Continuous Positive Airway Pressure (CPAP) is a gentle, non-invasive method of breathing support frequently used for newborns experiencing respiratory difficulties. This therapy delivers a continuous flow of air, often blended with oxygen, into the infant’s airways to assist natural breathing efforts. CPAP helps the baby breathe more easily without requiring invasive ventilation, which involves placing a tube down the windpipe. This support is common in neonatal intensive care units, especially for premature infants who are otherwise breathing spontaneously.
Medical Indications for Newborn CPAP
Newborns require CPAP when their lungs cannot fully maintain the necessary volume of air, leading to increased breathing effort. One common reason is Respiratory Distress Syndrome (RDS), which primarily affects premature infants whose lungs lack sufficient surfactant. Surfactant is a substance that reduces surface tension in the tiny air sacs, called alveoli, helping them stay open. When surfactant is insufficient, the alveoli collapse upon exhalation, forcing the baby to work harder to re-expand them.
Another frequent indication is Apnea of Prematurity, where the baby temporarily pauses breathing for more than twenty seconds due to an immature central nervous system. CPAP provides mild, constant pressure that acts as a gentle respiratory stimulant, helping maintain a regular breathing pattern. Transient Tachypnea of the Newborn (TTN) also responds well to this support, as this condition involves fluid remaining in the lungs after birth. CPAP helps push this excess fluid out of the air spaces, reducing the baby’s rapid breathing rate and work of breathing.
Understanding the CPAP Mechanism and Equipment
The underlying principle of CPAP is the application of continuous positive pressure throughout the entire breathing cycle. This constant pressure prevents the small air sacs in the lungs from completely deflating at the end of exhalation, which significantly increases the functional residual capacity. By keeping the alveoli inflated, CPAP reduces the energy the infant must expend to take the next breath, making the overall process much more efficient.
A complete CPAP setup involves several key components, starting with a pressure generator that delivers the air and oxygen mixture. The gas delivered to the baby must be heated and humidified, a function performed by a chamber filled with sterile water. This process protects the delicate airway lining, promotes defense mechanisms, and prevents the loss of body heat and moisture. The final component is the patient interface, which connects the circuit to the infant.
The interface is typically a soft, short set of nasal prongs that sit just inside the nostrils or a small nasal mask that fits over the nose. These are secured to the baby’s head with a soft cap or headgear to maintain a seal and ensure consistent pressure delivery. In some systems, known as bubble CPAP, pressure is generated by submerging the exhalation tube into a column of water, creating small oscillations that may improve gas exchange.
Monitoring and Associated Risks
Continuous monitoring is standard practice for newborns receiving CPAP to ensure the therapy is effective and safe. Medical staff constantly track the baby’s heart rate, respiratory rate, and oxygen saturation levels to assess lung performance. They also frequently check the CPAP machine settings, including the pressure level and the concentration of oxygen being delivered. The goal is to use the minimum effective pressure and oxygen level necessary to support the infant’s breathing.
One common side effect of CPAP is the potential for skin breakdown or irritation around the nose and face due to the constant pressure from the interface. Nurses frequently check the nasal septum and surrounding skin for signs of redness or injury, sometimes alternating between prongs and a mask to relieve pressure points. Another frequent concern is gastric distension, which occurs when pressurized air is inadvertently pushed into the stomach. This issue is managed by placing a small tube into the stomach to periodically vent the trapped air.
A more serious, though rare, risk is an air leak syndrome, such as a pneumothorax, where excessive pressure causes air to leak into the chest cavity. While the constant pressure helps keep the air sacs open, too much pressure can inadvertently overdistend the lungs. Medical teams are vigilant for sudden changes in the baby’s breathing or oxygen requirements, which could indicate this complication.