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Licensed Unlicensed Requires Authentication Published by De Gruyter August 4, 2015

Randomized control trial comparing physiologic effects in preterm infants during treatment with nasal continuous positive airway pressure (NCPAP) generated by Bubble NCPAP and Ventilator NCPAP: a pilot study

  • Craig Guerin , Sean M. Bailey , Pradeep V. Mally , Mary Rojas , Alok Bhutada and Shantanu Rastogi EMAIL logo



Nasal continuous positive airway pressure (NCPAP) is an accepted form of non-invasive ventilation in preterm infants. Few, if any, studies have shown an advantage of one type of NCPAP over another. It has been theorized that bubble-generated NCPAP may be advantageous for the preterm neonate versus traditionally used ventilator-generated NCPAP. The aim of this study was to examine for any short-term differences in physiologic parameters in preterm subjects receiving these two different methods of NCPAP.


We conducted a randomized, prospective, cross-over pilot study of preterm infants being treated with NCPAP in the neonatal intensive care unit. Subjects were continuously monitored for several physiologic parameters including heart rate, respiratory rate, oxygen saturation, cerebral tissue oxygen saturation and cerebral fractional oxygen extraction using routine neonatal monitors and near-infrared spectroscopy (NIRS) while on 2 h of bubble NCPAP and 2 h of ventilator NCPAP. Subjects were randomized to be monitored while either starting on bubble NCPAP and then switching to ventilator NCPAP or starting on ventilator NCPAP and switching to bubble NCPAP.


Eighteen subjects were included. We found no statistically significant difference in any of the physiologic parameters while subjects were receiving bubble NCPAP versus ventilator NCPAP during the monitoring time periods. While on bubble NCPAP, subjects showed a trend toward decreasing respiratory rate and decreasing cerebral fractional oxygen extraction over time, but this did not reach statistical significance.


There appears to be no difference in immediate physiologic effects between bubble NCPAP and ventilator NCPAP. This does not preclude the possibility of potential long-term differences, but any differences seen would likely be based on mechanisms that take more time to develop. A larger prospective trial is warranted to confirm our findings. identifier:: NCT02003846

Article note:

This article was selected from submitted papers on the occasion of the 38th Annual Scientific Meeting of The New York Perinatal Society, held on Monday, April 13, 2015.

Corresponding author: Shantanu Rastogi, MD, MMM, Associate Professor of Clinical Pediatrics, Albert Einstein College of Medicine, Attending Neonatologist, Maimonides Infant and Children’s Hospital, 4802 Tenth Ave, F-119, Brooklyn, NY 11219, USA, Tel.: +718-283-8853, E-mail: ; and Division of Neonatology, Maimonides Infant and Children’s Hospital, Brooklyn, NY, USA


The authors acknowledge the following grant funding: the Maimonides Medical Center Resident Research Grant (Grant number: 2013) and New York University School of Medicine Stefan Bennett Neonatology Research Fund (Grant number: 2013).


[1] Gregory GA, Kitterman JA, Phibbs RH, Tooley WH, Hamilton WK. Treatment of the idiopathic respiratory distress syndrome with continuous positive airway pressure. N Engl J Med. 1971;284:1333–40.10.1056/NEJM197106172842401Search in Google Scholar

[2] Committee on Fetus and Newborn. Respiratory support in preterm infants at birth. Pediatrics. 2014;133:171–4.10.1542/peds.2013-3442Search in Google Scholar

[3] Roberts CL, Badgery-Parker T, Algert CS, Bowen JR, Nassar N. Trends in use of neonatal CPAP: a population-based study. BMC Pediatr. 2011;11:89.10.1186/1471-2431-11-89Search in Google Scholar

[4] Morley C. Continuous distending pressure. Arch Dis Child Fetal Neonatal Ed. 1999;81:152–6.10.1136/fn.81.2.F152Search in Google Scholar

[5] Davis PG, Henderson-Smart DJ. Nasal continuous positive airway pressure immediately after extubation for preventing morbidity in preterm infants. Cochrane Database Syst Rev. 2003;(2):CD000143.10.1002/14651858.CD000143Search in Google Scholar

[6] Speidel BD, Dunn PM. Use of nasal continuous positive airway pressure to treat severe recurrent apnoea in very preterm infants. Lancet. 1976;2:658–60.10.1016/S0140-6736(76)92468-5Search in Google Scholar

[7] Subramaniam P, Henderson-Smart DJ, Davis PG. Prophylactic nasal continuous positive airway for preventing morbidity and mortality in very preterm infants. Cochrane Database Syst Rev. 2000;(2):CD001243.Search in Google Scholar

[8] Richardson CP, Jung AL. Effects of continuous positive airway pressure on pulmonary function and blood gases of infants with respiratory distress syndrome. Pediatric Res. 1978;12:771–4.10.1203/00006450-197807000-00006Search in Google Scholar

[9] Miller MJ, DiFiore JM, Strohl KP, Martin RJ. Effects of nasal CPAP on supraglottic and total pulmonary resistance in preterm infants. J Appl Physiol. 1990;68:141–6.10.1152/jappl.1990.68.1.141Search in Google Scholar

[10] Locke R, Greenspan JS, Shaffer TH, Rubenstein SD, Wolfson MR. Effects of nasal CPAP on thoracoabdominal motion in neonates with respiratory insufficiency. Pediatr Pulmonol. 1991;11: 259–64.10.1002/ppul.1950110313Search in Google Scholar

[11] Martin RJ, Nearman HS, Katona PG, Klaus MH. The effect of a low continuous positive airway pressure on the reflex control of respiration in the preterm infant. J Pediatr. 1977;90:976–81.10.1016/S0022-3476(77)80575-1Search in Google Scholar

[12] DePaoli AG, Davis PG, Farber B, Morley CJ. Devices and pressure sources for administration of nasal continuous positive airway pressure (NCPAP) in preterm neonates. Cochrane Database Syst Rev. 2002;(4):CD002977.10.1002/14651858.CD002977Search in Google Scholar PubMed

[13] Ahluwalia JS, White DK, Morley CJ. Infant Flow Driver or single prong nasal continuous positive airway pressure: short term physiologic effects. Acta Paediatr. 1998;87:325–7.10.1111/j.1651-2227.1998.tb01446.xSearch in Google Scholar

[14] Stefanescu BM, Murphy WP, Hansell BJ, Fuloria M, Morgan TM, Aschner JL. A randomized controlled trial comparing two different continuous positive airway pressure systems for the successful extubation of extremely low birth weight infants. Pediatrics. 2003;112:1031–8.10.1542/peds.112.5.1031Search in Google Scholar PubMed

[15] DePaoli AG, Morley C, Davis PG. Nasal CPAP for neonates: what do we know in 2003? Arch Dis Child Fetal Neonatal Ed. 2003;88:168–72.10.1136/fn.88.3.F168Search in Google Scholar PubMed PubMed Central

[16] Lee KS, Dunn MS, Fenwick M, Shennan AT. A comparison of underwater bubble continuous positive airway pressure with ventilator derived continuous positive airway pressure in premature neonates ready for extubation. Biol Neonate. 1998;73:69–75.10.1159/000013962Search in Google Scholar PubMed

[17] Wyatt JS, Cope M, Delpy DT, Richardson CE, Edwards AD, Wray S, et al. Quantitation of cerebral blood volume in human infants by near-infrared spectroscopy. J Appl Physiol. 1990;68:1086–91.10.1152/jappl.1990.68.3.1086Search in Google Scholar PubMed

[18] Bailey SM, Hendricks-Munoz KD, Mally P. Cerebral, renal, and splanchnic tissue oxygen saturation values in healthy term newborns. Am J Perinatol. 2014;31:339–44.10.1055/s-0033-1349894Search in Google Scholar PubMed

[19] Naulaers G, Meyns B, Miserez M, Leunens V, Van Huffel F, Casaer P, et al. Use of tissue oxygenation index and fractional tissue oxygen extraction as non-invasive parameters for cerebral oxygenation: a validation in piglets. Neonatology. 2007;92:120–6.10.1159/000101063Search in Google Scholar PubMed

[20] Gupta S, Sinha SK, Tin W, Donn SM. A randomized controlled trial of post-extubation bubble continuous positive airway pressure versus Infant Flow Driver continuous positive airway pressure in preterm infants with respitory distress syndrome. J Pediatr. 2009;154:645–50.10.1016/j.jpeds.2008.12.034Search in Google Scholar PubMed

[21] Pillow JJ, Travadi JN. Bubble CPAP: is the noise important? An in vitro study. Pediatr Res. 2005;57:826–30.10.1203/01.PDR.0000157721.66812.07Search in Google Scholar PubMed

[22] Diblasi RM, Zignego JC, Tang DM, Hildenbrandt J, Smith CV, Hansen TN, et al. Noninvasive respiratory support of juvenile rabbits by high-amplitude bubble continuous positive airway pressure. Pediatr Res. 2010;67:624–9.10.1203/PDR.0b013e3181dcd580Search in Google Scholar

[23] Diblasi RM, Zignego JC, Smith CV, Hansen TN, Richardson CP. Effective gas exchange in paralyzed juvenile rabbits using simple, inexpensive respiratory support devices. Pediatr Res. 2010;68:526–30.10.1203/PDR.0b013e3181f985f0Search in Google Scholar

[24] Huang WC, Hua YM, Lee CM, Chang CC, Yuh YS. Comparison between bubble CPAP and ventilator derived CPAP in rabbits. Pediatr Neonatol. 2008;49:223–9.10.1016/S1875-9572(09)60015-2Search in Google Scholar

[25] Pillow JJ, Hilman N, Moss TJM, Polglase G, Bold G, Beaumont C, Bubble CPAP enhances lung volume and gas exchange in preterm lambs. Am J Respir Crit Care Med. 2007;176:63–6.10.1164/rccm.200609-1368OCSearch in Google Scholar PubMed PubMed Central

[26] Pillow JJ, Sly PD, Hantos Z, Bates JH. Dependence of intrapulmonary pressure amplitudes on respiratory mechanics during HFOV in preterm lambs. Pediatr Res. 2002;52:538–44.10.1203/00006450-200210000-00013Search in Google Scholar PubMed

[27] Takami T, Sunohara D, Kondo A, Mizukaki N, Suganami Y, Takei Y, et al. Changes in cerebral perfusion in extremely LBW infants during the first 72 h after birth. Pediatr Res. 2010;68:435–9.Search in Google Scholar

[28] Roescher AM, Timmer A, van der Laan ME, Erwich JJ, Bos AF, Kooi EM, et al. In preterm infants, ascending intrauterine infection is associated with lower cerebral tissue oxygen saturation and higher oxygen extraction. Pediatr Res. 2015;77:688–95.10.1038/pr.2015.20Search in Google Scholar PubMed

[29] Tina LG, Frigiola A, Abela R, Artale B, Puleo G, D’Angelo S, et al. Near Infrared Spectroscopy in healthy preterm and term newborns: correlation with gestational age and standard monitoring parameters. Curr Neurovac Res. 2009;6:148–54.10.2174/156720209788970090Search in Google Scholar PubMed

[30] Dani CD, Bertini G, Cecchi A, Corsini L, Pratesi S, Rubaltelli FF. Brain hemodynamic effects of nasal CPAP in preterm infants less than 30 weeks gestation. Acta Pediatr. 2007;96:1421–5.10.1111/j.1651-2227.2007.00453.xSearch in Google Scholar PubMed

[31] Petrova A, Bhatt M, Mehta R. Regional tissue oxygenation in preterm born infants in association with echocardiolographically significant patent ductus arteriosus. J Perinatol. 2011;31:460–4.10.1038/jp.2010.200Search in Google Scholar PubMed

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2015-6-29
Accepted: 2015-7-9
Published Online: 2015-8-4
Published in Print: 2016-8-1

©2016 Walter de Gruyter GmbH, Berlin/Boston

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