Breathing is hard work for premature infants.

Depending on gestational age, preterm infants may have structurally immature lungs which lack the surfactant necessary to prevent collapse of their air sacs during exhalation.([FOOTNOTE=Schmölzer G, Kumar M, Pichler G, et al. Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis. BMJ. 2013;347:f5980.],[ANCHOR=],[LINK=]),([FOOTNOTE=Purandare CN. Fetal lung maturity. J Obstet Gynecol India. 2005;55(3):215-217.],[ANCHOR=],[LINK=]) These characteristics may put ventilated preterm neonates at risk for lung injury such as bronchopulmonary dysplasia, which may put them at risk for ongoing respiratory symptoms and long-term functional abnormalities.1

The Vulnerable Brain

Premature babies have extreme central nervous system vulnerability and may be susceptible to the long-lasting changes in physical structure and operation of the brain associated with premature birth.([FOOTNOTE=Salmaso N, Jablonska B, Scafidi J, Vaccarino FM, Gallo V. Neurobiology of premature brain injury. Nat Neurosci. 2014;17(3):341-346.],[ANCHOR=],[LINK=]),([FOOTNOTE=Newnham CA, Inder TE, Milgrom J. Measuring preterm cumulative stressors within the NICU: the Neonatal Infant Stressor Scale. Early Hum Dev. 2009;85(9):549-555.],[ANCHOR=],[LINK=]) The most common types of brain injury seen in premature infants are diffuse injury to the white matter as well as gray matter and hippocampal abnormalities.3

Beyond prematurity itself, low blood oxygen levels resulting from immature lung development,3 nutritional stress,([FOOTNOTE=Kuenen K, van Elburg RM, van Bel F, Benders MJNL. Impact of nutrition on brain development and its neuroprotective implications following preterm birth. Pediatr Res. 2015;77(1):148-155.],[ANCHOR=],[LINK=]) and environmental stresses([FOOTNOTE=Smith GC, Gutovich J, Smyser C, et al. Neonatal intensive care unit stress is associated with brain development in preterm infants. Ann Neurol. 2011;70(4):541-549.],[ANCHOR=],[LINK=]) have been linked to brain injury.

Alterations in brain structure due to prematurity may persist into adolescence and are associated with long-term cognitive difficulties, "particularly those involved with language and executive functions, and psychiatric illnesses including autistic spectrum and anxiety disorders."3

50% TO 70% 

An estimated 50% to 70% of very low-birth-weight preterm infants (≤1500 grams) have later dysfunction, including cognitive, behavioral, and social delays.([FOOTNOTE=Pickler RH, McGrath JM, Reuna BA, et al. A model of neurodevelopmental risk and protection for preterm infants. J Perinat Neonatal Nurs. 2010;24(4):356-365.],[ANCHOR=],[LINK=])

The Fragile Eyes

Retinopathy of prematurity (ROP) is an eye disease that primarily affects premature infants who weigh 1500 grams or less at birth.([FOOTNOTE=Jordan CO. Retinopathy of prematurity. Pediatr Clin N Am. 2014;61:567-577.],[ANCHOR=],[LINK=]) Approximately 14% of childhood blindness in the United States is associated with ROP, making it the third leading cause of blindness in American children.8

ROP is thought to be caused by growth of abnormal blood vessels in the retina which may bleed, which can cause retinal scarring and may eventually lead to retinal detachment.([FOOTNOTE=Facts About Retinopathy of Prematurity (ROP). National Eye Institute Web site. Accessed December 3, 2014.],[ANCHOR=],[LINK=])

Major risk factors for ROP include high blood levels of oxygen (due to treatment with excessive supplemental oxygen) and low birth weight.8 Oxygen saturation between 90% and 95% appears to be the safest target to reduce the risk of ROP in premature infants.8

20,000 Cases

ROP causes an estimated 20,000 cases per year of blindness or severe visual impairment.8

What you can do to reduce stress in the NICU

  • Ventilation - delivering synchronized breath, with both invasive and non-invasive ventilation, can have important benefits for neonates.([FOOTNOTE=Mahmoud RA, Proquitté H, Fawzy N, Bührer C, Schmalisch G. Tracheal tube airleak in clinical practice and impact on tidal volume measurement in ventilated neo¬nates. Pediatr Crit Care Med. 2011;12(2):197-202],[ANCHOR=],[LINK=])
  • Patient monitoring - providing continuous SpO2, pulse rate, and respiration rate monitoring, so clinicians may detect respiratory complications earlier and intervene sooner.([FOOTNOTE=Joint Commission Sentinel Event Alert: Issue #49, pp1-4, August 8, 2012. (Available at],[ANCHOR=],[LINK=]),([FOOTNOTE=ASA Standards for Basic Anesthetic Monitoring, Committee of Origin: Standards and Practice Parameters (Approved by the ASA House of Delegates on October 21, 1986, and last amended on October 20, 2010 with an effective date of July 1, 2011, excerpt from section 3.2.4.],[ANCHOR=],[LINK=]),([FOOTNOTE=Essential Monitoring Strategies to Detect Clinically Significant Drug-Induced Respira¬tory Depression in the Postoperative Period. Prepared by Stoelting, R. and Overdyk, F.],[ANCHOR=],[LINK=])
  • Procedural stress - reducing any associated pain, discomfort, or risk of infection may help.

Discover below which respiratory & monitoring products from Medtronic can help reducing stress of neonatal patients.


Discover our broad online education offering.

Patient Monitoring & Respiratory Interventions


Discover how we can support you in providing the best care for all your critical care & acute care patients.

Connect with Medtronic Patient Monitoring & Respiratory Interventions
Your platform for clinical & product educational content.