Evidence Regarding the Use of Bubble Continuous Positive Airway Pressure in the Extremely Low Birth-Weight Infant: Benefits, Challenges, and Implications for Nursing Practice

Adv Neonatal Care. 2018 Jun;18(3):199-207. doi: 10.1097/ANC.0000000000000509.


Background: Gentle ventilation with optimal oxygenation is integral to prevention of chronic lung disease in the extremely low birth-weight (ELBW) infant. Various types of noninvasive ventilation are used in neonatal intensive care units worldwide. Bubble continuous positive airway pressure (BCPAP) has been in use in newborn intensive care since 1975.

Purpose: To synthesize the current evidence on the use of BCPAP in the ELBW infant and its relationship to outcomes, particularly morbidity and mortality.

Methods/search strategies: A literature review was completed using PubMed, EMBASE, CINAHL, and Cochrane with a focus on BCPAP use in the ELBW population.

Findings/results: No study found was exclusive to the ELBW population. All studies ranged from ELBW to full-term neonates. Studies supported the use of BCPAP in the ELBW, demonstrating decreased incidence of chronic lung disease and barotrauma through the use of oscillation and permissive hypercapnia.

Implications for practice: Literature supports the use of nasal bubble CPAP in the ELBW population. Barriers such as septal erosion, pneumothorax, inconsistent pressures, and air in the abdomen were identified and management recommendations were provided.

Implications for research: Studies are needed comparing outcomes of nasal bubble CPAP use with other forms of CPAP in the ELBW infant, comparison of prongs to mask for nasal bubble CPAP, and comparing interventions to recommend optimal care bundles to prevent nasal septum injuries.

MeSH terms

  • Continuous Positive Airway Pressure / methods*
  • Female
  • Humans
  • Infant, Extremely Low Birth Weight*
  • Infant, Newborn
  • Infant, Premature
  • Intensive Care Units, Neonatal
  • Intensive Care, Neonatal / methods*
  • Intubation, Intratracheal / methods*
  • Lung Diseases / therapy*
  • Male