It’s a scary moment for even the most experienced first responder: A baby has been delivered in the hospital parking lot and isn’t breathing. Or a newborn’s parents call, sobbing, and report that their baby is in respiratory distress. Caring for babies facing respiratory emergencies is emotionally and physically challenging work. Baby airways are much smaller than those of adults, and the stakes are very high. A respiratory injury to a baby in respiratory distress can prove catastrophic. Here’s what you need to know to provide exceptional care to your most vulnerable patients.
Babies Face a Greater Risk of Airway Trauma
Iatrogenic airway trauma is common in babies and children. Their smaller airways and underdeveloped muscles make suctioning more difficult, especially in high-stakes emergency situations. Serious airway injuries can cause scar tissue that occludes the airway, leading to long-term breathing difficulties.
Airway Obstruction Is More Dangerous in Babies
Hypoxic injuries are a leading cause of childhood neurological issues, especially in neonates. Sixty percent of preterm babies suffer hypoxia, and 20 in 1,000 full-term babies are hypoxic at birth. Neurons quickly die when a baby is deprived of oxygen. When hypoxia is severe, it can compromise long-term development and potentially even shorten a child’s lifespan.
First responders should not hesitate to suction the airway of a baby with an airway obstruction. Seconds count, so act quickly, and drill as much as necessary to ensure you know how to access a baby’s airway safely.
The Anatomy Is Slightly Different
Pediatric airways contain all the same parts as adult airways, so many first responders mistakenly believe the airway is the same, just smaller. However, the airway changes and develops with time. The following important differences in infants’ airways can affect suctioning needs and other airway management techniques:
- The airway is smaller and shorter, necessitating smaller equipment.
- The tongue is proportionately larger, taking up more space in the oropharynx.
- The epiglottis is longer, narrower, and less rigid.
- The narrowest portion of the airway is at the cricoid cartilage below the glottis.
- The larynx is situated in a more anterior position, requiring a slight shift in intubation technique.
Technique Matters
The right technique is key to safely suctioning infants. Here are some important tips to keep in mind:
- Babies often move suddenly, so securing the infant in a stable position can reduce the risk of injury.
- Babies become hypoxic more quickly than adults. Suction for no longer than 10 seconds at a time.
- Neonates have limited head and neck control and may need padded support to remain in the right position.
- Use a smaller and more flexible suction catheter to reduce the risk of airway trauma.
- Signs of respiratory failure in a baby are different. They include a heart rate in excess of 130 bpm, retractions, and nostril flares, decreased oxygen saturation (even with oxygenation), and changes in breath sounds.
- Newborns are obligate nose breathers, so an upper respiratory obstruction is a much more serious complication in this group than in older babies.
The Right Equipment Is Critical
When a baby has a respiratory obstruction or other respiratory emergency, their life hangs in the balance. The wrong suctioning technique can cause serious, lasting damage so it’s important to use equipment that delivers consistent, reliable suction.
A suction machine compatible with smaller catheters ensures your team is prepared to work with the smallest patients. Portable suction is important because it ensures you can tend to sick babies without moving them. It also allows you to tend to neonates wherever they are, including those born on the way to delivery rooms or in hospital parking lots. Quality portable devices boast a long battery life and suction that rivals the best wall-mounted machines.
For help choosing the right portable suction machine for your agency, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.
Editor's Note: This blog was originally published in February, 2019. It has been re-published with additional up to date content.
