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Cheryl Bird, RN

CPAP Instead of Vent for Micropreemies?

By May 24, 2010

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In my NICU and in most NICUs around the country, babies who are born before about 27 weeks are placed on a ventilator at birth. Settings on the vent are gradually weaned until the baby is ready for CPAP or a nasal cannula.

New research, though, is showing that micropreemies may do better if they are placed on CPAP immediately after birth. Although most very small or very young preemies will eventually need to be intubated and placed on a ventilator, as many as 17% may never need the ventilator at all. Babies who do need a ventilator need it for shorter periods of time and have fewer side effects such as lung infections and lung scarring.

This new research is exciting - it's kind of radical to imagine a 24-weeker who never needs to be vented. The researchers plan to follow up when the babies in the study are toddlers, to see if there is a difference in the number of long term complications of prematurity these babies face.

My only problem with the study is the CPAP equipment itself. The delicate skin around the nose can break down quickly if the CPAP mask or prongs don't fit well, and getting a good fit is very difficult with some CPAP equipment. I'd love to hear from any readers who have a micropreemie who never needed the vent, or from parents with strong positive or negative feelings about CPAP!

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Comments
May 25, 2010 at 4:52 am
(1) Sue of Prem2Pram says:

A 24 week gestation baby that never needs to be vented, now that is what you call progress.

I agree with you regarding the fit of the CPAP as much husband who is a biomedical engineer will confirm that the masks are not available in sufficient sizes, if there were more variations in the sizes it might be easier to find a better fit.

June 1, 2010 at 1:12 am
(2) Scott Miller says:

Sounds great but what would be the difference?

The preemie baby requires a volume of air to be artificially pushed into thier lungs. Whether this is done through a ventilator tube or through nasal prongs in CPAP is a minor difference. It is this volume of air going in that does the damage.

Going straight to CPAP sounds like progress to us because we see it as a stage further on in the progress towards unassisted breathing. That may not be the case though. In my opinion the current CPAP designs are very poor, they undoubtedly cause the baby to get those indents in their temples that give the “preemie” look.

Having a baby intubated is very, very distressing and I fully understand the desire to progress to CPAP but doing so at 24 weeks might give more problems than anticipated.

In the NICU I was in, I wouldn’t have been happy leaving my baby overnight on CPAP so early. The nurses seem to lose their patience very quickly trying to adjust the CPAP headgear so the prongs are in and sealing well. It’s also such a fine adjustment to get the prongs in and sealing without damaging the baby’s septum.

August 19, 2010 at 4:55 pm
(3) confused mum says:

Just wondering if anyone on here has experienced the nasal breakdown? my son born 25 weeks gest was on the ventilator for 62 days then made it onto cpap, for a whole week i expressed my concerns that far too much pressure was being applied to his septum by the end of that week he stated to deteriorate so was re-intubated, at this point we could see the septum and it had broken down completely to the point where there was nothing there. we were told this happens all the time!!

August 20, 2010 at 11:54 am
(4) preemies says:

You should definitely not see so much breakdown so quickly. There are many things that NICU staff can do to reduce the amount of breakdown that CPAP can cause – using hydrocortisone cream regularly, using a NeoPrep barrier or a similar product, switching between prongs and mask, and using a different size headgear all help. It’s not unusual to see some breakdown in babies who are on CPAP for extended periods of time, but your case sounds extreme. At some point he’ll probably be re-extubated back to CPAP, and you might want to talk to a respiratory therapist or to a member of your son’s nursing staff to see how you can avoid this next time.

October 14, 2010 at 7:09 pm
(5) Mark Toohey says:

Hi, nice to find this blog. Our twins born 23w 6d have been on the oscillator, regular ventilator and then moved to nasal CPAP with a back up rate about 2 weeks ago. Today the backup was taken off our daughter, they tried the same with our son but he reacted badly.

My observation is that the aparatus is very awkward. Its difficult for the respiratory technicians to place, it moves around and it really limits the possibilities for placing the babies on their sides or stomach.

Looking at it I feel there must be a better way to deliver the air without strapping those large tubes to their little heads and driving staff crazy with the constant management the current design demands.

Are any NICU using a different system with the same or better results?

June 25, 2011 at 11:26 am
(6) Ann says:

my 22.5 weeker Josie was on a ventilator and at 3 months old transferred to a CPAP until she was 7 months old which left marks on her face for a long time! Josie got out of the nicu at 7.5 months old and is now a thriving 9 month old I can still see faint marks from the CPAP

October 28, 2012 at 7:12 pm
(7) Renee says:

my grandaughter was born October 7, at 25 1/2 weeks gestation. she was less then 24 HOURS on a vent. using only a nasal canula. because of a little fluid on her lungs this last week, she was put on c pap, mostly to make it easier for her, not because it was needed. she is at 21% on the c pap which they say is very low, and is to come off it tomorrow. this little angel has had no complications and xrays and cat scans show everything to be perfect! the c pap does not look comfort for a preemie to have to have on, but it doesn’t seem to bother her. my only concern with the c pap is that what air isn’t needed in the lungs, go to the belly, causing it to distend. she was up to 8cc feeding every 2 hours, and had to be taken of feeding because of the distention, and has to start over at 1cc of feeding. but, she is doing amazing and the nurses are awesome with her. she is a miracle. a gift from God. my son has lost 2 babies in a years time, a lot of prayers went up for this baby from the moment she was conceived. I am certain, her progress is due to prayers and an amazing God. I pray everyone struggling with a preemie and the many issues, will all take their little angels home soon. God bless all these angels on earth.

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