Newborn Breathing - An Overview

Introduction:

The breathing rate in infants can slow down to 30 to 40 breaths per minute while sleeping. There can be mild pauses between breathing that last for less than ten seconds and again commence after that. This is normal, and parents need not worry. However, changes in body color while breathing, using parts of the chest or other muscles to breathe, and extreme variations in breathing patterns can be a cause of concern.

How Does Breathing in Newborns Differ From Adults?

The breathing in newborns is different because:

• Newborns use their nostrils more than their mouths to breathe.

• Airways are small and can be obstructed easily.

• The chest wall is flexible since it is mostly comprised of cartilage.

• They can have traces of meconium and amniotic fluid in the airways after birth.

• The lungs are underdeveloped, and infants need to get acquainted with their lungs and other muscles of respiration.

What Are the Conditions That Affect Breathing in Newborns?

A rapid respiratory rate is called tachypnea. Unusual tachypnea indicates a lack of oxygen, and the body works hard to compensate for oxygen deprivation. Certain risk factors that can affect the breathing rate in newborns include:

• Premature baby.

• Cesarean delivery.

• Aspiration of fluid into the airways during delivery (meconium aspiration syndrome).

• Infection involving the amniotic fluid or the fetal membrane.

• Maternal gestational diabetes (elevated blood glucose levels during pregnancy).

• Decreased level of amniotic fluid during pregnancy (oligohydramnios).

What Are the Various Infant Breathing Disorders?

Various disorders that can affect breathing in the newborn are:

• Pneumonia: Newborns are susceptible to developing pneumonia since their immune system has not fully developed. They may show signs of rapid breathing, vomiting, fever, and so on.

• Transient Tachypnea of the Newborn (TTD): It is a temporary condition that occurs in the newborn and resolves within 24 hours. The baby’s lungs do not use oxygen for breathing when in the womb and utilize the blood from the placenta. The lungs are filled with fluid, which is absorbed by the lungs around the time of delivery or forced out through the birth canal during delivery. When the air enters the lungs for the first time after delivery, the lungs are filled with air, and excess fluid is coughed by the baby or reabsorbed by the blood or lymphatics. If any fluid remains back or moves out very slowly, the breathing becomes rapid to allow sufficient oxygen into the lungs.

• Persistent Pulmonary Hypertension of the Newborn (PPHN): In this condition, the newborn’s circulatory system continues to work the same way as it did in the womb by directing the blood away from the lungs. This can cause the baby to breathe rapidly, accompanied by increased heart rate and bluish skin.

• Conditions Present at Birth (Congenital Anomalies): Structural variations in the heart, lungs, nose, and airways can affect breathing in newborns.

• Collapsed Lung: Fluid collection between the lungs and the chest wall can interfere with breathing by hindering the inflation of the lungs. Trauma can also cause lung collapse.

What Are the Signs of Difficult Breathing in Newborns?

The signs are as follows:

• Rapid breathing.

• Flared nostrils (nostrils move out while breathing).

• Extra noises when breathing.

• Babies can use the neck muscles while breathing, which makes them bounce their heads up and down.

• Pulling or sucking in between the ribs. This means that the baby’s lungs work more to get increased oxygen.

• The baby’s tongue, lips, skin, fingers, and nail beds can turn pale or blue when there is an increased demand for oxygen.

How to Measure Respiratory Rates in a Newborn?

The most commonly used and reliable method is measuring a newborn’s breathing rate for 60 seconds. Breathing is checked by gently placing a hand on the infant’s chest or abdomen and counting the number of breaths. Each rise of the abdomen is considered as one count. Another method is to keep the fingers at a considerable distance from the nostrils of the infant and count each exhalation as a single breath.

What Are the Different Breathing Sounds in Infants?

Recording the different breathing sounds by the infants is essential so that it can be reported to the pediatrician (child specialist). Different breathing sounds are as follows:

• Whistling Sound: This sound occurs when there is an obstruction in the nasal passage. The nasal passages in the newborn are small, and if there is any hindrance in the passage due to the presence of mucus or dried milk, it can cause difficulty in breathing and thereby create a whistling sound.

• Hoarse Cry or a ‘Barking’ Cough: Infection in the larynx (voice box), trachea (windpipe), or in the small tubes of the lungs (bronchioles), and the presence of mucus can create a hoarse cry or a ‘barking’ cough.

• Stridor or High-Pitched Squeaky Sound: The presence of excess tissue around the larynx can cause a high-pitched squeaky sound, which is harmless and gets resolved by two years of age. The sound increases when the baby is lying on its back, and is noticed during inhalation.

• Deep Cough: A blockage in the tubes that carry air to the lungs (bronchi) can cause a deep cough.

• Wheezing: Bronchioles are small airways that come out from the bronchi. Blockage in the bronchioles can cause wheezing during exhalation.

• Snoring: The presence of mucus in the airways can cause babies to snore, but respiratory problems or lung diseases can also cause snoring.

• Grunting: An instant low-pitched sound during exhalation is called grunting. This can indicate an issue in one or both lungs or an infection.

• Frequent Sneezing: Sneezing is a common condition, but frequent sneezes accompanied by coughing, fever, and breathing difficulty can indicate a respiratory infection. Also, allergies can cause babies to sneeze frequently.

• Periodic Breathing: Periodic breathing is characterized by short pauses between breaths that last for three seconds, which is normal. If the pause is for more than 20 seconds, it can indicate infant apnea (unexplained episode of stoppage of breathing for 20 seconds or longer). The breaths following the pause can be in clusters and be rapid and shallow.

• Hiccups: Hiccups are common in babies as well as adults and can occur if the air enters the food passage or if one eats quickly. It can also happen if the stomach contents move back into the esophagus (a tube through which food passes from the mouth to the stomach). This is called gastroesophageal reflux.

How to Diagnose a Newborn’s Breathing Condition?

Various methods of diagnosis include:

• Physical Examination: Physical examination of the baby can help determine the problem.

• Chest X-Rays: This helps to find the efficiency of lung expansion and if the size and function of the heart are affected by any lung problem.

• Skin Sensors: Skin sensors measure the blood’s oxygen and carbon dioxide levels.

• Heart Test: A test such as an echocardiogram can help detect any heart abnormalities.

• Blood Tests: Blood tests are taken to find the presence of any infection.

What Should Parents Do if Babies Breathe Abnormally?

Though different breathing patterns in babies can be stressful to parents, the following measures can be taken to manage the condition:

• Parents must be aware of normal breathing patterns to identify abnormal patterns.

• A short video of the baby’s breathing can be taken and shown to the doctor during online or offline consultation.

• According to research, making the babies lie on their backs reduces the risk of sudden infant death syndrome (SIDS- sudden, unexplained death of a healthy baby under one year of age during sleep). Parents or caretakers must avoid techniques that involve inclining the baby or the cradle at a certain position without a pediatrician’s advice.

• Drops that relieve congestion, as prescribed by the pediatrician, must be used to relieve the baby from respiratory difficulty.

• Babies must not be wrapped in too many clothes. This can cause overheating. Infants must be covered with breathable fabric and a single layer of cloth, like a sweater, to keep them warm.

• Babies must never be shaken to restore normal breathing, as it can cause injury to the brain.

• Infants must not be laid down with their faces on soft pillows, cots, bean bags, comforters, or waterbeds, as it can hinder breathing.

• The environment around the baby should be smoke-free. Anyone touching the child after smoking must be asked to change their dress and wash their hands.

• Sleep positioners and wedges used for sleeping and feeding are not recommended by the Food and Drug Administration (FDA) as it increases the risk of Sudden Infant Death Syndrome (SIDS).

When to Seek a Doctor?

It is advised to consult a physician immediately if the following signs are noted:

• Varied breathing patterns that last more than a few minutes.

• Unusual breathing with fever or any fever that occurs in an infant less than two months of age.

• Difficulty breathing or irregular breathing pattern after a bath or water.

• Difficulty breathing or irregular breathing pattern after choking or a near choking incident.

• Unusual breathing and being lethargic.

• Unusual breathing with difficulty in feeding.

• Frequent pauses in between breaths.

• Bluish skin color during normal breathing.

• Repeated vomiting episodes.

• Being pale or blue around the mouth.

• Unresponsive baby.

Conclusion:

Babies breathe faster than adults, and this is normal. But respiratory distress can pose a threat in babies more than in adults. Parents or caretakers must know the usual breathing patterns, respiratory rate, and different breathing sounds in babies and distinguish these from unusual breathing conditions. Medical help must be sought immediately in case unusual breathing conditions are observed.