In the NICU – How does C-PAP differ from a ventilator?

help-breathing2Some premature babies are put on C-PAP to help them breathe. Others are on a ventilator.  What’s the difference?

In C-PAP (continuous positive airway pressure), air is delivered to a baby’s lungs either through small tubes in the baby’s nose or through a tube that has been inserted into her windpipe. The tubes are attached to a machine, which helps the baby breathe but does not breathe for her.  With C-PAP, the baby breathes on her own, but the steady flow of air coming in through the tubes keeps enough pressure in her lungs to prevent the air sacs from collapsing after each breath.  It’s a little extra support to help the lungs do their job.

A mechanical ventilator is a breathing machine that delivers warmed and humidified air to a baby’s lungs. The sickest babies receive mechanical ventilation, meaning that the mechanical ventilator temporarily breathes for them while their lungs recover. The air is delivered to the baby’s lungs through an endotracheal tube (a small plastic tube that is inserted through a baby’s nose or mouth down into the windpipe). The amount of oxygen, air pressure and number of breaths per minute can be regulated to meet each baby’s needs.

For those of you who had a premature baby, was she on C-PAP or a ventilator?  How did you feel when you saw the equipment?

 

Updated October 2015.

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57 Responses to “In the NICU – How does C-PAP differ from a ventilator?”

  1. Nina Tate Says:

    I have two sets of twins 17 months apart – all 4 were in the NICU for some period of time. My son (Twin B of younger set) was in for 3+ weeks and was on C-PAP first and then was put on a ventilator. After he came off the ventilator, he was back in C-PAP, then a little “bubble” plastic cube that was over his head (have no clue what they call that one), and then just an oxygen nose cannula. It was heart wrenching when his condition deteriorated and all of the equipment was scary, especially on a baby so small and young. Luckily, the NICU staff, especially the respiratory therapist that was assigned to him, were amazing at explaining what everything was, why he needed it and what the next steps were. I took pictures of him on the C-PAP, but didn’t on the ventilator and chest tube (it was too much and I don’t want him to see it when he’s older).

  2. april Says:

    My son was born at 32 weeks. He was on a c-pap machine and the tube was inserted through his nose. It broke my heart to see him like that, it was very scary. He had been breathing without any machinery for almost 24 hours after his birth but he was getting tired, and the nurses were afraid he would give up. It is very overwhelming having a pre-mature baby, it’s even more overwhelming to see them all hooked up to everything. My son was my second 32 weeker, but my daughter had done very well. With the exception of a little jaundice she was fine. It was a very different experience.

  3. Lindsay Says:

    Nina, you certainly have had more than your share of NICU experiences. That “bubble plastic cube” probably was an oxygen hood. They look weird, but they provide warm, moist air to the baby which feels really good to them. I hope all is well with your growing four.

  4. Molly Says:

    My son was born at 28 weeks, and started out on a ventilator, then moved to CPAP and later the cannula. After he had a g-tube placed, he had to go back on the ventilator for a couple of days, then back through the weaning off of CPAP and so forth. It was scary at first, when I saw him the first time, but I accepted what had to be done pretty quickly. He’s almost 4 now, and doing really well. He has some problems with Cerebral Palsy (spastic diplegia) and we’re working on him learning to walk, but they think that with a surgery he will likely go on to live a completely normal life.

  5. Arleth Says:

    I had a 27weeker baby that spent 4 long months in the NICU and she was put on both and just seeing the change of machines from Vent to a C-PAP was a major milestone for my daughter.

  6. Diane Says:

    I had twin boys at 30 weeks in January; they are actually 7 months old today! One weighed 2lbs. 2oz. and the other weighed 3lbs. 1oz. The smaller twin actually did better and was only on the ventilator for 1 week and CPAP just briefly. The bigger twin was on and off the ventilator for quite awhile, spending a total of three weeks on it and CPAP for quite awhile, too. He had more breathing issues than the smaller twin and would also pull the venitilator tube out all of the time. So, they would try the CPAP or canula for awhile and he’d end up needing the vent again because he’d be working too hard himself to breathe. They ended up coming home on the smallest amount of oxygen and had that for 4 weeks before being taken off oxygen altogether. Today, they have no breathing issues at all.

  7. sarah pidcock Says:

    My daughter who is 4 now was born 3 months premature she was on a ventilator for about 2 months she recived her trach at 2 months she was diagnosed with trachiamalasia. She never was on the c-pap. She spent 3 months in nicu and she is doing awesome now. She got her trach out June 3, 2009 and is doing amazing!

  8. Elizabeth Drew Says:

    My son was born at 29 weeks and for the first 4 hours he was on a ventilator. He started breathing over top of it, and then he just had a cannula for about 2 weeks. I have only seen pics of him on the ventilator as after he was born I was still in pretty bad shape. (I had preeclampsia and my bp was not really responding to meds). He’s 3 months old now, and doing just great. Best of all, hes up to 8lbs 12oz from a low of 2lbs 4oz. Looking back now, I realize I never really paid attention to any of the machines in the nicu. I only saw that for all his tiny size, my son was healthy and absolutely beautiful.

  9. Shannon Says:

    My son who was born at 28 weeks spent 5 months in the NICU and was on the ventilator for 2 months, then a c-pap, then a nasal canula.
    He came home on oxygen but after a sleep study months later he no longer needed it. He does have chronic lung disease and asthma now, but his o2 stats are great.

  10. Stephen Says:

    My son was born at 27 weeks. We were fortunate in that my wife realized something wasn’t right and we went to the emergency room, they were able to stop the preterm labor and delay it for almost 2 weeks. That extra time (and steroids) allowed my son to develop his lungs to the point where when he was born, he was able to breathe on his own. Therefore, he never had to be on a ventilator and only on CPAP. Despite him being born 3 months early, he only was in the NICU for 2 months. He is almost 3 now and shows no signs of side effects from being born so early.

  11. Lindsay Says:

    April and Molly – I can only imagine how scary it was to see your baby hooked up to these machines. Arleth, you’re right, it is a major milestone to step off the vent to C-PAP.
    Diane, you bring up a good point. The baby’s size doesn’t necessarily indicate his strength or need for help. There are some very big babies in the NICU who need help too. Glad the boys are breathing fine today.
    Sarah – Hooray, no more trach!!! That’s great!
    Shannon – Good O2 stats are really important so good for him. I hope the CLD and asthma improve over time.
    Stephen – steroids can make a real difference if there is time enough to give them. Good to hear your 3 year old is goin’ strong.

  12. Tina Says:

    My daughter was born at 27 weeks. She was quick from labor to delivery, so the steroid shots didn’t have time to take effect. Still, we were so very lucky that she only spent 5 days on the vent, 5 days on c-pap, and about 3 weeks on the nasal cannula. She stayed in the NICU a total of 2 months, and went home without the need for oxygen or apnea machines. She’s our little miracle!

  13. Karen Says:

    My grandson was born at 24 weeks weighing
    1pound 2ounces. He was on the vent about
    2 months, then Si-pap, then Flo-pap, then
    c-pap and now nasal cannula oxygen.
    The NICU respiratory , nurses, & doctors
    are all angels in getting our miraculous
    baby where he is today. He is 6 1/2 months
    old and is set to go home in
    2 weeks. His weight now is 10 pounds 2 ounces .
    If you don’t understand something that you’ve
    been told , ask the nurse, they will be glad to explain.

  14. Lindsay Says:

    Tina – your daughter sounds like she really wanted to get here! She has done amazingly well.
    Karen – you must be so happy to see light at the end of the tunnel. I’m sure you can’t wait to see your grandson finally arrive home. Yes the docs and nurses in the NICU are very special folks. I can’t imagine what we would do without their understanding and care for the whole family, not just the baby in the isolette.

  15. Mrslala Says:

    I had twins at 30 weeks. Both were on the vent for about 24 hours, then c-pap for awhile. I don’t remember how long, maybe two weeks? After that it was just cannula. They both have asthma now (they will be two next mont) but no major breathing issues. Neither came home on oxygen.

  16. Sylvia Says:

    My twins were born at 28w5d after hospital bedrest for PROM at 24 weeks. My babies also had benefit of having two rounds of steriods given at 24 and 27 weeks. My daughter weighed 1lb 15oz and my son was 2lb14oz. They were put on the vent for 24 hours as a precaution but were breathing over it the whole time. They were taken off and never had to go back on. They both went on and off the CPAP a few times over the course of their 8 and 10 week stays. Today they are 10 years old, active, healthy and academically gifted 5th graders. We are so grateful to the March of Dimes and all they do for our preemies!!!!!

  17. Amanda Chavez Says:

    My son was born at 29 weeks and had a cpap. He was only on it for less than 24 hours and then pulled it off himself. 🙂 has been breathing room air since! (no vent or cannula) He has always been quite the feisty one. Now at 3 he is just as strong willed as ever!

  18. Danielle Says:

    my son was born April 29, 2010. He was 4 months earlier. He was 1lb 30z when he was born and now he is 7lbs 1.2oz. He is still in the NICU. He just had his g tube surgery on September 2. We are still waiting to see whether or not he will receive a trach. They haven’t been able to ween him off of the ventilator

  19. Wendy Williams Says:

    My little girl was born in Aug 2012 at 25 weeks. She is now 7 months old and still in the NICU. She has a feeding tube and is on a NAVA ventilator. We have lost her a few times and the wonderful doctors and nurses brought her back. She is such a fighter. She has good weeks and then it seems like she has a huge setback. I will have to say that I have seen a big improvement since they took her from the regular ventilator to the new NAVA ventilator, still not close to coming off of it though. I pray for all the babies and the parents that have to go through this. I do know that it sure has made me a stronger person. Prayers to all of you that have been or are in this situation.

  20. Lindsay Says:

    Wendy – Thank you so much for sharing your daughter’s story with us. She does sound like a tough little girl and it’s so nice to hear that she is making progress. May the improvements continue daily and may she graduate from the ventilator soon.

  21. Wendy Williams Says:

    Lindsay-Thank you so much. We would love to have her home by her first Birthday, but I have to be Thankful for each day I have her. I too hope that she soon will get rid of the ventilator.

  22. Tammy Says:

    My nephew was born in Nov 2012 at 28 weeks and remains in the NICU. He was place on a vent then on CPAP and intubated about 5 times. He is such a fighter because he keeps extubating himself. However he had many ups and downs and is currently on CPAP. his care providers is recommending a tracheotomy and a feeding tube in order for him to be discharge from the hospital. These interventions seem scary to care for him at home and outside the hospital setting. He is doing ok on CPAP Im scared that these invasive procedures will cause more harm than good.

  23. Lindsay Says:

    Tammy – I’m sure it really is scary to think about these procedures and caring for the little fellow once he comes home. The good news is that his parents will receive plenty of training in the hospital before he is released. In the meantime, they can write down all their questions and ask them of the docs and nurses so that they feel more confident about potential circumstances that might arise.

    You can read more about leaving the NICU and bringing your baby home on our website. You and your nephew’s parents might benefit a lot from our online communicty for NICU families called Share Your Story: http://www.shareyourstory.org/. It offers a discussion group called “Home after the NICU,” which you can join.

    Best wishes to this little guy and to your family.

  24. Paul Says:

    My DD was born normally but after one week developed breathing problems. Rushing her to hospital one night only to be told its an emergency. The docs said she was totally dehydrated and had to undergo dialysis for a week to help in healing the injured kidneys which was very successful. The only problem is that her breath failed completely and she has been on a ventilator for two weeks now. Its really heartbreaking to see a little angle sleeping all long helplessly.

  25. Lindsay Says:

    Paul – You’re right, it is so hard to watch. I’m sorry your DD had this happen but it’s good to know she is improving from the treatments. Hang in there.

  26. Ashley Says:

    My sister had her baby 3 days ago on December 1st born at 31 weeks. It is her first baby and she is slightly scared about all the machines her baby is on. She is on cpap and they started her out on +6 setting, today they lowered it to +5. My sister is in need of some information so im trying to help her out. I have found through this website what cpap is but now I am wondering when a baby can be taken off of it. How is it determined the baby no longer needs the extra help. Any answers/support is greatly appreciated.

  27. Lindsay Says:

    Ashley, sorry your little niece arrived so early, but it’s good to know that she only needs the c-pap and that the levels are being reduced. Everything is going in the right direction, although some times they may have to adjust the pressure upward for a day or two and then back down, so don’t be surprised if that happens.
    There are not set time limits for when a baby is able to be taken off the c-pap. It varies from infant to infant and just depends on when the lungs are mature enough to function completely on their own. Your sister should feel free to write down her questions (so she doesn’t forget any of them) and then ask them all on her next visit to the NICU. The nurses and docs are great at answering questions and explaining how everything works. They know that the more parents understand, the more easily they can rest.
    I suggest your sister visit our Share Your Story site where she can start a blog and chat with other parents of preemies. It’s hugely supportive. Here’s a link: http://share.marchofdimes.com/
    All the best – Lindsay

  28. Eboni Says:

    Our daughter was born at 28 weeks and 5 days. She is now three and a half weeks old. She was originally on vent,the CPAP for one day,back to the vent until the other day. She was on NIPPV for about two days and is now on CPAP. Thankfully she is doing well, making good progress. It was great to read about others experiences. Gives us even more hope!

  29. Viktoria Jane Corry Says:

    I had twins at 24 weeks after my waters went, they were both in nicu and on ventilator twin 1 passed away after 2 weeks, twin 2 was bigger of the twins at 669 grams was on vent for 3 weeks tried cpap got a few days back on vent tried again few days back on vent and is now 5 weeks and has been on cpap for 6 days.. had a blip yesterday oxygen kept dropping low and had to use neopuff on him but have still kept him on cpap.. hopefully this will be him starting to get strong and grow he is now 800 grams

  30. Lindsay Says:

    Eboni, often with preemies you see two steps forward and one step back. As long as the overal trend is forward the prospects are very reassuring. It is so nice to hear of your daughter’s progress. Keep it up little one!

    Viktoria, I’m sorry you delivered your sons so early and that you lost one of your little boys. It must be very hard to watch the other one struggling to grow. It sounds, however, that he is tough little guy and is doing a good job of moving forward. I’m sending best wishes for continued daily progress. Thank you for sharing your story.

  31. Nia Says:

    My son was born at 29weeks 2days.. he was on the ventilator for only about 8 hours.. they took him off of that & gave him the nasal cannula, which he was on for 5 days.. now he is 3 weeks, still in the NICU & breathing perfectly fine.. he is expected to come home soon!

  32. linda Says:

    My baby boy was a 24 weaker .he was only 220 grams .He was on a ventilated for a while then he was on a nasal c- pap . He had a lot of ups and downs never knew exactly what was wrong with him . Doctors really don’t want to update you as a parent. We are still fighting! ! With many complications. I hope my baby will get through all of this one day.

  33. Sara Says:

    Linda, it sounds like your son is a tough little guy. You may find our website for NICU parents very helpful. It is called Share Your Story (http://share.marchofdimes.com/). Here NICU parents talk to one another and offer support and encouragement. It can be a great resource.

  34. Dilip Says:

    Hi,
    I’m from India writing this from the Natal ICU. I have just had premature (30. 2 weeks) twins.was worried and heart wrenched but after reading all your support comments, I got some strength. Babies are doing OK. Hopefully they recover soon and I can get them home. Linda hope things get better soon.

  35. soorya balaji Says:

    Hi I’m mrs. Balaji I got delivered twin boys on sept 15th of dis year. More than 20 days my sons kept in nicu due to less weight. Pre mature babies. V admitted in metha hospital chennai. Really dey r giving good treatment. My first son was affected by Neumoniya. Kept in ventilator for one week. Nw he s out of ventilator n nw in cpap. Really im vry upset nw n scared to c my baby wit tat tubes. Omg god shd tc of my son.I’m praying for him. Soon he shd get normal.

  36. bhushan Says:

    Hii i am from india.i have just had 29 weeks preemie twins baby boys.twin A was never on ventilator but twin B was on ventilator for three days after birth.after three weeks twin A is now completely on mothers milk in nicu and twin b still requires ventilator in between.twin B is also taking mothers milk but not as twin A.but doctors says both are growing well and have incresed in weight.but i m worring for my babies, specially for twin B who is my little champ and fighting a lot, god plz bless my childrens and all those who are sailing with me on same boat.

  37. trisha Says:

    in 36 or 35 weaks ..is it neccesary to put the baby in ventileter or c-pap for brithing??

  38. Sara Says:

    Hi Trisha. At 35-36 weeks some babies may need breathing assistance but others will not. It just depends on individual baby. If you have questions or concerns, make sure you talk to your health care provider.

  39. Myste Says:

    I had my daughter 1 month ago today. She is a surving Di di twin,her brother passed a few days before I delivered her. She was born at 23.6 weeks and was taken off the jet and ventilator when she was 4 days old. 2 days after breathing on her own her right lung collapsed and it has been an uphill battle ever since. She is now basically 4 1/2 weeks on the ventilator and has had & gotten rid of pneumonia twice. I would pay anything for her lungs to work right and for her to be on a cpap! 🙁

  40. juliet Says:

    hi sorry 2 hear about ur son. An I would pray for your daughter 2 get well lets leave all to God. I have a niece who was born 36 weeks and been in ventilator for a month now. All we have to do is pray for the u are not alone. Stay strong

  41. Millie Says:

    My granddaughter is 7 months old and has been through so much in her little short life. She was born at 25 weeks…on the ventilator for about a little over a month, then on the cpap, and months later on the high flow. She has a heart murmur, ASD, and developed BPD. She had to have a Gtube, which put her back on the ventilator and nitro oxide machine for 4 days and then weaned off the vent and put on on cpap with nitro oxide machine and then eventually put on high flow oxygen. She was in the NICU for almost 6 months. She was discharged on April 1, 2015, April Fool’s Day. She was on 0.5 liter of home oxygen. Eventually after being home for almost a month, her O2 sats kept fluctuating which kept us back and forth in the emergency room. Her pulmonologist increased her home oxygen to 2 liters of home oxygen because of her desats, but never really checked anything else. Her heart doctor showed her murmur and ASD with no change so didn’t felt the desats were nothing to worry about. Well the desats continued as I said about a month and we were back and forth to emergency room. Then her appointment with her pulmonologist showed increasing the liters still did not help her sats so he scheduled a blood gas which showed her co2 in the high 80s. She was admitted. Then an outside cardiologist was consulted which he informed us that her murmur had increased in size of the aorta. So she was airlifted to another hospital to have the PDA closed. That hospital assessed her and showed no increase in the murmur, but notice a little shunting and since shes now at their hospital they thought it was best for them to go ahead and closed the PDA, which my daughter consented to. Closing the PDA caused her to be back on the ventilator since May 13, 2015 and now her pressures in her lungs are so high, which the BPD worsen because it went untreated for so long. She is still on high pressures of the ventilator and can’t seemed to be able to get weaned off. They have her on so many medicines from the heart murmur procedure and the BPD high pulmonary pressures in her lungs. She’s on viagara…yes viagara, bosentan, lasix steroids, aldectone, HCTZ, sodium chloride…caught pseudomonas infection so on gentimycin and many more. She doesn’t seem to be able to stabilize her co2, which I think is caused by the leakage in her tubing. I am just furstrated because her home health nurse knew something was wrong and kept contacting her pulmonologist and cardiologist and they just kept putting it on each other, but never really saw about the baby’s high pulmonary lung pressures and high co2, which worsen over times. Now she’s fighting to live. That makes me angry, but I have to stay strong for my daughter and grandbaby, but it’s very depressing to see how well she once improved to get out the NICU, only to be back in a far away hospital in a PICU on a ventilator and not seeming to do well. 🙁

  42. Alicia Says:

    My middle son, now almost 9 years old, was born at 27 weeks. He was on the ventilator for about 5 weeks at which time, he extubated himself and was put on a CPAP. He did very well with that and was discharged at 35 weeks weighing a little over 4 pounds. He is the sweetest little boy you would ever have the pleasure of meeting and made the 3rd grade honor roll every quarter this year. He also plays baseball. He is still smaller than most in his age group, but he can catch up with the best of them.

    My youngest daughter and final baby, was born tuesday, June 9 at 27 weeks. She is on the ventilator now, but I am confident that she will do just as well.

  43. Teresia Warren Says:

    My 27 weeker was on the oxlatoter vent for a while then on the regular vent we stay on cpap a month then had to go back to the ventilator now we’re trying cpap again she is 6 months old weighed 1 pound and 12 oz .How many times will they keep trying before they do a treack. I don’t want them to have to do a track.

  44. Nikki chapman Says:

    My son was born 12-15-15 at 39 weeks weighing 8lbs 5 oz even though he was a full term baby and weighed that much he still hasn’t gotten the hang of breathing he’s been in the NICU since the day he was born and is under the CPAP and is making some improvements and is feed by a feeding tube.

  45. Gunjan Suri Says:

    My twins were born on 3rd sep 2016…Baby girl is still on ventilator and boy is on cpap (was on oxygen for few days but was shifted to cpap again). they lost weight after birth but now have started gaining few gms evey day (good sign). doctors say that they should do well once they recover their birth weight 680 and 690 gm and should keep on increasing..will improve their condition.
    We are so scared and keep praying all the time. It will give us relief when they will be on normal breathing.

    Can someone tell how did their kids performed after recovering from NICU? Hope they didn’t have any problems and such kids can lead a normal life like other kids after completing their tough time in nicu ?

    My heart gives blessing to these kids all the time and wish them a b’ful life ahead. May god give them and their parents enough patience and strength to bear this tough phase of life.

  46. Rakesh Says:

    My friend baby of 1 month got problem for breathing. So now she is on ventilator from 4 days, and heart rate is going upto 100 to 109. After four days doctor removed baby from ventilator, but after 20 minutes again baby getting breathing problem. So now again they kept baby in ventilator. So what to do save baby.

  47. Rakesh Says:

    My friend’s baby of 1 month got problem for breathing. Actually she have problem in neck, the size of neck had increased. So now she is on ventilator from 4 days, and heart rate is going upto 100 to 109. After four days doctor removed baby from ventilator, but after 20 minutes again baby getting breathing problem. So now again they kept baby in ventilator. So what to do to save a baby life. Please reply as soon as possible.

  48. Sara Says:

    Hi Rakesh,
    The length of time a baby is on a ventilator depends on a number of factors. Some babies who are born extremely early and very small just need more time to allow their lungs to develop. Weaning a baby from a ventilator is really a matter of trial and error; doctors don’t have an exact way to tell when a baby’s lungs are ready to function on their own. It’s not really a setback when your baby’s ventilator settings are lowered and then raised again—it’s just that the doctor was guessing that your baby was ready, and it turned out to be a little too early.

    Make sure your friend asks the doctors and nurses any questions. They can be very helpful.

  49. Jennifer Mora Says:

    My son Presley was born at 23 week’s 2 days. He weighs 1 lb and 2oz. Today he is 26 weeks and 2 days. He has been on the ventalator since day 1, and has had trouble with low oxygen. The doctor’s are trying to take him off the ventalator, and now have started low dose steriod treatments to acheive this. He already had 2 emergencies. Can anyone give advise on a baby with severe lung issues. Thanks

  50. Scott Says:

    I didn’t realize that a c-pap machine helped keep air pressure on the lungs so as to not have them collapse. I can see why this would be good to know about if your baby has trouble breathing. I’ll have to remember this if my next baby has problems breathing.

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