Bubble Continuous Positive Airway Pressure (Bubble CPAP) is a non-invasive method of respiratory support used primarily for newborns who are breathing spontaneously but require assistance. It delivers continuous positive airway pressure (CPAP), meaning a constant flow of air and oxygen is pushed into the baby’s airways. This continuous pressure prevents the tiny air sacs in the lungs from collapsing after the baby exhales. The therapy provides necessary support without requiring a tube to be placed down the infant’s windpipe.
The Purpose of Bubble CPAP
Bubble CPAP is a standard treatment for newborns experiencing breathing difficulties, most commonly Neonatal Respiratory Distress Syndrome (RDS) and Transient Tachypnea of the Newborn (TTN). RDS occurs in premature infants whose lungs lack sufficient surfactant, a substance that keeps the air sacs open. TTN is often seen in full-term or late-preterm babies due to a delay in clearing lung fluid after birth.
The physiological purpose of the therapy is to stabilize the infant’s lungs by maintaining a functional residual capacity (FRC), the volume of air left in the lungs after exhalation. By keeping the airways open, the continuous pressure reduces the physical effort, or work of breathing, the infant must expend. This support conserves the baby’s energy and allows for more effective gas exchange.
How Bubble CPAP Works
The Bubble CPAP system generates therapeutic pressure using a water-filled chamber. A warm, humidified blend of air and oxygen is delivered to the baby’s nose through a short nasal interface, typically small prongs or a mask. The gas then flows through a circuit to the water chamber, which is the system’s defining component.
The expiratory tubing is submerged into the water, and the depth of this submersion dictates the amount of positive pressure delivered to the baby’s lungs. As the gas flows out, it creates bubbles in the water chamber.
These bubbles cause small, rapid fluctuations, or oscillations, in the water level and the pressure delivered to the infant. This oscillating pressure is believed to mimic a natural breathing pattern, which can help improve gas distribution within the lungs and potentially aid in the release of natural surfactant.
Advantages Over Invasive Respiratory Support
Bubble CPAP provides significant advantages over invasive respiratory methods, such as mechanical ventilation, which requires intubation. Invasive ventilation carries a greater risk of lung injury due to the high inflation pressures involved. The gentler nature of Bubble CPAP helps protect the delicate, underdeveloped lung tissue of premature infants.
By avoiding intubation, the therapy substantially lowers the incidence of chronic lung conditions like Bronchopulmonary Dysplasia (BPD). It also preserves the infant’s natural breathing reflex and reduces the risk of serious complications, including infection. Furthermore, the system is relatively simple and cost-effective, making it a first-line treatment in various clinical settings worldwide.
The Infant Experience During Treatment
Infants on Bubble CPAP are typically positioned with their head slightly elevated to optimize breathing mechanics. The nasal prongs or mask are secured with a soft bonnet and headgear, which must be carefully fitted to ensure an effective seal while minimizing the risk of skin breakdown. Because the prongs exert pressure on the delicate skin of the nose, protective hydrocolloid dressings are often applied.
Monitoring is continuous, with healthcare providers tracking the infant’s heart rate, respiratory rate, and oxygen saturation levels. A common side effect is gastric distension, which occurs because some pressurized air is inadvertently diverted into the stomach. To manage this, a thin tube is usually placed into the stomach to vent the excess air.
Infants receiving this support are generally alert and are often able to be held by their parents for skin-to-skin contact, known as Kangaroo care. Feeding while on the therapy is possible, with many infants receiving milk through a temporary nasogastric tube until their work of breathing decreases. Oral feeding can begin when the infant’s respiratory rate stabilizes below 60 to 70 breaths per minute and they show clear feeding readiness cues.