What Is CPAP for Newborns and Why Is It Used?

Continuous Positive Airway Pressure (CPAP) is a common, non-invasive method of respiratory support used for newborns experiencing breathing difficulties. This therapy delivers a continuous flow of air or oxygen-enriched air, helping to support the infant’s developing lungs. CPAP provides gentle, consistent pressure to their airways, helping babies breathe more easily and manage respiratory challenges.

What is Newborn CPAP?

Newborn CPAP works by delivering a continuous stream of air, or air mixed with oxygen, at a constant pressure to the baby’s airways. This continuous positive pressure helps to keep the small air sacs in the lungs, called alveoli, from collapsing during exhalation. By maintaining an open airway and inflated lung volume, CPAP makes it easier for the infant to breathe, reducing the effort required for each breath. This process is distinct from mechanical ventilation, which uses a breathing tube inserted into the windpipe to actively breathe for the baby.

The air delivered through CPAP is typically heated and humidified, which helps to protect the delicate airway lining and maintain its natural defense mechanisms. The constant pressure helps to enhance the functional residual capacity (FRC) of the lungs, which is the volume of air remaining in the lungs after a normal exhalation. Maintaining this volume helps to keep the lungs open and ready for the next breath.

Conditions Requiring CPAP Support

Newborns require CPAP support for several common medical conditions that affect their ability to breathe effectively. Respiratory Distress Syndrome (RDS) is a primary reason, especially in premature infants whose lungs lack sufficient surfactant, a substance that helps keep air sacs open. CPAP helps these babies by providing the continuous pressure needed to prevent alveolar collapse and improve oxygen exchange. Early initiation of CPAP for RDS can reduce the need for more invasive mechanical ventilation.

Apnea of prematurity is another condition where CPAP is beneficial, characterized by pauses in breathing in premature infants. CPAP stabilizes the airway and provides gentle stimulation, which can help reduce the frequency and severity of these apneic episodes. Transient tachypnea of the newborn (TTN), a mild and usually short-lived breathing problem due to retained fluid in the lungs after birth, also benefits from CPAP. CPAP helps clear this excess fluid and supports the baby’s fast breathing until the fluid is absorbed.

How CPAP is Administered

CPAP is typically administered in a specialized hospital setting, such as a Neonatal Intensive Care Unit (NICU), where continuous monitoring and expert care are available. The system involves several components: an air and oxygen source, a humidifier to warm and moisten the gases, and a pressure generator. The prepared air/oxygen mixture is then delivered to the baby through an interface, which creates a sealed pathway to the airways.

Common interfaces include soft nasal prongs that fit into the nostrils or a nasal mask that covers the nose. Less commonly, a nasopharyngeal tube might be used. The choice between prongs and masks often depends on the baby’s individual needs and aims to minimize skin irritation while ensuring an effective seal.

Care and Potential Considerations

While newborns receive CPAP, medical teams closely monitor their breathing, oxygen levels, and overall comfort. One consideration is the potential for skin irritation or pressure sores on the baby’s face, particularly around the nose, from the interface. To manage this, healthcare providers carefully select appropriately sized interfaces and may alternate between nasal prongs and masks to alleviate pressure points. Regular repositioning of the baby also helps to prevent skin breakdown.

Another common consideration is gastric distension, or bloating of the stomach, which can occur if air from the CPAP system enters the baby’s stomach. This is typically managed by inserting a small tube into the baby’s stomach to vent the air. Although CPAP is generally considered safe, instances of air leaks, such as pneumothorax where air escapes the lung, are potential complications that the medical team watches for.

Discontinuing CPAP Therapy

Discontinuing CPAP therapy marks a positive milestone in a newborn’s respiratory recovery. As the baby’s lungs mature and their breathing becomes stronger and more stable, the medical team gradually reduces the pressure and/or the amount of supplemental oxygen provided. This weaning process is carefully managed, with healthcare professionals monitoring the baby’s ability to maintain adequate breathing without support.

The decision to completely remove CPAP is made when the baby can consistently breathe effectively on their own, often after demonstrating stability on minimal settings for a period. This transition indicates that the infant’s respiratory system has matured sufficiently to support independent breathing.