nCPAP Failure in RDS Management Using RAM Cannula Versus Short Binasal Prongs in Preterm Infants: A Randomized Clinical Trial

Abstract

Background: The optimal application of non-invasive continuous positive airway pressure (CPAP) for preterm neonates with respiratory distress syndrome (RDS) has always been considered a significant clinical challenge. Effective continuous distending pressure (CDP) must ensure suitable oxygenation and ventilation throughout respiratory management. The choice of interface plays a critical role in delivering nasal continuous positive airway pressure (nCPAP), with various designs such as nasopharyngeal tubes, binasal prongs, and nasal masks. Over the past decade, the RAM cannula (RC) has emerged as a new alternative, prompting studies into its ability to provide adequate CDP and expanding interest in RDS management strategies using the RC. Objectives: One of the primary advantages of utilizing nasal cannulas in nCPAP delivery is the minimal restriction they impose on the infant's head and neck movements during respiratory support. Additionally, this interface promotes improved mother-infant bonding compared to other methods. It also minimizes facial trauma, as it requires no external fixation. However, concerns persist regarding the adequacy of pressure delivery due to air leakage around the cannulas. This study aims to evaluate whether the RC can deliver optimal CDP compared to short binasal prongs (SBPs). Methods: This randomized clinical trial included preterm neonates with a gestational age of 28 to 32 weeks, diagnosed with RDS and receiving nCPAP support using either SBPs or RCs. The study was conducted at Shahid Beheshti and Alzahra hospitals in Isfahan between March 2023 and December 2024. Results: The study found no statistically significant difference between the SBP and RC groups regarding the need for mechanical ventilation (MV), the requirement for surfactant administration and total doses administered, duration of noninvasive respiratory support, incidence of chronic lung diseases (CLDs), occurrence of grade III/IV intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), pneumothorax, and mortality rate. Conclusions: This study did not demonstrate significant superiority for nCPAP delivered via the RC, nor did it show any inferiority compared to the use of SBPs. Therefore, as the RC does not require the cumbersome fixation equipment associated with SBP, this may represent a practical advantage in its clinical application.