Helping your premature baby breathe at home

Babies born before 32 weeks or who have or have had bronchopulmonary dysplasia (BPD) are more likely to have ongoing breathing problems, such as asthma, wheezing or apnoea. Apnoea is a common condition where a baby stops breathing for a few seconds before breathing normally again. Find out more about breathing support for premature babies. 

The healthcare team will make sure you’re confident supporting your baby with their breathing before you go home. They will also give you details of who to contact if you’re worried about your baby’s breathing. They may give you advice on keeping your baby safe at home, for example, avoiding tobacco smoke and pollution. 

Giving your baby extra oxygen at home

Some babies need long-term oxygen treatment, for example, if they have bronchopulmonary dysplasia, sleep apnoea or high blood pressure in the blood vessels that supply the lungs. They may need oxygen 24 hours a day or just when they’re asleep. The healthcare team will explain why your baby needs oxygen and when they need to use it. 

Your baby may be able to go home on oxygen if:   

• their oxygen needs are stable
• they are likely to need oxygen for at least 2–3 weeks 
• their health is otherwise stable
• they are up to date with their vaccinations
• you are willing to take on the responsibility
• your home is suitable, for example there’s enough space for the oxygen equipment
• you have a reliable telephone for emergencies, such as a landline or mobile phone (making sure it’s always charged).

Looking after your baby at home when they’re on oxygen can be demanding so it’s important that you have support from family, friends and your healthcare team. But it can allow you to begin family life at home while your baby’s treatment continues.

The healthcare team will work with you to decide whether home oxygen treatment is suitable for your baby. They should give you a written copy of the discharge plan. 

It’s natural to feel nervous about giving your baby extra oxygen but the healthcare team will make sure you feel confident before you take your baby home. You may be able to stay in the hospital overnight with your baby so you can practice giving them oxygen before you go home.    

How oxygen therapy works

Oxygen is usually given to your baby through a machine called a concentrator. You plug the concentrator into an electrical socket. It takes oxygen from the air in the room and feeds your baby through narrow tubing to small prongs (nasal cannula) that sit inside their nostrils.  

You can have long tubes running from the machine around your home so that you can connect to the oxygen supply in 2 different rooms.  

You will also have some small oxygen cylinders that you can carry in the pram or a rucksack. This means your baby can continue to have oxygen in the garden (if you have one) or when you go out. You can also use these cylinders as a back-up, in case there’s a problem with the concentrator machine. 

Learning how to use oxygen at home

Oxygen is a fire hazard, so it’s important that you are confident in how to use the equipment safely. The healthcare team will show you how to use it. They will also give you clear written instructions and a list of emergency phone numbers. They will ask for your permission to pass your baby’s details to the supplier, fire brigade and other relevant organisations.  

The oxygen supply company will then deliver the equipment to your home and show you how to use it. They will give you a 24-hour emergency contact number in case of any problems with the equipment. They will also tell you how to keep safe while you have oxygen in your home. 

Oxygen makes things burn more easily, so it’s important to:     

• avoid smoking or using e-cigarettes nearby
• keep away from candles, including birthday cake candles
• avoid flammable liquids or oil-based products, such as aerosols or Vaseline
• store oxygen cylinders at least 6 feet away from cookers and heaters
• have working smoke alarms in your home
• tell your local fire service that you have oxygen at home
• check your soke alarms to make sure they are working properly.

You will need to tell your home and car insurance companies that you are using oxygen at home and when travelling. Tell your electricity company if you have a concentrator machine so they can reconnect you quickly if there’s a power cut. You may be able to get a refund through your oxygen supplier for the electricity the concentrator uses. 

A member of the healthcare team will visit you regularly at home to support you after you’ve received the equipment. 

You can read more about home oxygen on the NHS and Bliss websites.

Asthma

Asthma is a common lung condition that causes occasional breathing difficulties. There's no cure, but there are treatments that can help keep the symptoms under control. Being born prematurely can increase the risk of getting asthma.

The main symptoms of asthma are:

• a whistling sound when breathing (wheezing)
• breathlessness
• coughing. 

You may also notice that your baby is finding it harder to breathe if their nostrils are flaring or they look like they’re using lots of their body when the breathe – for example if their chest or stomach is going up and down rapidly or they are shrugging their shoulders up and down. 

See your GP if you think your baby has asthma symptoms. Call 999 or go to A&E if your baby’s symptoms suddenly get worse and they are struggling to breathe.

Apnoea

This is pronounced like 'ap-nee-ya'. It is a condition where a baby stops breathing for a few seconds before breathing normally again.  

Babies may have single episodes of apnoea. Or they may have a few episodes together, with less than 20 seconds of normal breathing in between – this is called periodic breathing.  

Apnoea may not cause any problems in healthy premature babies but, if it continues, it can lead to low oxygen levels. Some babies may have apnoea together with bradycardia (a slow heart beat) or cyanosis. This is when a baby’s skin, lips, tongue or nail beds may have a blue tinge if there’s not enough oxygen in their blood.  

If your premature baby was diagnosed with apnoea while in hospital, they should have a plan in place to manage this when they were discharged. Speak to your healthcare team if you are unsure.

Speak to your midwife GP if you suspect that your baby has apnoea. Call 999 straightaway if they are struggling to breathe. 

Do I need an apnoea alarm?

Premature babies are not usually discharged from the baby unit if they have apnoea. Occasionally, a baby with ongoing apnoea may go home if the healthcare team and parents agree. In this situation, the healthcare team may give you an apnoea alarm to use at home. 

Some parents choose to buy an apnoea alarm once they return home in case their baby has an apnoea episode. This is a pad or clip that monitors your baby's breathing, alerting you if your baby has not breathed for 20 seconds or more. 

Health professionals do not recommend using these alarms unless you have been advised to by the healthcare team. This is because they can make parents feel unnecessarily worried, for example if your baby rolls off the mat, you may think they have stopped breathing. Apnoea is not linked with sudden infant death syndrome and there is no evidence that alarms reduce the risk of SIDS. 

Call 999 straight away if your baby is struggling to breathe. 

Bronchopulmonary dysplasia (BPD), also known as chronic lung disease

Some premature babies develop lung damage, called Bronchopulmonary dysplasia or BPD. This happens when the lungs haven’t had time to develop properly, so the baby needs extra oxygen for at least 28 days after birth to help them breathe. 

A baby with BPD may go home on oxygen and some will need to continue this therapy for several months. If this happens, you will be supported by specialist nurses in the community.

Wheezing 

This is a high-pitched sound that comes from the chest when your baby is breathing out. Wheezing can have many causes, so it does not necessarily mean your baby has asthma. However, wheezing is a sign of respiratory distress, so it is important to get medical help. See your GP urgently, but if you are worried that your baby is having difficulty breathing, go to your local A&E or call 999. 

Other infections

It’s important to look out for other illnesses that may affect your baby’s breathing. Find out more about protecting your premature baby from illness at home. 

Call 999 or take your baby to A&E if they have breathing problems, make a grunting sound as they breathe, their chest muscles sink into their body or if their skin looks blue. They may need treatment with oxygen. 

First aid for parents

The baby unit team will talk to you about possible emergency situations and how to deal with them. They may show you how to perform cardiopulmonary resuscitation (CPR) or how to deal with choking.  

If you would like to learn more first aid skills, you could ask your healthcare team, contact the British Red Cross or search online for private courses.