P1.190: Impact of RAM Nasal Cannula Use on Rate of Bronchopulmonary Dysplasia in Low Birthweight Infants

Background: Many premature neonates require respiratory support shortly after birth due to lung immaturity and an underdeveloped respiratory drive. There are several methods of non-invasive ventilation, including continuous positive airway pressure (CPAP) and nasal intermittent positive pressure ventilation (NIPPV), used to decrease invasive mechanical ventilation and the associated risks such as bronchopulmonary dysplasia (BPD). Although the RAM nasal cannula was approved by the FDA for providing supplemental oxygen with 60–80% nasal occlusion, it has been used off-label to provide CPAP because of its ease of use and perception of reduced nasal injury. Compared to a traditional nasal cannula, its stiffer design allows a higher flow rate and pressure delivery. Due to its softer material, there’s decreased airflow resistance and a tendency for less nasal trauma. Despite the proposed benefits of the RAM nasal cannula, there continues to be discourse regarding its efficacy as some have found it delivers suboptimal pressures. While prior studies have compared the RAM nasal cannula to other modes of respiratory support, there lacks further investigation on how using RAM can impact the development of morbidities seen in premature newborns, such as BPD.

Methods: An IRB-approved retrospective chart review was conducted of neonates born at < 33 weeks gestation with birth weight of ≤1500 grams admitted to Cooper University Hospital NICU between January 2018 and December 2023. For each subject, the type and duration of respiratory support they received during their NICU stay was recorded. This included duration of RAM use, whether intubation was required after RAM initiation, and postmenstrual age (PMA) of when each infant was weaned off CPAP and when transitioned to room air. BPD was defined as requiring supplemental oxygen at 36 weeks PMA. Data was analyzed using chi-square and one-way ANOVA.

Results: A total of 246 neonates were evaluated, and of these 39% (n=96) were administered CPAP/NIPPV via RAM nasal cannula. There was no significant difference in gender (p=0.20), gestational age (p=0.21), or birthweight (p=0.45) between RAM vs. non-RAM groups. Mean PMA at room air of the subjects that used RAM was 37.02 (±4.61). Of the subjects that did not use RAM (n=150), the average PMA at room air was 33.87 (±2.89). Mean PMA off CPAP in the RAM vs. non-RAM group was 32.90 and 31.49, respectively (p < 0.001). There was a significant difference in the odds of developing BPD between neonates who used RAM compared to those who did not (OR = 4.35, 95% CI [2.478, 7.639]). With the use of RAM, subjects were more likely to develop BPD, χ2 (1, n=96) = 27.604, p< 0.001.

Conclusion: In low birthweight infants, administration of CPAP/NIPPV with the RAM nasal cannula is associated with increased rate of bronchopulmonary dysplasia.