Baby's first breath: A new method for helping preemies to breathe

December 12, 2019

Getting premature babies to breathe without assistance has always been a stressful mission for doctors. But by carefully ventilating babies with 100% oxygen researchers have found a way to jump-start these first independent moments.

Spontaneous breathing at birth is critical so that doctors can avoid using invasive respiratory interventions on fragile newborns. But hypoxia - a lack of adequate oxygen supply to the body - is a huge inhibitor of natural breathing and a particularly large risk for premature babies.

However, there may be hope on the horizon. Dr. Janneke Dekker and Prof. Arjan te Pas from the Leiden University Medical Centre, Netherlands and Prof. Stuart Hooper from Monash University, Australia have demonstrated how oxygen can be used to tackle this problem in two research studies, both of which feature in Frontiers in Pediatrics.

Most preterm infants need some kind of support at birth because of their low muscle strength and the fact that their lungs haven't fully developed. This assistance is generally provided non-invasively through the use of a facemask in order to avoid more complicated procedures that risk lung and brain injury. But to make the facemask effective, the preterm infants already need to be breathing on their own. So how to encourage this first breath?

It was thought that giving pure oxygen in the baby's first few moments may stimulate it to breathe deeper and more frequent, but the team needed to make sure the theory was sound in principal before moving onto clinical studies with human babies.

The first paper provided the groundwork. Dekker and colleagues divided 26 preterm rabbit kittens that had difficulty breathing into two groups that received non-invasive breathing support at birth. One group received 21% oxygen via a facemask (equivalent to the normal amount of oxygen in air) and the other received 100% oxygen. They found that giving pure oxygen immediately after birth resulted in more stable breathing as well as a better rate of breathing.

With these promising results in mind, Dekker turned her attention to clinical studies in humans.

In the second paper, Dekker used a similar technique for stimulating breathing in premature human babies. Like the first study, 52 premature babies were stabilized at birth and randomly assigned to two treatment groups. One received an initial oxygen concentration of 30% via a non-invasive facemask and the other group received an initial oxygen concentration of 100%. The amount of oxygen present in the baby's blood was measured by using a pulse oximetry probe and compared to the internationally recommended reference values. The facemask oxygen was then adjusted to maintain an oxygen level of the blood within these recommended ranges.

Their results matched their predictions: the premature babies in 100% O2 group had a higher rate of breathing effort as well as a better oxygenation rate, and ultimately needed less time of positive pressure ventilation. This meant that vital organs and tissues in these fragile infants were getting more of the precious oxygen they needed to survive and could be independent from assisted breathing sooner.

So why not give all babies 100% oxygen all the time? Because too much oxygen can also be a bad thing. It's known that high concentrations of oxygen over time can lead to hyperoxia - a potentially harmful situation that causes tissue damage. Dekker and colleagues were careful to avoid this by slowly decreasing - titrating -the excess amount of oxygen as it became clear the babies no longer need the support.

This careful balancing act of stimulating babies to breathe with excess oxygen, and then dialing it back once it's no longer needed could save lives in the future.

Before that can happen, Dekker notes that: "this clinical trial was not designed to demonstrate any significant differences in clinical outcomes, but rather provide knowledge on one of the factors that could improve breathing effort at birth. The next step will be to combine this new technique into a bundle of care and compare the outcome to current clinical practices."

While more research needs to be done before using the technique globally, Frontiers' Field Chief Editor Dr. Arjan te Pas says the findings are exciting in and of themselves:

"The finding that oxygenation is a dominant driver for breathing effort at birth is exciting as this offers the possibility to be more successful in supporting preterm infants in a non-invasive manner. The knowledge gained from this research could help us design future studies on improving the effectiveness of the use of oxygen at birth, without increasing the risks that are associated with hyperoxia."
Notes to Editors

Please link to the original research article in your reporting:

Article 1:

Article 2:

Corresponding author: Janneke Dekker,

Corresponding Author's Institution: Department of Pediatrics, Leiden University Medical Centre, Netherlands


This research was supported by the National Health and Medical Research Council (NHMRC) Program Grant (606789), NHMRC Research Fellowships (SBH: APP1058537, MT: APP1111134) and the Victorian Government's Operational Infrastructure Support Program. A.B. te Pas is recipient of an NWO innovational research incentives scheme (VIDI 91716428). E.V. McGillick was supported by a Monash University Postdoctoral Fellowship (BPF17-0066) and a NHMRC Peter Doherty Biomedical Early Career Fellowship (APP1138049). M.J. Kitchen is a recipient of ARC Future Fellowship (FT160100454). We acknowledge travel funding provided by the International Synchrotron Access Program (ISAP) managed by the Australian Synchrotron and funded by the Australian Government (AS/IA173/12909 and ISP12221).

Frontiers is an award-winning Open Science platform and leading Open Access scholarly publisher. Our mission is to make research results openly available to the world, thereby accelerating scientific and technological innovation, societal progress and economic growth. We empower scientists with innovative Open Science solutions that radically improve how science is published, evaluated and disseminated to researchers, innovators and the public. Access to research results and data is open, free and customized through Internet Technology, thereby enabling rapid solutions to the critical challenges we face as humanity. For more information, visit and follow @Frontiersin on Twitter.


Related Preterm Infants Articles from Brightsurf:

Early MRI scans can predict motor development risks for preterm infants
A new software tool developed at Cincinnati Children's can employ early MRI scan data to predict which preterm infants are most at risk of brain developmental disorders.

Antibiotics affect breast milk microbiota in mothers of preterm infants: University of Toronto study
A team led by researchers at the University of Toronto and The Hospital for Sick Children has found that mothers of preterm babies have highly individual breast milk microbiomes, and that even short courses of antibiotics have prolonged effects on the diversity and abundance of microbes in their milk.

Omega-3s provide no benefits against bronchopulmonary dysplasia in very preterm infants
Consumption of DHA supplements, an omega-3 fatty acid, by breastfeeding mothers is ineffective in preventing bronchopulmonary dysplasia in preterm infants born before the 29th week of pregnancy.

Apgar score effective in assessing health of preterm infants
The vitality of preterm infants should be assessed with an Apgar score, a tool used to measure the health of newborns immediately after birth.

Unplanned extubations in preterm infants leads to poor outcomes, increased care costs
Unplanned extubations in adult and pediatric populations have long been associated with poor clinical outcomes and increased costs to health care systems.

Very low-dose Avastin effective for preventing blindness in preterm infants
Babies born prematurely who require treatment to prevent blindness from retinopathy of prematurity (ROP) could be treated with a dose of Avastin (bevacizumab) that is a fraction of the dose commonly used for ROP currently.

Children born preterm are more likely to be placed outside the home
Children born prematurely, i.e. before week 37, are more likely to be placed outside the home as a supportive child welfare measure than their full-term counterparts, according to a population study conducted by the Finnish Institute for Health and Welfare (THL).

Umbilical cord milking may be linked to higher risk of brain bleeding in preterm infants
Milking the umbilical cord -- gently squeezing the cord and pushing the contents into the newborn's abdomen before clamping the cord -- could increase the risk for severe intraventricular hemorrhage, or bleeding into the brain's fluid-filled cavities, in extremely preterm infants, according to results of a study funded by the National Institutes of Health that was halted for safety concerns.

Deaf infants' gaze behavior more advanced than that of hearing infants
Deaf infants who have been exposed to American Sign Language are better at following an adult's gaze than their hearing peers, supporting the idea that social-cognitive development is sensitive to different kinds of life experiences.

Prolonged antibiotic treatment may alter preterm infants' microbiome
Treating preterm infants with antibiotics for more than 20 months appears to promote the development of multidrug-resistant gut bacteria, suggests a study funded by the National Institutes of Health.

Read More: Preterm Infants News and Preterm Infants Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to