arriving almost three months too soon. They weighed about as much as a football.

"It could go hour by hour or day by day but you just got to stick in there," mother of preemies Martina McCloud said.

Typically, tubes help the sickest babies breathe. Ventilators keep them alive but in 20 to 50 percent of cases, the pressure damages their lungs.

"Every baby that has respiratory problems gets put on mechanical ventilation. I think that we're doing more damage at this point with that technology than benefit," professor of pediatrics Dr. Mario Rojas said.

At Vanderbilt, instead of ventilators, doctors use a low-tech machine many adults use for sleep apnea. The CPAP machine covers the nose, not the mouth, and provides a continuous flow of air to prevent little lungs from collapsing.

In a study, 74 percent of preemies didn't need a ventilator, only a CPAP machine to breathe. The less invasive approach reduced the rate of chronic lung disease by 10 percent and cut costs.

On average, a ventilator could cost between $27,000 and $36,000. A system like CPAP could cost less than $500.

Without the ventilator attached, Martina McCloud rocks and holds her babies.

Proving less may be more when it comes to caring for the tiniest survivors.

Mechanical ventilation is still used as a last resort for the sickest preemies.

Doctor Rojas is using this study to promote the use of CPAP machines in developing countries where nearly four million babies die every year because of respiratory problems.

REPORT: MB #3019

A premature baby is one born before the 37th week of pregnancy. Premature birth occurs in between 8 and 10 percent of all pregnancies in the United States. Preemies weigh much less than full-term babies, putting them at an increased risk of complications. They may have health problems because their organs did not have enough time to develop. Preemies need special medical care in a neonatal intensive care unit, or NICU. They stay there until their organ systems can work on their own.

Many preemies are put on mechanical ventilation to help them breathe. Without it, many infants would die, but its use can also damage tiny, immature lungs unprepared to handle the machine. In as many as 20 to 50 percent of cases, the pressure from mechanical ventilation can damage the lungs. "Every baby that has respiratory problems gets put on mechanical ventilation," Mario Rojas, M.D., Associate Professor of Pediatrics at Vanderbilt University Medical Center in Nashville, Tenn., told Ivanhoe. "I think that we're doing more damage at this point with that technology than benefit."

A new study suggests that a less high-tech, lower cost and perhaps underutilized approach may work better than mechanical ventilation for some babies. Researchers say early Continuous Positive Airway Pressure (CPAP) might be an option for some babies born with respiratory distress. CPAP is currently used to help adults with sleep apnea to prevent airway collapse during sleep. In preemies, it works the same way. While the baby breathes, the continuous airflow through the nose keeps the lungs from collapsing.

The CPAP looks like an oxygen mask, but it only covers the nose, not the mouth. The study in Bogota, Columbia involved 279 infants born at 27 to 32 weeks gestation with signs of respiratory distress. In this part of the world, expensive mechanical ventilators are less available and more babies die from respiratory failure. Within an hour of birth the babies were placed on nasal CPAP. The babies in the study did well on nasal CPAP, and the further along babies were in gestation, the less likely the need was for mechanical ventilator use.

Researchers believe this could signal doctors in the U.S. to use the less invasive nasal CPAP instead of mechanical ventilators, reducing the potential for lung damage. This may not only be better for the babies, but it could also drastically reduce costs. On average, a ventilator could cost between $27,000 and $36,000. A system like CPAP could cost less than $500, some even cost less than $100. Dr. Rojas says the sickest babies may still need mechanical ventilation, but this study supports CPAP as a viable option for many other preemies who could benefit from a less invasive approach.

Craig Boerner
National News Director Vanderbilt University Medical Center
(615) 322-4747

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