At what age can a newborn safely travel by plane?

When Can a Newborn Travel by Plane

For healthy newborns, wait at least 1 week after birth before air travel to ensure the infant is healthy and stable. 1

General Recommendation for Healthy Newborns

The British Thoracic Society guidelines explicitly state that it is prudent to wait for 1 week after birth before allowing infants to fly to ensure the infant is healthy. 1 This waiting period allows time to:

• Identify any previously unrecognized congenital abnormalities 1
• Ensure stable feeding and weight gain 1
• Confirm normal cardiopulmonary adaptation to extrauterine life 1

Special Considerations for High-Risk Infants

Infants with Neonatal Respiratory Problems

If the infant has had any neonatal respiratory problems, the proposed journey should be discussed with a paediatrician and a hypoxic challenge test considered before flight. 1

Key risk factors requiring pre-flight assessment include:

• Preterm infants (especially those <12 months corrected age) 2
• Ex-premature infants with chronic lung disease (bronchopulmonary dysplasia) 1
• Any history of neonatal respiratory distress 3

Research demonstrates that 81% of ex-preterm infants with neonatal lung disease who were not on supplemental oxygen at home still desaturated below 85% during hypoxic challenge testing, warranting in-flight oxygen prescription. 2 Infants less than 12 months corrected age are at particularly high risk. 2

Oxygen-Dependent Infants

For oxygen-dependent children where flying is imperative, oxygen requirements should be titrated in a body box before flight. 1 The process involves:

• Placing the infant in a body box with oxygen via nasal cannulae 1
• Diluting air to 15% oxygen with nitrogen to simulate cabin conditions 1
• Titrating oxygen flow to maintain baseline oxygen saturation 1
• Providing this calculated oxygen flow during the actual flight 1

Commercial aircraft maintain cabin altitudes between 6,000 and 8,000 feet, producing an inspired PO₂ of 118 mm Hg versus 159 mm Hg at sea level, which can cause significant hypoxemia in infants with marginal pulmonary reserves. 1

Physiological Rationale

The one-week waiting period is critical because:

• Cabin pressure changes can cause up to 60% expansion of any residual air in body cavities 4
• Newborns have limited cardiopulmonary reserve and may not tolerate the reduced inspired oxygen concentration at altitude 1
• Baseline oxygen saturation >95% at sea level does not predict adequate oxygenation during flight 2

Practical Implementation

For Healthy Term Infants:

• Wait minimum 7 days after birth 1
• Ensure infant is feeding well and gaining weight appropriately 1
• Confirm no respiratory symptoms or concerns 1

For At-Risk Infants:

• Mandatory pediatric consultation before booking travel 1
• Consider hypoxic challenge testing for any infant with respiratory history 1, 2
• Contact airline well in advance to arrange oxygen if needed 1
• Obtain physician certification for fitness to fly 1

Common Pitfalls to Avoid

• Do not rely on room air oxygen saturation alone - infants with SpO₂ >95% at sea level may still require in-flight oxygen 2
• Do not assume ex-preterm infants off oxygen are safe to fly - 81% still require supplemental oxygen during flight 2
• Do not use brief awake oximetry studies (20-30 minutes) for weaning decisions - these are misleading and inadequate 1
• Avoid travel in the first week even if infant appears healthy - this allows time to identify previously unrecognized problems 1