This question reflects something I hear from almost every family of a premature baby in the first weeks at home, and the answer matters enough that I want to be very precise about it. Premature babies do have a slightly different baseline breathing pattern from term babies. Their breathing may be slightly faster, and it is entirely normal for premature babies to have periodic breathing, a pattern of normal breaths interspersed with brief pauses of a few seconds, which resolves as the nervous system matures. What I am asking parents to watch for is change from their baby's normal baseline, and specific signs that are never within the range of normal at any gestation. The specific signs that require you to bring your premature baby to Vatsalya Children's Hospital, Varanasi for same-day assessment, without waiting, are: a breathing rate that is consistently above 60 breaths per minute when the baby is calm and not feeding, which you can count by watching the chest for one full minute; any new sound that was not there before, including a wheeze (a soft, musical sound on breathing out), a grunt (a small noise the baby makes at the end of each breath out, which indicates they are using their own vocal cords to maintain airway pressure), or any coarse rattling or gurgling sound in the chest rather than the nose; visible recession, in which you can see the skin being pulled inward between the ribs, at the base of the throat, or below the ribcage with each breath, which indicates the baby is working hard to bring air in; any colour change, including blue or dusky colouring of the lips or the area around the mouth; any episode of pausing in breathing that is longer than fifteen seconds or that is accompanied by colour change or reduced responsiveness; and a baby who is so breathless that they cannot feed, because feeding and breathing require coordinated effort and the baby is using all their effort for breathing. In a premature baby at home, any of these signs means same-day assessment at Vatsalya Children's Hospital, not waiting to see if it improves.
Written by Dr. Rajendra Pathak, MBBS, MD (Paediatrics), Senior Consultant Paediatrician and Founder-Director, Vatsalya Children's Hospital, Varanasi 221002. Phone: +91 9838585111.
