One of the most common clinical conditions in premature babies is immature lungs. In mild cases, it can result in transient tachypnea of the newborn, known as wet lungs.

The baby exhibits rapid breathing, likely due to fluid still remaining in his lungs.

In more serious cases, it can cause respiratory distress syndrome (RDS).

This is caused by the delay in the maturation of a type of lung cells which produces surfactant, a chemical required to help lungs stay aerated and expanded.

In premature lungs where there is insufficient surfactant, the lungs tend to collapse, making it very difficult for the premature babies to breathe and receive oxygen. RDS can result in complications, such as respiratory insufficiency requiring mechanical ventilation and surfactant therapy, pneumothorax and even chronic lung disease.

All these conditions can result in premature babies staying longer in hospital, and can be affected by other conditions or even lead to death.

During the delivery of a premature baby, if there is time, the obstetrician will usually try to delay the birth by 24 hours and give injections to expedite lung maturity.

These are a special type of steroid injection which can help premature babies' lungs mature faster.

After the injections are given, some premature babies are able to breathe normally after birth and do not require oxygen or respiratory support.

However, these babies are still more prone to respiratory illness in the few years of life, although they have a lower risk compared with premature babies who have significant respiratory difficulty at birth. Generally, premature babies are at a higher risk of developing upper respiratory illness, bronchiolitis and hypersensitive airway disease.

Some steps to help premature infants improve their immunity and lower the risk of respiratory illness include breastfeeding for the first six months, introducing plenty of fresh fruit and vegetables when the baby is weaned, and getting vaccinations against whooping cough, pneumococcus and influenza, a common cause of childhood respiratory illness.

Parents should also practise good hand hygiene for the child's sake and avoid crowded places in the first two years of his life, especially if he is unwell.

DR LOW KAH TZAY
Paediatrician and neonatologist, Mount Elizabeth Hospital