Melbourne study captures complexities of babies’ first breaths

Medical researchers in Melbourne have captured detailed images of the lungs of newborn babies as they take their first breaths, which they say could help other infants with respiratory issues in the future.

The study, led by the Murdoch Children’s Research Institute (MCRI) and recently published in the American Journal of Respiratory and Critical Care Medicine, looked at full-term babies born at Melbourne’s Royal Women’s Hospital.

The researchers generated detailed images of how air was moving through the babies’ lungs using electrical impedance tomography (EIT).

The researchers have found that infants’ lungs are far more complicated than previously thought.

“This technology allows us to do something we’ve not been able to do before, which is to really see how every single breath the baby takes after they’re born is adapting to that process of being an independent person outside of their mother’s womb,” clinical neonatologist David Tingay said.

“It’s really like a big bang for the baby — if the lungs don’t fill with air and get that oxygen in, all the other organs can’t kick off and start doing what they need to do.

Newborns’ first cries critical for independent breathing

Crying at birth helps the lungs fill with air and helps the baby adapt to breathing air.

“From that very first breath a pre-term baby takes there can be lung injury, so this is why we need to be able to intervene as early as possible from that very first breath with the most protective and effective therapies,” Dr Tingay said.

“Most mothers know that a nice healthy baby will take a big cry when they’re born, and we saw that 80 percent of the first breaths that healthy babies take are cries and seem to be more important than just making noise.

“They’re critical to how a baby fills their lungs up with air and clears all that womb fluid out of their lungs and allows them to be independent with their breathing.”

“Babies are super clever and if their lungs are having some trouble clearing that liquid they’ll move air from one part of their lungs to another to try and protect those lungs.”

Previously, researchers had not been able to see the breath because the technology was too cumbersome or exposed the baby to radiation.

That meant doctors did not have the tools to make clinical decisions to resuscitate babies.

The EIT technology involves placing a small belt of silk-like material around the chest of newborns.

Researchers can use that material to measure the electrical currents that are going through babies’ lungs, and image from that how air is passing in and out of babies’ lungs while they take their first breaths.

Parents welcome promising new technology

Joanna Bezette’s daughter Milly, who is now 14 months old, was born prematurely and has chronic lung disease.

She spent five months in neonatal intensive care and was intubated just eight minutes after birth.

Ms Bezette said it was remarkable to think about the potential of the new lung imaging technology for premature babies like Milly.

She said it could help spare other parents from what she went through in the first few weeks of Milly’s life.

It took doctors about a month to get a full picture of how underdeveloped Milly’s lungs were.

“It was terrifying, having a baby in intensive care who is being monitored 24/7, it was absolutely terrifying, without a doubt the worst experience of my life,” Ms Bezette said.

“I think having issues identified earlier would be very reassuring for a lot of parents with very sick babies, because it’s terrifying when you don’t have any idea what’s going on and what the future might look like.”

Research will help doctors plan swift medical interventions

About 10 per cent of newborns and almost all pre-term infants need resuscitation because their lungs do not properly fill with air at birth.

Respiratory problems were the most common reason babies needed to be treated in intensive care, Dr Tingay said.

He said the study had provided the first detailed picture of how exactly a baby’s lungs filled with air in the moments after they were born.

“At the moment we are lacking any way of taking the sort of knowledge base we have outside of the delivery room such as in ICU, and translating it in a way that we can look at how to support babies while they’re taking these first few breaths which are changing very quickly,” he said.

“And if they don’t get it right, then they get into trouble and they need help.”

Because that “knowledge gap” has been filled, he said it could help doctors predict when a baby’s lungs might fail at birth, and make it easier to plan interventions.