Initiation and maintenance of respiration in the premature infant is of primary concern.

The lung maturity varies in accordance with the degree of prematurity, drugs given before hand, and/or prolonged stress before delivery. The alveoli began to form at twenty six to twenty eight weeks gestation.

The longer the delivery of the baby can be delayed, the greater will be the ability of the lungs to sustain extrauterine life.

a. At the moment of delivery, the newborn must switch from passive reception of oxygen to establishing and maintaining ventilation by untried lungs. Not infrequently, the premature infant is incapable of this task, making resuscitation necessary. The respiratory muscles are poorly developed, the chest wall lacks stability, and production of surfactant is reduced. Effective resuscitation must be established to prevent the development of irreversible respiratory acidosis.

b. The infant should be positioned to allow for easy drainage of mucus from his mouth. Very small infants are placed on their side, whereas, large infants are placed on their abdomen. The infant’s head may be tilted down except when danger of increased intracranial pressure or increased respiratory distress, which is due to his liver pressing on the diaphragm.

c. The best way to evaluate the baby’s oxygen status is through arterial blood gases. Caution must be applied during the administration of 100% oxygen during resuscitation or to maintain respirations because it places the immature infant in danger of developing pulmonary edema or retrolental fibroplasia.

d. The infant needs continuous monitoring/assessment for:

(1) Respiratory rate, depth, and regularity.

(2) Periods of apnea greater than 20 seconds.

(3) Respiratory rate after apneic episode (same, increased, or decreased).

(4) See-saw respirations.

(5) Expiratory grunting.

(6) Chin tug.

(7) Retractions.

(8) Nasal flaring.

(9) Cry (feeble, whining, and high-pitched).

(10) Heart rate (usually increased).

(11) Cyanosis (when it occurs, where, relieved by O2, and amount of O2 needed).

(12) Reflexes (gag and swallow).

(13) Prebirth history.