NRP CPAP in the delivery room the best guide

CPAP in the Delivery RoomCPAP in the Delivery Room

This video demonstrates administration of CPAP as part of delivery room resuscitation.

Continuous Positive Airway Pressure (CPAP) in the Delivery Room: An Essential Skill in Neonatal Resuscitation Program (NRP)

The Neonatal Resuscitation Program (NRP) is a critical training program designed to equip healthcare providers with the skills and knowledge needed to effectively manage and resuscitate newborns who face respiratory and cardiac challenges at birth. Among the various techniques taught in NRP, the application of Continuous Positive Airway Pressure (CPAP) in the delivery room stands out as a vital intervention for newborns experiencing respiratory distress.

Understanding CPAP in the delivery room

CPAP is a non-invasive ventilation strategy that delivers a constant flow of air pressure into a newborn’s airways, helping keep the alveoli open during both inhalation and exhalation. This continuous pressure facilitates improved gas exchange and helps prevent the collapse of the alveoli, which is crucial for babies who are unable to maintain adequate lung expansion on their own.

Indications for CPAP in the Delivery Room

In the delivery room, CPAP is particularly beneficial for newborns who exhibit signs of respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), or other conditions that impair effective breathing. Key indicators for CPAP include:

  1. Grunting: A sign that the newborn is trying to keep the alveoli open.
  2. Flaring of the Nostrils: Indicates increased effort to breathe.
  3. Retractions: The inward pulling of the chest wall during inspiration.
  4. Tachypnea: Abnormally rapid breathing rate.
  5. Low Oxygen Saturation: Despite receiving supplemental oxygen, the newborn’s oxygen saturation levels remain low.

Equipment and Setup for CPAP in the delivery room

To administer CPAP in the delivery room, the following equipment is typically required:

  1. CPAP Machine: A device that delivers a continuous flow of air.
  2. Interface: Nasal prongs or a mask to deliver the air pressure to the newborn.
  3. Humidifier: Ensures the air is warm and moist, reducing the risk of mucosal drying.
  4. Monitoring Devices: Pulse oximeters and cardiorespiratory monitors to continuously assess the baby’s oxygen levels and heart rate.

Application of CPAP in the delivery room

  1. Initial Steps: As with any neonatal resuscitation, the initial steps include providing warmth, positioning the baby’s head to open the airway, clearing secretions if necessary, and drying the baby to stimulate breathing.
  2. Assess Breathing: Evaluate the newborn’s respiratory effort and oxygen saturation. If the baby shows signs of respiratory distress, CPAP may be indicated.
  3. Prepare Equipment: Ensure that the CPAP machine is set up correctly, with the appropriate pressure settings (usually starting between 4-6 cm H2O) and that the interface fits the newborn snugly but comfortably.
  4. Administer CPAP: Apply the nasal prongs or mask to the baby’s nose and mouth. Ensure that the seal is secure but does not cause excessive pressure on the baby’s face.
  5. Monitor and Adjust: Continuously monitor the newborn’s oxygen saturation and respiratory rate. Adjust the CPAP pressure and oxygen concentration as needed to maintain optimal oxygenation and minimize respiratory effort.

Benefits of CPAP in the delivery room

CPAP offers several benefits in the management of newborns with respiratory distress:

  1. Prevention of Atelectasis: By maintaining positive pressure in the airways, CPAP prevents the alveoli from collapsing, ensuring better lung expansion and gas exchange.
  2. Reduction in Work of Breathing: CPAP decreases the effort required to breathe, reducing fatigue in the newborn.
  3. Improved Oxygenation: Enhances the delivery of oxygen to the tissues, ensuring that vital organs receive adequate oxygen.
  4. Non-Invasive: Compared to mechanical ventilation, CPAP is less invasive and can be administered without intubation, reducing the risk of lung injury and infection.

Challenges and Considerations

While CPAP is highly beneficial, it is not without challenges. Ensuring a proper fit of the nasal prongs or mask can be difficult, and air leaks can compromise the effectiveness of the therapy. Additionally, over-reliance on CPAP without proper monitoring can lead to complications such as gastric distension or nasal trauma.


CPAP is an essential skill in the NRP toolkit, providing a non-invasive and effective means of supporting newborns with respiratory distress in the delivery room. By maintaining alveolar stability, reducing the work of breathing, and improving oxygenation, CPAP plays a crucial role in the initial management of at-risk neonates. Proper training and practice in the application of CPAP can significantly improve outcomes for newborns, highlighting the importance of this technique in neonatal resuscitation. If you are interested in booking a class or learning more click here or contact us directly

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