CPAP (continuous positive airway pressure) 

Evidence 

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002271.pub3/full 

Jacqueline J Ho, Prema Subramaniam, Peter G Davis 

Breathing difficulties due to lung immaturity are the most common cause of death in preterm infants. These breathing difficulties are often mild soon after birth and worsen over the first hours or days of life.  

CPAP is a relatively simple way of providing breathing assistance to a baby that might reduce lung damage. This method relies on the baby continuing to breathe. A continuous pressure is applied by means of a tube in the nostrils (binasal prong), a mask covering just the nose (nasal mask), a face mask or by a tube placed in the lungs (endotracheal tube). This opens the baby's airways and makes breathing easier. 

Education 

Continuous positive airway pressure, commonly called CPAP, is a type of respiratory support or non-invasive mechanical ventilation used in premature and sick babies, who’s lungs may not be fully developed, and are having trouble breathing.  

CPAP is used to help your baby’s breathing by keeping the lungs partially inflated.  This helps your baby to breathe easier.  It also helps get more oxygen into baby’s blood and stops the lungs collapsing when baby breathes out.  CPAP is a safe and effective way to treat babies with undeveloped lungs whilst reducing damage to the lungs. 

The CPAP is given through short prongs in the baby’s nose or through a small mask that fits snugly over the nose. The tubes are attached to a machine, which delivers air or oxygen as well as the pressure that helps the baby breathe. The amount of pressure and oxygen can be controlled to meet each baby’s needs. 

Babies on CPAP breathe on their own, the machine does not breathe for them. The steady flow of air (or extra oxygen if needed) coming through the tubes keeps enough pressure in the lungs to prevent the air sacs from collapsing after each breath. It’s a little extra support to help the lungs do their job. 

CPAP in babies is mainly used to treat respiratory distress syndrome (RDS), which happens when babies are born too early, and their lungs aren't fully developed.  

We all have surfactant (a substance that helps our lungs expand and contract smoothly during breathing) in our lungs. However, babies that are born too early may not be able to make their own surfactant.  

Without enough surfactant, breathing is hard work. CPAP provides a continuous flow of air (or extra oxygen if needed) to make breathing easier for these babies until their body starts making surfactant. This may take a few days. 

CPAP is also used if your baby has apnoea, which is when babies briefly stop breathing, which can slow down their heart rate. It's common in premature babies because their breathing control is still developing. CPAP helps them breathe more regularly, reducing these pauses. The apnoea will go away as they grow, and their breathing control improves. 

Once your baby has been stabilised on CPAP, you will be able to, cuddle your baby and feeding may be commenced through the orogastric tube. 

While your baby is on CPAP, it is important for your healthcare team to regularly suction down your baby’s nose and mouth. This will usually be done 2-3 hourly or as required in special cases. Babies do not like this sensation, but it is a quick procedure and is vital to clear mucous from their breathing passages. This helps to reduce the work required for breathing.  Your healthcare team will regularly check to make sure that the CPAP prongs are not rubbing against the nose, as this can cause injury to the area. 

Depending on your baby’s age or condition, your baby may require CPAP for a few hours or many weeks.  Every baby is different and how long your baby will need CPAP will depend on how well they grow and if they meet certain criteria for stability. Some babies stop needing CPAP quickly, while others gradually need less support until they can safely breathe on their own. Sometimes babies will come off CPAP and start high or low flow nasal oxygen through smaller prongs instead. 

Sometimes your baby will come off CPAP and then have to go back on due to oxygen desaturation. This is a drop in the level of oxygen circulating in their blood. This can feel like a step backwards but it’s important to ensure your baby receives the necessary support to keep oxygen and prevent potential complications. 

What can parents do for their baby while on CPAP? 

You can help with the care of your baby by assisting your healthcare team at general care times, this is called Family Integrated care. 

• You can help your baby at suction times by soothing and touching them 

• You can change your baby’s nappy. 

• You can learn how to do eye and mouth care. 

• You will be shown how to express your milk to give to your baby.

• If you are not always visiting at general care times, you can hold your baby’s hand or just talk to your baby.

Empowerment 

It can be disconcerting for a parent to see their tiny baby hooked up to a mask or with tubes coming out of their nose, but understanding the purpose of CPAP can help ease some of that worry. CPAP, or Continuous Positive Airway Pressure, is a vital tool designed to gently support your baby’s breathing. It delivers a steady flow of air to keep their airways open and ensure their lungs can function effectively, allowing them to take in the oxygen they need to grow stronger.   

Although it may seem overwhelming at first, CPAP is often a temporary measure, helping babies to gradually develop their breathing skills. You can take comfort in knowing that this treatment is a step toward your baby’s progress and "graduation" from the Neonatal unit.  

As a parent, your role in your baby’s journey remains crucial. You can help by providing comforting touch, talking or singing to your baby, and staying involved in their care. Ask the healthcare team to explain the equipment and how it’s helping your baby, so you feel more informed and confident. Remember, your presence, love, and advocacy make a big difference in their recovery.   

Useful Links 

The Royal Women's Hospital, Victoria 

https://thewomens.r.worldssl.net/images/uploads/fact-sheets/Apnoea-Bradycardia-in-premature-babies-140119.pdf  

Panda - Perinatal Mental Health  

https://panda.org.au/  

COPE – Centre of Perinatal Excellence  

http://www.cope.org.au/new-parents/first-weeks/coping-following-a-premature-birth/ 

Miracle Babies Foundation 

https://www.miraclebabies.org.au/content/family-stories/gjm2co