Babies Preemies Continuous Positive Airway Pressure (CPAP) and Preemies By Cheryl Bird, RN, BSN Cheryl Bird, RN, BSN, is a registered nurse in a tertiary level neonatal intensive care unit at Mary Washington Hospital in Fredericksburg, Virginia. Learn about our editorial process Cheryl Bird, RN, BSN Medically reviewed by Medically reviewed by Lyndsey Garbi, MD on November 25, 2019 linkedin Lyndsey Garbi, MD, is a pediatrician who is double board-certified in pediatrics and neonatology. Learn about our Review Board Lyndsey Garbi, MD on November 25, 2019 Print Jacqueline Hunkele / Getty Images Continuous positive airway pressure, commonly called CPAP, is a type of respiratory support, or 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 the lungs stay open and helps prevent apnea. CPAP can deliver more pressure than the nasal cannula, so is often used in babies who are breathing well enough on their own that they do not need mechanical ventilation, but who need more support than the cannula offers. CPAP can also be used to deliver higher concentrations of oxygen to premature babies who have trouble maintaining good oxygen levels in their blood. Respiratory Support in NICU How to Wear a CPAP With infants, CPAP is applied using binasal cannula (nasal prongs), a single nasopharyngeal cannula, or a soft nasal mask. Of these methods, short binasal prongs are preferred by many clinicians. Most recently, researchers have been experimenting with using a helmet to administer CPAP. CPAP Resistance Measures CPAP can consist of the following resistance measures: Electronic feedback control Flow opposition to fluid flow reversal during expiration Underwater seal It's debatable which form of resistance makes breathing easier for an infant. Variable Flow vs. Continuous Flow Systems Commercial CPAPs can be divided into two types: Continuous flow systems: Continuous flow systems adjust the CPAP level either by using a valve in the expiratory circuit to modulate resistance or by placing the expiratory tubing under water. Both these systems require high rates of constant flow to match the infant's peak inspiratory flow. Variable flow systems: Variable flow systems set a CPAP level using rapid adjustments in flow rate. The pressure generated by variable flow systems is measured using a manometer hooked up to an alarm. Which Type of CPAP Is Best? We have yet to exactly elucidate a "best" route of administration of CPAP. In other words, there's no weighty evidence favoring the use of a specific nasal interface or flow system. However, bubble systems (a type of continuous flow system) may be better than Infant Flow Systems (a type of variable flow system) when treating infants with respiratory distress syndrome (RDS). Specifically, some research suggests that babies with RDS placed on bubble systems needed less time on CPAP and were more likely to be extubated successfully. (Extubation is medical jargon meaning removal of a tube, in this case, removal of the CPAP tube and interface.) Other studies have also suggested that bubble systems result in better oxygenation. When Is CPAP Used in Infants? CPAP in infants is mainly used to treat respiratory distress syndrome (RDS). Respiratory distress syndrome results when a baby is born premature and her lungs have yet to fully develop. The lungs of these infants are deficient in surfactant, a slippery substance that reduces surface tension in the lungs and enables respiration. Was this page helpful? Thanks for your feedback! Track your baby’s most exciting moments with our milestone checklist. Get it free when you sign up for our newsletter. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Chang GY, Cox CA, Shaffer TH. Nasal cannula, CPAP, and high-flow nasal cannula: effect of flow on temperature, humidity, pressure, and resistance. Biomed Instrum Technol. 2011;45(1):69–74. doi:10.2345/0899-8205-45.1.69 Fedor KL. Noninvasive Respiratory Support in Infants and Children. Respir Care. 2017;62(6):699–717. doi:10.4187/respcare.05244 Liu Q, Gao Y, Chen R, Cheng Z. Noninvasive ventilation with helmet versus control strategy in patients with acute respiratory failure: a systematic review and meta-analysis of controlled studies. Crit Care. 2016;20(1):265. doi:10.1186/s13054-016-1449-4 Bahman-Bijari B, Malekiyan A, Niknafs P, Baneshi MR. Bubble-CPAP vs. Ventilatory-CPAP in Preterm Infants with Respiratory Distress. Iran J Pediatr. 2011;21(2):151–158. Committee on Fetus and Newborn. American Academy of Pediatrics. Respiratory support in preterm infants at birth. Pediatrics. 2014;133(1):171–174. doi:10.1542/peds.2013-3442 Additional Reading Agarwal S, Maria A, Roy MK, Verma A. A Randomized Trial Comparing Efficacy of Bubble and Ventilator Derived Nasal CPAP in Very Low Birth Weight Neonates with Respiratory Distress. 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