Most respiratory diseases of the neonate occur as a result of the immaturity of the premature neonate’s lungs. Their respiratory system is under-developed and adequate gas exchange does not take place naturally. With this, there is a need for providing external respiratory support.

With this goal of improvising patient care, Compamedic designed nPAP – A Neonatal CPAP Delivery System, having range models for NICUs, which are based on a technology with 20 years of proven clinical benefits and for use with spontaneously breathing neonate & infant patients, requiring respiratory support. Incorporating unique features and leading humidification technology, Compamedic nPAP has been developed to provide a respiratory support system that is safe, effective and easy to use. Adaptability to current practices has been taken into consideration with the choice of various system models; such that it can be adapted to any patient interface, thus making it easily adaptable and economical.

The nPAP series of Neonatal CPAP Delivery includes the following models:

• nPAP Easy Neonatal CPAP Delivery
• nPAP Compact Neonatal CPAP Delivery
• nPAP Electra Neonatal CPAP Delivery
• neoRUS+ Neonatal CPAP Delivery with Infant T-Piece Resuscitator

The Compamedic’s nPAP is a revolutionary way to help newborns with breathing problems. It provides the highest quality of care for babies in NICU, with its unique technology and makes a significant difference in how newborns with breathing problems are treated.

In this blog post, we will explore and delve deeper about the CPAPs and Compamedic’s Neonatal CPAP Delivery System.

What is CPAP?

CPAP is an acronym for Continuous Positive Airway Pressure. It is a method of non-invasive respiratory therapy for spontaneously breathing patients, in which respiratory gas, at a set pressure and flow is delivered to the patient through the nose OR nose and mouth, to keep the breathing airways open. It is a common treatment used to assist in breathing for patients having apnea and other respiratory disorders.

What is Neonatal CPAP?

A Neonatal CPAP Delivery System is a method of non-invasive respiratory therapy for spontaneously breathing neonates, having difficulty in breathing. Respiratory support is critical for the survival of some neonates, especially those with respiratory problems or who were born prematurely. Neonatal CPAP is a recommended alternative to routine intubation and invasive ventilation in neonates / preterm infants with respiratory distress syndrome (RDS), apnea OR other respiratory disorders.

It primarily comprises of the following parts:

• Flow / Respiratory Gas Source: It generates a respiratory gas, which is a blended flow of air and/or oxygen, at the required oxygen saturation (FiO₂) level.
• Heated Respiratory Humidifier: It adds heat and humidifies the respiratory gas before delivering to the patient.
• Patient Circuit: It is the tubing used to deliver respiratory gas to and from the patient. It comprises of 2 parts:
  • Inspiratory Limb: The tubing used to deliver respiratory gas to the patient.
  • Expiratory Limb: The tubing used to take the gases exhaled by the patient and the excess respiratory gas delivered to the patient (not inhaled by the patient).
• Patient Interface: It comprises of:
  • Nasal Tubing: It is the tubing mounted on the patient and is used to deliver the respiratory gas to the patient and vent out the gases exhaled by the patient and the excess respiratory gas delivered to the patient (not inhaled by the patient).
  • Nasal Prongs / Nasal Masks: It is an anatomically shaped silicon piece which is mounted on the nose OR nose and mount of the patient, to deliver the CPAP. The user has the option of using either a Nasal Prongs OR Nasal Mask. It is very imported to properly seal nose OR nose and mount of the patient to deliver CPAP effectively, hence the user should appropriately select the sized of the Nasal Prong / Nasal Mask to us for achieving an adequate seal.
  • Infant Bonnets: It is knitted cap for the infant to hold the Nasal Tubing and Nasal Prongs / Nasal Mask. It also prevents any heat loss of infant’s head.
• CPAP Generator: It generates the Continuous Positive Airway Pressure that is required to be delivered to the patient.

Optionally / Additionally a medical air compressor may be required if there is no stable and reliable source for medical grade air OR an oxygen analyser may be required to check the oxygen saturation of the respiratory gas, if not available.

Use & Type of Neonatal CPAP?

There are primarily three types of Neonatal CPAP that are used in neonatal intensive care units (NICU) to help support and regulate breathing:

• Bubble CPAP: It involves delivering a continuous flow of respiratory gas from an air-oxygen blender / mixer, using calibrated flowmeter (Flow / Gas Source). The blended flow is then delivered to a respiratory humidifier, which in turns heats and humidifies the gas and delivers it to the patient via patient circuit’s inspiratory limb and patient interface. The exhaled gases from the patient and the excess gases delivered to the patient are transferred to a chamber filled with water, referred to as Bubbler (CPAP Generator) via expiratory limb of the patient circuit. The exhaled gases from the patient and the excess gases delivered to the patient are vented to ambient atmosphere, via a tube / column submerged in water. Immersion of the tube in water provides a back pressure which generates CPAP. The CPAP pressure required for the neonate can be changed by adjusting the height of tube / column dipped inside the water. Some clinical studies on bubble CPAP have indicated that minor chest vibrations are caused by the pressure oscillations from the bubbling, which are reverberated back into the infant’s airway and provides an alternate form of gas exchange through the principle of facilitated diffusion. The Bubble CPAP is also referred to as a Passive CPAP Delivery System since the CPAP is generated away from the patient.
• Flow Driver / Variable Flow CPAPs: It involves delivering respiratory gas from a Flow Driver (Flow / Gas Source). The blended flow is then delivered to respiratory humidifier, which in turns heats and humidifies the gas and delivers to the patient via patient circuit’s inspiratory limb and patient interface. The exhaled gases from the patient and the excess gases delivered to the patient are vented in the ambient atmosphere. The specialized nasal tubing / jet (CPAP Generator) generates the required CPAP to be delivered to the patient. Level of pressure is controlled by adjusting the flow. It is also referred to as Active CPAP Delivery System since the CPAP is generated right at the patient’s nose.
• Ventilator CPAPs: It involves delivering a continuous flow of respiratory gas from a ventilator (Flow / Gas Source & CPAP Generator). The blended flow is then delivered to respiratory humidifier, which in turns heats and humidifies the gas and delivers to the patient via patient circuit’s inspiratory limb and patient interface. The exhaled gases from the patient and the excess gases delivered to the patient are transferred to the expiratory port of the ventilator via the expiratory limb of the patient circuit. The ventilator calculates the flow and generates CPAP required to be delivered.

All the above types of CPAPs are equally effective and works by delivering a required flow and CPAP to the neonate patient, which keeps the airways open and improves respiratory function in newborns.

Compamedic manufactures, Bubble CPAP as well as Flow Driver Neonatal CPAP Delivery System.  Compamedic also manufactures accessories such as respiratory humidifiers, humidification chambers, medical air compressor, air-oxygen blenders / mixers, etc., which are also used by other CPAP & Ventilator manufacturers.

Clinical Practice for Neonatal CPAP?

There is a lot of clinical data & studies available supporting the use of Neonatal CPAP in NICUs, as an established modality, for some of the common medical conditions in neonates and infant patients. Some of the medical conditions in which the Neonatal CPAP is use are:

• Respiratory distress syndrome (RDS)

It is required to deliver CPAP to patients having RDS, right from the time of birth. The PEEP (Positive end-expiratory pressure) is individualized depending on the clinical condition, oxygenation, and perfusion.

• Apnea: Delivering CPAP therapy is effective in reducing the frequency and severity of apnea in preterm infants. It helps in opening the patient’s airway and decreasing the risk of obstructive apnea.
• Low Birth Weight: CPAP decreases the depth and duration of oxygen desaturation during apnea by helping maintain a higher end-expiratory lung volume.
• Bronchiolitis: CPAP opens the airway obstruction, improves lung compliance, chest wall retractions, thereby decreasing the respiratory rate in patients with bronchiolitis.

CPAP use in neonates has become increasingly popular over the years as it is an effective treatment for a variety of respiratory problems in newborns. CPAP can be a crucial tool in helping newborns overcome these difficulties and prevent further complications.

The Neonatal CPAP is usually operated by a respiratory therapist or neonatologist. A close monitoring of the patient is necessary to ensure the appropriate level of pressure is maintained and to identify any complications that may arise.

Benefits of using Neonatal CPAP?

CPAP has been regarded as the gold standard for non-invasive support in neonates and infants for many applications. There are several benefits to using CPAP in neonates, which is why it is such a commonly used treatment in the NICU. Some of the main benefits are:

• Effectively maintains Functional Residual Capacity (FRC): Most lung diseases that lead to respiratory failure are commonly associated with a reduced FRC. Maintaining FRC is very important to premature neonates who have a greater tendency of airway closure when FRC falls below closing volume. The CPAP helps to keep the airways open and improves the oxygenation of the blood. It also helps to prevent atelectasis, or the collapse of small air sacs in the lungs, which can lead to further respiratory problems.
• Helps reducing the infant’s Work of Breathing (WOB): It improves the work of breathing by reducing the energy required to expand the lungs for breathing by elevating end-expiratory lung volume, which helps to unload the inspiratory muscles. There is a decrease in infant’s minute volume and respiratory rate with CPAP.
• Assist in maintaining airway mucosa and mucociliary function: CPAP delivers heated and humidified gas to the patient’s airway, assisting with natural defense mechanisms, maintaining airway mucosa and mucociliary function, and promoting conservation of energy for growth.
• Reduces the need for intubation and invasive ventilation: The use of CPAP avoids the need for intubation, thereby reducing the possibility of airway injury and secondary infection associated with the use of the ET tube. It further reduces the need for mechanical ventilation that minimizes the possible incidence of barotrauma.
• Tends to reduce the incidence of Chronic Lung Disease (CLD): Early treatment with CPAP for infants with respiratory distress reduces the severity and duration of the disease.
• Improve non-pulmonary outcomes: Improved non-pulmonary effects such as the tendency to increase mean weight at 36 weeks corrected gestation, increase mean length and head circumference, reduction time to reach full oral feeds and average length of stay.

In addition to providing respiratory support, CPAP also helps to prevent other complications associated with respiratory distress syndrome, such as apnea, bradycardia, and hypoxemia. By maintaining a stable oxygen level in the baby’s bloodstream, CPAP can help prevent damage to the baby’s lungs and other vital organs.

Conclusion

Overall, the use of CPAP in neonates and infants with breathing problems, is a safe and effective therapy and improves respiratory function, thereby reducing the need for invasive ventilation, leading to improved outcomes and reduced morbidity and mortality.

It is commonly used in the NICU to support infants with respiratory distress syndrome, bronchopulmonary dysplasia, and apnea of prematurity. CPAP helps to prevent airway collapse and improve oxygenation, which can lead to improved outcomes for newborns.

However, as with any medical intervention, there are risks and potential complications associated with the use of CPAP. Therefore, it is important to note that Neonatal CPAP should only be used by a certified trained medical professional in a NICU environment. Like any medical intervention, there are risks associated with CPAP use, including infection and airway injury. Therefore, medical staff needs to monitor the patient closely and adjust the therapy as needed to ensure optimal outcomes.

Compamedic’s nPAP Neonatal CPAP Delivery System are reliable and efficient solution for NICUs for treating respiratory problems. With nPAP design and features, it provides optimum CPAP therapy, thereby reducing the need for invasive ventilation for neonates and infants and has helped countless patients to survive and thrive.

Compamedic also manufacturers a range of accessories used along with Neonatal CPAPs such as respiratory humidifiers, humidification chambers, medical air compressor, air-oxygen blenders / mixers, oxygen analysers, etc., which are also used by other CPAP & Ventilator manufacturers, there assuring the complete reliability in safety and performance. Overall, Compamedic’s commitment to quality and innovation makes them a trusted partner in providing respiratory care & neonatal solutions for hospitals and OEM Partners.