Continuous Positive Airway Pressure (CPAP) and Preemies

Continuous positive airway pressure, commonly called CPAP, is a type of respiratory support or noninvasive mechanical ventilation used in adult and pediatric patients. In premature babies, CPAP is delivered through a set of nasal prongs or through a small mask that fits snugly over a baby’s nose.

Like nasal cannula, CPAP is used to deliver constant air pressure into a baby’s nose, which helps the air sacs in their lungs stay open and helps prevent apnea. Because CPAP can deliver more pressure than the nasal cannula, it is often used for babies who are breathing well enough on their own that they do not need more invasive mechanical ventilation like a ventilator.

CPAP can also be used to deliver higher concentrations of oxygen to premature babies who have trouble maintaining good oxygen levels in their blood.

Why Would a Baby Need a CPAP?

Because their lungs may not be fully developed, premature babies sometimes have trouble breathing. CPAP offers non-invasive breathing support for babies with conditions that impact breathing.

Respiratory Distress Syndrome

CPAP in infants is mainly used to treat respiratory distress syndrome (RDS). RDS occurs when a baby is born prematurely before their lungs have fully developed. The lungs of these infants are deficient in surfactant, a slippery substance that enables smooth lung expansion and contraction. Without these surfactants, breathing becomes difficult.

Apnea of Prematurity

Apnea is a condition characterized by long pauses in breathing that lead to an abnormally slow heart rate (bradycardia). Apnea is generally caused by delayed development in the part of the brain that controls respiration and affects some premature babies. CPAP may reduce some apnea episodes by promoting regulated breathing.

What Does Infant CPAP Look Like?

With infants, CPAP is applied using binasal cannula (nasal prongs), a single nasopharyngeal cannula, or a soft nasal mask connected to a long tube. Of these methods, short binasal prongs are preferred by many clinicians because they are less cumbersome and less likely to cause skin irritation.

Researchers have also been experimenting with using a helmet to administer CPAP to infants. So far, the results are promising. One study found infant CPAP helmets were better tolerated and had a lower risk of leaks and skin sores than traditional CPAP masks.

Drawbacks of CPAP for Babies

When discussing the need for CPAP with premature babies, it's also necessary to explain the risks. The potential complications associated with CPAP include:

• Chronic lung disease (CLD)
• Gastric distention ("CPAP belly")
• Gastroesophageal reflux
• Nasal damage
• Oral feeding delays
• Preventing physical contact with parents and caregivers

One apparatus, the bubble CPAP (b-CPAP), which provides heated, humidified gas mixture to the infant, is associated with a notable reduction in chronic lung disease, one of the more serious complications of CPAP in babies. Every medical treatment comes with some risk, but the benefits of CPAP for infants who need it far outweigh these risks.

How Long Will My Baby Need CPAP?

There is a wide range in how long a baby might need CPAP. Doctors consider a few different factors to determine when it's time to "wean" or discontinue this form of respiratory support.

First, they look at the baby's chronological age, which is the age based on the day they were born, and their corrected age, which is their actual age minus the number of days or weeks they were born preterm. That's an important distinction because a 4-week-old baby born a month premature may have some developmental delays compared with a full-term baby at 4 weeks old.

Doctors also look at the baby's weight and if they are meeting certain respiratory markers to determine when it is safe to discontinue CPAP. Depending upon the case, they can remove CPAP suddenly and completely, introduce a nasal canula in place of the CPAP, and/or gradually reduce respiratory support over time.

Frequently Asked Questions

How long will my baby be on a CPAP?

It's hard to say how long your baby will need CPAP because every preemie progresses at a different rate. Much depends on your baby's growth and if they are meeting certain stability criteria. For some babies, CPAP is discontinued at once. For others, respiratory support is gradually reduced until they are safely and consistently breathing on their own.

How long will my baby be off CPAP and still in the NICU?

Every baby in the NICU has unique health concerns. Even if your baby is weaned off of CPAP, they may still need further care for other medical issues. Don't hesitate to ask your NICU healthcare team for an update on your baby's progress and answers to any questions you may have during your baby's hospital stay.

What does a CPAP machine for a preterm baby look like?

Most CPAP devices for infants consist of either a small mask or a set of nasal prongs extending into the baby's nose on one end and attached to an air source on the other. When applied properly, your baby should feel no discomfort when using CPAP.

What is the most effective device for infant CPAP?

There isn't necessarily one type of CPAP device that is best for all infants. Much depends on the baby and the condition they are being treated for. In babies with respiratory distress syndrome (RDS) some research suggests bubble systems (a type of continuous flow system) may be better than Infant Flow Systems (a type of variable flow system). Those infants treated with bubble systems needed less time on CPAP and were more likely to be extubated successfully.

Why would a premature baby need a bubble CPAP?

Bubble CPAP is one type of CPAP device used to provide heated and humidified gas to assist with breathing in infants. The benefits of b-CPAP in smaller babies include lower risk of chronic lung disease, improved overall outcomes, and shorter NICU stays.

A Word From Verywell

It can be disconcerting for a parent to see their tiny baby hooked up to a mask or with tubes coming out of their nose. But CPAP is an important tool to help the smallest babies breathe effectively so they can continue to grow and one day "graduate" from the NICU.