What is a Neonatal Respiratory Therapist? (A post for #RespiratoryCareWeek 2016)

A NICU RT is a specially trained dedicated member of a newborn’s Intensive Health Care team.  They combine high-tech life support with compassionate hands-on care. They will provide whatever care necessary to make sure that the infant breathes effectively, comfortably, and continuously from the delivery room until discharge.


A Neonatal Respiratory Therapists performs procedures that are both diagnostic and therapeutic such as:

  • Obtaining, Analyzing, and Interpreting data of blood gas specimens.
  • Obtaining Sputum specimens.
  • Operating and maintaining highly sophisticated respiratory equipment
  • Placing a breathing tube (called an endotracheal tube) to help babies breath.
  • Utilizing different breathing machines to help babies breathe adequately.
  • Providing medication and therapy that will help babies lungs inflate easier, prevent the airways from having spasms, treat infections, and prevent or decrease swelling in the lungs.
  • Monitoring equipment and babies responses to therapy.

Premature babies, or babies who have been under stress, have problems breathing. Signs that your baby might need help are nasal flaring (widening nostrils), grunting (singing noise), tachypnea (fast breathing) and/or retracting (skin pulling in between the ribs, abdomen, or above the collar bones). Breathing problems are the most common issue for premature babies.

Respiratory Therapists may use a variety of this equipment to help babies breathe:

Oxygen:  The air around us is 21% Oxygen and the rest is mostly Nitrogen.  Some babies require more oxygen than 21% Oxygen.  In the NICU we give oxygen based on their oxygen saturation (Sp02 or Sat).

Nasal Cannula:  A flexible hollow tube with small openings or prongs that direct oxygen flow towards the baby’s nostrils. This is used when a baby is breathing well on their own, but requires extra oxygen.  This tube will be attached to a bottle of room temperature water to help humidify the gas (referred to as cool humidity or a “bubbler”).  Some babies may require a higher flow of gas into their lungs to help them breathe easier.  Different equipment is used for these babies because the higher flow needs to be heated and humidified so the baby’s nose does not dry out. You may hear this referred to as a High Flow Nasal Cannula (HFNC) or Heated Humidified Nasal Cannula.

Hood: A transparent Hood or Tent around the baby’s upper body and head that allows a higher percentage of oxygen close to the baby’s mouth and nose.  The baby breathes normally, but each breath will contain higher amounts of oxygen than 21%.

CPAP: This machine exerts a constant pressure of air and oxygen into the lungs while the baby breaths on its own, exhaling against the pressure to keep its lungs open. This helps make breathing is easier for the baby because its lungs don’t collapse with each breath. CPAP can be given through a breathing tube, but is usually given through two prongs or a mask to the nose.

Endotracheal Tube (ETT): An ET tube is a thick Poly Vinyl Chloride (PVC) tube that goes from the baby’s mouth (sometimes nose) into the windpipe (trachea). It connects to a ventilator that supplies the baby with air and oxygen at a regulated rate and pressure/volume. 

Ventilator: A ventilator is a complex life support device that controls the amount of air and oxygen a baby receives.  It controls the number of times it gives the baby a breath and also controls how deep of a breath your baby will receive.  The ventilator can breathe for a baby completely, partially, or support a baby when it’s breathing all on its own.

High Frequency Oscillating Ventilation (HFOV):  This ventilator is referred as an oscillator.  This type of ventilator is different from other ventilators because it delivers very small amounts of air and oxygen to the baby, at a very rapid pace.  

Airway Clearance – Baby’s lungs frequently cannot perform the cough mechanism due to their prematurity. A Respiratory Therapist may use a percussive device on the baby’s chest to help loosen up secretions stuck in its chest. This can be referred to as percussion, vibrations, chest physiotherapy, or airway clearance.

Surfactant – a drug given directly into the baby’s lungs to line the lung and prevent it from sticking together by decreasing surface tension. In premature infants <28 weeks gestation surfactant is not being produced by the lungs because they do not have the cells needed to make the surfactant. With older babies the Surfactant can be destroyed by pneumonia, breathing in meconium, or breathing in blood. When a healthy term baby is born their lungs open and stay open. Babies born without enough Surfactant, or have had their Surfactant destroyed, have Respiratory Distress Syndrome (RDS).  Their air sacs open when they breathe in, but collapse when they breathe out, cause them to become fragile and damaged. Surfactant doses can be repeated several times until the baby’s lungs stay open well with CPAP. As the baby becomes >28 weeks gestation it will begin to produce surfactant on its own.

iNO – Nitric oxide is a gas that is inhaled. It works by relaxing smooth muscle to widen blood vessels, especially in the lungs. This improves oxygen delivery to the body. Nitric oxide is used together with a breathing machine to treat respiratory failure.

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