Bubble CPAP, or Continuous Positive Airway Pressure, is a non-invasive method of respiratory support used for newborns in the neonatal intensive care unit (NICU). It is considered a gentle way to help babies who can breathe on their own but need assistance to do so more effectively. The system provides a steady flow of warmed, humidified air and oxygen to the infant, helping to keep their lungs open and making breathing less work. This support is a common and effective therapy for infants facing breathing challenges shortly after birth.
Why Babies in the NICU Need Breathing Support
Many newborns, particularly those born prematurely, require breathing support because their lungs are not yet fully developed. A primary cause is Respiratory Distress Syndrome (RDS), a condition common in premature infants resulting from a deficiency of surfactant. Surfactant is a substance that lines the tiny air sacs in the lungs, called alveoli, preventing them from collapsing when an infant exhales. Without enough surfactant, the alveoli collapse, making it difficult for the baby to breathe.
Another frequent reason for breathing support is Apnea of Prematurity. This condition affects preterm infants and is characterized by pauses in breathing that can lead to a drop in heart rate and oxygen levels. The immature respiratory control center in the brain is often the cause of these breathing interruptions. Bubble CPAP helps by providing constant pressure that can stimulate the infant to breathe more regularly.
A less severe condition known as transient tachypnea of the newborn (TTN) can also necessitate respiratory assistance. This condition involves rapid breathing that occurs when fetal fluid in the lungs is cleared too slowly after birth. While it typically resolves within a few days, Bubble CPAP can provide the support needed to help the baby breathe comfortably during this transition.
How Bubble CPAP Works
The Bubble CPAP system is composed of a few main parts that work together to provide steady breathing support. It begins with a gas source that blends air and oxygen, which is then warmed and humidified to protect the baby’s delicate airways. This prepared air is delivered to the baby through a set of small prongs that fit gently into the nostrils or a soft mask that covers the nose.
The “CPAP” in the name stands for Continuous Positive Airway Pressure. This means the system delivers constant air pressure that helps keep the alveoli from collapsing at the end of each breath. This pressure helps establish and maintain the functional residual capacity (FRC), which is the amount of air left in the lungs after a normal exhalation.
The “bubble” aspect is a unique feature of this specific CPAP method. The tube carrying the exhaled air from the baby is submerged in a bottle of water. As the gas exits the tube, it creates bubbles in the water, which produces gentle pressure oscillations, or vibrations. These vibrations are transmitted back into the infant’s airways and are thought to improve the exchange of gases, similar to the effects of high-frequency ventilation. The depth of the tube in the water determines the amount of pressure delivered.
What to Expect When Your Baby is on Bubble CPAP
When your baby is on Bubble CPAP, you will notice the gentle bubbling sound from the water bottle, which is a normal sign that the system is working correctly. You will also see the small prongs or mask secured to your baby’s face with a special cap and straps. The NICU team continuously monitors the baby’s heart rate, breathing rate, and oxygen saturation levels to ensure the support is effective.
The nursing staff is diligent about checking the baby’s skin for any signs of irritation or redness around the nose and mouth, making adjustments as needed. They may alternate between using nasal prongs and a mask to relieve pressure points on the baby’s face. You might also observe nurses occasionally clearing condensation, or “rain out,” from the tubing to ensure the system functions properly.
Even with the breathing apparatus, you can and should interact with your baby. The NICU team will guide you on how to hold, touch, and talk to your infant. Skin-to-skin contact, often called kangaroo care, is frequently encouraged and is possible while a baby is on Bubble CPAP. This close contact helps with bonding and has been shown to help stabilize the baby’s heart rate and breathing.
Weaning from Bubble CPAP
The process of weaning a baby off Bubble CPAP is gradual and depends entirely on the individual infant’s progress and stability. This transition is a positive milestone, indicating that the baby’s lungs are maturing and growing stronger.
Care providers look for several signs of readiness before starting the weaning process. These indicators include:
- A consistent and stable breathing rate
- Maintaining good oxygen levels in the blood
- A significant reduction in apnea episodes
- The ability to breathe comfortably without showing signs of distress, such as nasal flaring or chest retractions
Weaning involves slowly reducing the amount of pressure delivered by the CPAP machine. The team may lower the setting from a starting point of around 4 to 6 cm of H2O in small increments. Another approach is to provide trial periods where the baby breathes completely on their own for short, increasing durations. Throughout this time, the baby is monitored very closely to see how they tolerate the change.