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Dear collagues In our nursery we use BabyFlow from Dräger to provide NIV via VN500. We are planning to introduce the Seattle-PAP system (a bubble CPAP system) from Dräger to deliver nCPAP.  Previously we have used beneveniste-CPAP. So moving to BabyFlow is quite a big step as the headgear and interface is quite different and much more bulky compared to what we have used for many years.    Is there anyone out there using BabyFlow who would be willing to share experience? Our nurses are working hard to get used to the nasal interface and fixation system and especially when using bubbleCPAP we have lots of difficulties with leakage.    many thanks in advance   cheers Christian   A few words about the unit: Level 3 NICU in Denmark. From 23 weeks GA to term+, noninvasive resp support and Conventional and HFO ventilation, iNO, ECMO, cardiac and pediatric surgery on site in addition to ENT, ortho and neurosurgical surgery and retrieval service

thank you very much for your reply and in the narrow range of weight and gestational age, which values of ph make reference as the minimum objective

I have observed this repeatedly in babies whose mothers were taking SSRI antidepressants, specifically Zoloft. Happy baby who does not cry. Cheers, MK

Great question, Juan Carlos. I am partial to the VN500, but I'm sure both devices can deliver VG quite well. The problem is that babies don't like to be acidotic. Consequently, there is a problem with permissive hypercapnea in the first days of life in small preemies, because their kidneys are not able to compensate for respiratory acidosis. Therefore, the baby will try to generate a tidal volume sufficient to bring the PCO2 down and normalize the pH. As you know when the tidal volume exceeds the target value, PIP will come down and pretty soon, your baby may be on endotracheal CPAP with rising oxygen requirement (due to the drop in MAP), tachypnea and increased work of breathing. You would have to sedate the baby sufficiently to suppress their respiratory drive, which is a bad idea. People find all kinds of ways to reduce the support for the baby's effort, for example changing from AC to SIMV at a low rate, so the baby is unable to generate adequate minute ventilation and correct the acidosis. So, the baby is struggling, but the doctor is happy, because the PCO2 is where he or she wants it. If you can buffer the acidosis by adding some acetate to your TPN and get the pH up to near normal, you might be able to let the CO2 rise gradually.  The focus needs to be on pH, not PCO2, because it's the pH that is the primary stimulus for respiratory drive.  Basically it is better to support the baby's effort to maintain normal pH and avoid the mistake of looking only at the PCO2. Ultimately, it is the perivascular pH that controls cerebral circulation, but unfortunately all studies keep focusing on PCO2 and ignoring pH. What we know is that rapid fluctuations in PCO2 confer the greatest risk of IVH.  Once the baby is a bit older and the kidneys are more mature, it'a s lot easier to allow permissive hypercapnia if they still need mechanical ventilation. I hope this helps,  MK  

We use this system on an ongoing basis. Very comfortable and does not damage the nasal septum.