Atelectasis in Premature Babies

Definition of Atelectasis in Infants and Preemies

Atelectasis is the collapse of the small air sacs (alveoli) in the lungs. Because oxygen enters the bloodstream through the alveoli, these tiny air sacs are very important to lung function. If too many alveoli collapse, the lungs can't get oxygen to the rest of the body.

Premature baby being held
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What Causes Atelectasis in Newborns?

There are many causes of atelectasis in newborn babies, whether they were born prematurely or at full term. Some reasons the small airways may collapse include:

  • Prematurity: Atelectasis is a relatively common complication of prematurity. Premature babies may not have enough surfactant, a chemical that helps keep alveoli open. This can cause small airway collapse and respiratory distress syndrome (RDS).
  • Meconium aspiration: Meconium is the name for a baby's first stools. If babies pass this stool before birth, it can get in their airways and make them very sick. Meconium can block air from entering the alveoli, causing them to collapse.
  • Pneumonia: Pneumonia or other lung infections can cause mucous to fill the lungs. Like meconium, this mucous can keep air from getting into the alveoli and make them collapse.
  • Breathing problems: Muscle or neurologic problems that cause difficulty breathing deeply can prevent the airways from filling all the way and cause them to collapse.

How Is Atelectasis Prevented?

Knowing that prematurity puts newborns at increased risk for atelectasis, a woman's pregnancy is usually monitored for signs of preterm labor. If preterm labor begins, physicians will likely use a combination of bed rest, hydration, medications, and other interventions to try to delay birth long enough to administer antenatal steroids that help advance lung development.

What Are the Signs of Atelectasis?

Usually, babies will display symptoms of atelectasis within minutes of being born but sometimes not until a few hours later. Symptoms may include:

  • A bluish tint to the skin and mucous membranes (cyanosis)
  • Brief pauses in breathing (apnea)
  • Decreased urine output
  • Nasal flaring
  • Rapid breathing
  • Shallow breathing
  • Shortness of breath and grunting sounds while breathing
  • Unusual movements during breathing

How Is Atelectasis Diagnosed?

If doctors suspect atelectasis, they will perform various tests to diagnose the condition. These may include:

  • Blood gas analysis, which evaluates oxygen and acid levels in body fluids.
  • Chest x-ray, which may show a "ground glass" appearance in the lungs.
  • Lab tests to rule out infection as a cause of breathing problems.

How Is Atelectasis Treated?

There are a few ways that doctors treat atelectasis in newborns, depending on the cause. Some babies may be positioned in ways that allow fluid to drain or airways to open. Premature babies may be given artificial surfactant to help their alveoli stay open. Respiratory support or breathing treatments with medications can also help keep airways open and allow babies to breathe better.

In addition, babies with atelectasis should be provided supportive care such as a calm setting, gentle handling, maintenance of ideal body temperature, optimal fluids, and nutrition management, and prompt treatment of infections.

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  2. Johns Hopkins Medicine. Atelectasis.

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