Top 10 for 2021: #6 | Bubble CPAP for Increased Lung Function in Premature Babies

Top 10 for 2021: #6 | Bubble CPAP for Increased Lung Function in Premature Babies

Underweight and frail, early deliveries are susceptible to a number of issues. Premature babies often require specialized care upon arrival, including ventilation for those with infant respiratory distress syndrome, or IRDS. Neonatologists have been exploring the use of bubble CPAP or b-CPAP in the delivery room and as a primary mode for respiratory support of all premature infants in respiratory distress.

In place of mechanical ventilation that is associated with lasting lung injury, b-CPAP is a non-invasive ventilation strategy providing continuous positive airway pressure to maintain lung volumes during exhalation. A mixture of humidified oxygen is delivered through infant-sized nasal prongs, and pressure is maintained by immersing the end of the expiratory tubing and water. Gas flow generates bubbles under the water, causing oscillations of the water level and subsequently of the pressure delivered to the patient. An infant on b-CPAP receives a fluctuating rather than a constant pressure, adding to its effectiveness.

 Compared with mechanical ventilation and tracheal intubation, b-CPAP minimizes physical trauma and stimulates lung growth when administered over a prolonged period. Given its chronic lung disease reducing capabilities, b-CPAP allows the growth of strong children with lungs full of life.

William Morris, MD:
This is Dr. William Morris, and I’m joined today by Dr. Hany Aly, Department Chair of Neonatology at Cleveland Clinic, talking about #6, ‘Bubble CPAP for Increased Lung Function in Premature Babies.’ Dr. Aly, can you tell us a little bit more about this procedure and why, in premature infants, is this so important?

Hany Aly, MD:
So premature babies, in general, are very vulnerable to have lung disease or lung insufficiency, and they need support. And for the longest time, we used to intubate these babies and put them on ventilators in order to support their breathing. However, we discovered that the damages that occur due to ventilators are actually causing harm to these babies, and a significant number of these babies end up having chronic lung disease. So nationally, statistics show around one-third of premature babies in the NICU with a birth weight less than 1500 grams will have chronic lung disease.

The use of bubble CPAP, which is clear and noninvasive, involves a setup where small prongs attach to the baby's nose and the tip of the tube at the expiratory side is immersed under the water, causing this kind of pressure. So there are studies that showed that this actually stimulates the lungs to grow. Also, the chance for these babies to have chronic lung disease is much more decreased.

William Morris, MD:
And so, with the advent of the bubble CPAP, when do you see this becoming and being adopted as a gold standard?

Hany Aly, MD:
So I say it will take some time. However, there are studies starting to appear, showing that it is efficacious, and it is reproducible. We are now receiving more and more requests from different neonatal units that are trying to reproduce the same thing. It requires some orientation and training for staff at the bedside to make sure they are doing it correctly, but in the next few years, possibly I’d say we'll see much more use of it nationally.

William Morris, MD:
Well, thank you very much, Dr. Aly, for sharing this important innovation for these premature patients in the acute stage, but also in their future life.

Hany Aly, MD:
Thank you!
 

To read more about #6, click here. To watch the full one-on-one interview with Drs. Morris and Aly, click here.

Get In Touch With Us