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Welcome to The NICU Translated Podcast, where we break down the complex world of the NICU into clear, relatable insights for families and the professionals who support them. Hosted by Mary Farrelly—a certified NICU nurse, doula, and educator—this podcast is your go-to resource for navigating the NICU with confidence and compassion.
Whether you’re a doula looking to better support NICU families, a healthcare professional seeking deeper understanding, or a parent preparing for or living through a NICU journey, you’ll find actionable tips, evidence-based guidance, and heartfelt stories to inspire and empower you.
Each week, we’ll explore topics like:
-NICU 101: Terms, diagnoses, and medical equipment explained.
-Preemie care basics and developmental milestones.
-How to advocate for your NICU baby with confidence.
-Emotional and trauma-informed support for NICU families.
-Insights from NICU professionals and families who’ve been there.
With episodes featuring expert advice, list-style guides, and real-life interviews, The NICU Translated Podcast is here to equip you with the tools and knowledge to make the NICU journey less overwhelming and more empowering.
Subscribe now and join our community dedicated to bringing more joy and less trauma to the NICU experience—because the NICU is only the beginning.
Let’s navigate this journey together.
Mary Farrelly (00:00)
Today we're talking about something you'll see in almost every NICU. Those little hats and nose prongs delivering gentle air to help babies breathe. It's called CPAP and while it can look intimidating at first, it's actually one of the most common and gentle forms of support we use to help babies grow stronger. I'll walk you through what CPAP is, how it works, why babies need it, and share my favorite balloon analogy that makes it all click.
Hi everybody and welcome back to this week's episode of the NICU Translated Podcast. This is the first of many short educational episodes I'm calling the NICU Translated, where we take the alphabet soup that comes along with the NICU and all the weird acronyms and abbreviations and funny little words and sayings and topics that can feel really overwhelming and confusing.
both for new families, for non-medical professionals, and even sometimes for medical professionals to explain in a way that feels ⁓ concise and easily to kind of digest and understand by people who don't fluently speak, make you or medical jargon language topics. So today's episode is the very first and I'll be sprinkling these throughout ⁓ the different episodes that are published. So if you ever have a topic or ⁓
something that you want to have translated, please let me know. You can DM me. I'm on Instagram at TheNICUTranslator. You can leave a comment in the show notes below, or you can email me at hello at theNICUtranslator.com. So today's very first episode is all about
CPAP because CPAP is one of the most common things you will see in the NICU and it can feel kind of intimidating to look at because there's a lot of gear and a lot of things going on and especially for a new parent who's coming down maybe from giving birth and coming into the NICU and seeing their baby covered with tubes and wires like is involved in CPAP can feel a little scary. But today, hopefully by the end of this episode, you'll have a basic understanding of
what CPAP is how it works and why a baby might need it. So first of all, what does CPAP stand for? CPAP stands for Continuous Positive Airway Pressure. And one thing I hear from families is like, oh yeah, know, I have sleep apnea, or my uncle or my dad or my mom, whoever has sleep apnea and they use CPAP at home, is it the same? And it's basically the same idea.
works slightly differently in babies and we're going to talk about that, but it is kind of the idea that you're using this extra pressure to kind of help the lungs and airway stay open. So babies and adults when they use CPAP can breathe more easily. So CPAP basically provides a steady stream of air pressure and it helps to keep a baby's lungs gently open, which helps them breathe more easily. Unlike other forms of respiratory support or breathing support in the NICU,
The goal of CPAP isn't to breathe for the baby. The baby is still taking breaths on their own. They still have what we call respiratory drive. So their brain has the ability and the maturity, especially for preemies, or the capacity for those sick infants to take breaths on their own.
but there may be these breaths are not as effective or regular or deep as they need to be to be able to exchange gas because the whole point of breathing is to allow the body to exchange gas and be able to breathe in and absorb oxygen for all of the cells to take in and all the magic that is living to continue to go on. So it basically helps to make the breathing
easier for the baby. And we are going to talk about in future NICU Translated episodes about those types of breathing support or ventilation support, which is what you might hear in the NICU, that do breathe for the baby. But CPAP doesn't breathe for the baby. What it does do is provides that extra pressure and sometimes extra oxygen to allow the baby to breathe more effectively. But they're still doing the work themselves. When I'm explaining this to parents at the bedside, it still can kind of seem a little bit like, okay, but like,
Why can't my baby breathe? They have lungs. Like, why is this not working? Like, is this scary? Is this forever? Are they going to have long-term complications from this? What's going on? So I like to kind of use a visual analogy of a balloon. So imagine you're at a birthday party and you get the fresh bag of traditional, you know, basic balloons from the party store. And you, if you go to take one out of the bag and you go to blow it up right away without doing anything else to it,
you really have to take a deep breath in and really forcefully push air in to get those, that first part of the balloon to like start going. And once it's open, you can usually do, it's like stretched out, it's ready to go. And you can usually add some smaller, less intense breaths to fill up the rest of the balloon. The same idea is happening with babies' lungs, especially those that need CPAP. So a baby that needs CPAP
often times having lungs that are either
stiff and new like a preemie or they're very sticky. So they don't have a lot of something called surfactant, which is a topic that we're going to talk deep about when we go into the next NICU, NICU translated topic, which is RDS or respiratory distress syndrome. But instead of the baby needing to take every single time a deep, huge breath in. imagine a
brand new baby that has lungs that are a little bit stiffer or stickier, if they don't have the support of oxygen or airflow that CPAP provides, every single breath will feel like that first breath that you need to take to blow up a balloon. Everyone is going to need a lot of support, a lot of power, a lot of, so because every single time they breathe in, they have to use all these extra muscles to be able to expand their lungs to the point
that it needs to be to be able to, again, exchange gas. What CPAP does is it basically makes it so that the balloon, the baby's lungs, don't ever have to fully deflate. It always leaves a little bit of air. So in that case, that would be the balloon. Say we blew up a balloon, it got really, really big, and then we started to let air back out. Makes that silly little fart noise, right, that all kids like. It's shrinking, shrinking, shrinking, shrinking.
But then instead of letting all the air out and it get floppy and sticky again, we leave a little bit of air at the bottom. So that is CPAP. CPAP is leaving a little bit of air or pressure at the end of each breath. So that end pressure is called PEEP, which is positive end expiratory pressure. So if your baby is on CPAP in the NICU or you're supporting a family on CPAP, you're going to hear a number of their PEEP. So you're going to say the baby's on a CPAP of plus four.
or plus five or plus six. That number is the number of pressure or the number of the peep that the baby is needing to keep their lungs open. So a higher peep, that number that's more like CPAP of six or sometimes higher depending on what's going on with the baby, that baby's needing a lot of pressure to keep those lungs open. Those lungs are either really stiff, sick, sticky or something's going on where if the pressure wasn't there,
the baby would have a really hard time re-expanding them. And if a baby is having a hard time expanding, you're gonna see it. It's gonna be something called work of breathing. So you're gonna see them use their extra muscles. You're gonna see them kinda suck in their chest. You're gonna see them bob their head. You're gonna see them flare their nostrils or maybe even make a little noise called grunting, which is that ⁓ every time they breathe. That's them trying to make their own peep and help to keep their own lungs open.
But if we kind of do the work for the baby and let them have this peep from the machine, from the CPAP, then they're able to take their next breath with a much less effort and which will ultimately lead to better oxygenation, better recovery. And in the case of preemies, the ability to grow and develop and have their lungs mature to then hopefully be able to not need CPAP and to be able to do all of the work of breathing and gas exchange all by themselves.
The other tricky thing with CPAP and work of breathing is if they're not getting enough support, sometimes babies can do it by themselves for a little bit. They'll be able to, what we call compensate. So they'll be able to use those muscles. They'll be able to make that funny noise. But ultimately over time, they simply get tired and the lungs will get stickier and stickier and then it gets harder and harder to open up each breath. So in that case, the baby might need more peep or more pressure.
Or they maybe even need to go to the next level of support, which could be a breathing tube that is placed into the baby's trachea, sits right above the lungs, attached to a ventilator that helps the baby take even more specific amount of pressure and air and volume in with each breath. But oftentimes a lot of babies are very successful on CPAP and they really thrive and are able to exchange gas, just like those little lungs are supposed to be doing.
Mary Farrelly (09:57)
This week's episode of the NICU Translated Podcast is sponsored by NICU Doula Academy.
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Mary Farrelly (10:48)
Why might a baby need CPAP is the next question. The most common reason is prematurity. So the lungs are immature. They were in there and growing, but they weren't quite ready to be turned on yet. And the fact that the babies now earthside and born means that we do need them to start doing their job. And so those babies will likely need some form of CPAP to help ⁓ the lungs do the work while they're still growing and developing. Some babies that are term need it after delivery.
In utero, the lungs are kind of just hanging out. They're there, they're taking little practice breaths, but they're mostly filled with fluid. even in utero, the baby's blood circulation kind of skips over the lungs. It's like, you're cool, but we don't really need you right now. But then at birth, when the baby takes that first deep breath in, all systems must go. And some babies just need a little bit of extra support to help get some of the fluid off the lungs.
maybe fight an infection, help to have that surfactant kind of replace, which is another topic we're going to talk about later on. So even term infants do and often do need CPAP, sometimes just for a few hours, sometimes for a couple of days, sometimes for longer. But it is again, oftentimes a bridge to the baby then being able to do everything independently. Sometimes we also use CPAP as a transition off of the ventilator. So some babies that are born that are very premature or
having a really hard time transitioning at birth for whatever reason, or have some anatomy or other issues, we'll need to have that breathing tube or be intubated very quickly on. And so the transition often from being intubated to having that tube taken out, which is called extubation, is another round of CPAP because it's that bridge. It's like, okay, we'll help you transition, but now you're doing some more work. And then we slowly wean it down. So we drop the amount of pressure until it's that point where like, okay, let's see what they can do without it.
It can also be used during procedures. So if the baby had to go to surgery and come back up and maybe they're a little bit sleepy and not taking very deep breaths. Um, or also for chronic lung conditions like BPD, which is another one of those alphabet soups we're going to talk about, which stands for bronchopulmonary dysplasia. But we'll worry about that in a different episode. What does CPAP look like? Depending what NICU you're in, CPAP might look different. There are a lot of different, what we say like modalities or brands or kind of set up for CPAP.
The idea is all the same. It's giving this constant pressure, this peep to the lungs so that they don't collapse at the end of each exhale. But the actual gear can look different. Oftentimes there's usually a little hat or bonnet that the baby is wearing that is attached to either some prongs or a mask. Some systems have both that the baby goes back and forth between the prong and a mask that sits on or in the baby's nose. And it gently delivers this steady flow of air.
Sometimes some babies can find it a little bit interesting to try to play with their CPAP. It's like something to grip onto, so they might be playing with it or kind of hitting at it. Usually the process of getting it set up and like kind of messing with the baby's face and putting the proper stickers and the hat on is what makes them frustrated. And then once it's on and working, they're usually like, oh, great, I can breathe. This is wonderful. This is so cool. Now we can hang out. Some types of CPAP also have a extra system called bubble CPAPs. You might hear,
Gentle bubbling, it's basically a little bit of water that adds instead of just constant air, it almost like has little tiny gentle pops of air, little bubbles of air that are passed into ⁓ offering an even more gentle way of delivering CPAP. So if you have a baby that is your baby that you're helping to care for, or that is your own baby in the NICU, if they're on bubble CPAP, you want to hear the bubble sound because that means that it's working. CPAP needs to have a seal, meaning that
There can't be any like one prong can't be hanging out and like kind of flopping in the wind. Sometimes babies will get really tricky and try to pull it in their mouth. Sometimes they'll pop off different pieces of tubing. So if you don't hear the bubbling, something, something got popped off and usually it's a quick fix. So we can just pop it back together. So again, it can look really intimidating, but it's actually one of the most gentle forms of support and it can hopefully ideally, especially for babies that just need it as a bridge, prevent them from having more invasive types of
of respiratory support, which would be that breathing tube or being intubated and things like that. So as a parent or someone supporting a parent, it's still really important to know that you can still bond and connect with your baby. You can talk to them, touch them. Oftentimes they can still come out and be held safely, skin to skin. Sometimes babies that are feeling a little bit frustrated by their CPAP might do really well with some gentle containment, like holding with a hand hug, which we're going to talk about non...
pharmacologic ways to support a baby in upcoming episodes. It can also be helpful to take pictures that you can then show your child one day and say, hey, this was part of your story. Look how mighty you are trying to rip this CPAP off your face or how tiny or how strong and look at you now. Look at how incredibly powerful you are and how you went through this NICU journey with such like a fierce strength.
So even though it can feel like maybe I don't want these pictures of my babies with these tubes and wires, it is still part of their story. And a lot of times kids are very, very curious about their beginnings and all the things that they went through.
so to wrap things up, CPAP is a gentle air pressure support that helps babies breathe by keeping their lungs open. It looks a lot more complicated than it is, and it's really just helping those little balloons, those little lungs stay inflated.
if you found this helpful, share it with another NICU parent, doula or professional who might be learning right alongside you. And don't forget to follow the NICU Translated Podcast for more bite-sized breakdowns of all things NICU. See you next time and NICU love. Love, Mary.