Article Text

Download PDFPDF
Gas flow in preterm infants treated with bubble CPAP: an observational study
  1. Cameron D Payne1,2,
  2. Louise S Owen1,3,
  3. Kate Alison Hodgson1,3,
  4. Colin J Morley4,
  5. Peter G Davis1,3,
  6. Brett James Manley1,3
  1. 1 Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
  2. 2 Department of Medicine, Peninsula Health, Frankston, Victoria, Australia
  3. 3 Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
  4. 4 Obstetrics, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Cameron D Payne, Newborn Research Centre, The Royal Women's Hospital, Parkville, VIC 3052, Australia; cameron.payne{at}


Objective To measure the nasal gas flow in infants treated with bubble continuous positive airway pressure (CPAP) and compare it with commonly used flows during nasal high flow (nHF) treatment.

Design This is a prospective, single-centre study. Bubble CPAP pressure was measured at the nasal prongs. Set gas flow was reduced until bubbling in the water chamber just ceased. Set gas flow without bubbling then approximated flow entering the infant’s nose (‘delivered flow’).

Setting Neonatal intensive care at The Royal Women’s Hospital, Melbourne, Australia.

Patients Clinically stable preterm infants receiving bubble CPAP therapy.

Main outcome measure Delivered flow (L/min) when bubbling stopped at a range of clinically set CPAP pressures (cm H2O).

Results Forty-four infants were studied, with a mean (SD) gestational age at birth of 28.4 (2.2) weeks and birth weight of 1154 (419) g. At the time of the study, infants had a median (IQR) age of 4.5 (2–12) days and a mean (SD) weight of 1205 (407) g. Delivered flow ranged from 0.5 to 9.0 L/min, and increased with higher set CPAP pressures (median 3.5 L/min at CPAP 5 cm H2O vs 6.3 L/min at CPAP 8 cm H2O) and heavier weights (median 3.5 L/min in infants <1000 g vs 6.5 L/min for infants >1500 g).

Conclusions Nasal gas flows during bubble CPAP in preterm infants are similar to flows used during nHF and increase with higher set bubble CPAP pressures and in larger infants.

Trial registration number ACTRN12619000197134.

  • neonatology
  • therapeutics

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors CJM formulated the original study concept and protocol framework. PGD, BJM, LSO, KAH and CDP planned and developed the protocol, completed the ethics application, collected the data and analysed the results. All authors were responsible for interpreting the results, drafting and revising the manuscript, and had final approval of the submitted manuscript and supporting data. All authors also agree to be accountable for the accuracy and integrity of the study.

  • Funding Funding was received from The Royal Women's Hospital, Melbourne (Program Grant #1113902) for the equipment used in this project.

  • Competing interests CJM is a consultant for Fisher & Paykel Healthcare.

  • Patient consent for publication Not required.

  • Ethics approval The protocol was approved by The Royal Women's Hospital Human Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

Linked Articles

  • Fantoms
    Ben J Stenson