If a baby is born preterm, organ systems can be quite immature and therefore need medical support. Especially the lungs of preterm infants are often not fully developed and if there is a lack of surfactant, a surface active agent that lowers surface tension and prevents atelectasis (collapsed lung), they are more likely to develop respiratory distress syndrome. As the first breath is essentially in the initiation of the transition from the fetal to the post-natal circulation and physiology, infants need further respiratory support such as positive pressure ventilation and supplemental oxygen. If infants are breathing spontaneously but cannot create pressure to prevent the lung from getting atelectatic, continuous positive airway pressure is applied as it provides the infant with positive end-expiratory pressure (PEEP) and maintains the pressure throughout the breathing cycle. It’s like having a balloon: as long as the pressure inside the balloon is greater than outside, it is stable, but as soon as air and pressure slip out, the balloon is going to collapse. In preterm infants the alveoli would collapse as the surface tension is low therefore, they are provided with CPAP. 😊 
However, there are many more possibilites concerning breathing support in babies... Coming soon!  

Caffeine for babies?!?

But first, coffee! Who else needs at least one cup of coffee per day? Caffeine wakes us up in the morning and keeps us awake in the afternoon. But in fact, it’s way more than that. Caffeine is a Methylxanthine and therefore, stimulates breathing effort. The exact mechanism is still unknown, but an advanced response of chemoreceptors to pCO2 rise as well as an improvement of respiratory muscles and the stimulation of the central nervous system have been described. Preterm babies, whose respiratory function isn’t completely developed at birth, are often on caffeine as it facilitates extubating earlier, prevents BPD (chronic lung disease) and leads to a better neurodevelopmental outcome. 



Armanian AM, Iranpour R, Faghihian E, Salehimehr N. Caffeine Administration to Prevent Apnea in Very Premature Infants. Pediatr Neonatol. 2016

Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Te Pas A, Plavka R, Roehr CC, Saugstad OD, Simeoni U, Speer CP, Vento M, Visser GHA, Halliday HL. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2019 Update. Neonatology. 2019

Just a simple mouse klick and those annoying red eyes are gone. But in fact, the 


is a physiological sign that is tested for early detection of vision abnormalities (e.g. cataract, glaucoma, retinoblastoma, retinal abnormalities, ...) which is an essential examination of the NIPE (see below).
Thereby, light is transmitted through all normally transparent parts of an eye, reflects off the ocular fundus and is then transmitted back and finally, a red spot can be seen by the examiner (through a ophthalmoscope).
If any factor blocks this pathway (mucus, cataract, iris abnormalities affecting the pupil, foreign bodies, corneal opacities, retinal abnormalities, tumors, ...), the red reflex is modified or disappears. 
And as babies are pretty much unable to tell us if their vision is totally fine, this examination can help us in detecting vision abnormalities as soon as possible.

Reference:  American Academy of Pediatrics; Section on Ophthalmology; American Association for Pediatric Ophthalmology And Strabismus; American Academy of Ophthalmology; American Association of Certified Orthoptists. Red reflex examination in neonates, infants, and children. Pediatrics. 2008 Dec;122(6):1401-4. doi: 10.1542/peds.2008-2624. Erratum in: Pediatrics. 2009 Apr;123(4):1254. PMID: 19047263. 


The Newborn and Infant Physical Examination screening programme aims to identify congenital abnormalities of the eyes, heart, hips and (in males) testes within 72 hours of birth. The examination will be repeated after 6 to 8 weeks, mostly at the GP, to further examine abnormalities, which haven't been detectable until then. 


Stabilization of a very and extremely preterm infant 

  • Extremely preterm (less than 28 weeks)
  • Very preterm (28 to 32 weeks) 
  • Moderate to late preterm (32 to 37 weeks)

Good to know:

  • 85% of infants breath spontaneously at birth
  • 10% start breathing after drying, stimulating and airway opening manoeuvres
  • 5% require positive pressure ventilation
  • 0.4% to 2% need to be intubated
  • less than 0.3% receive chest compression
  • 0.05% need adrenaline