Nasopharyngeal Prongs versus RAM Cannula for Delivering Noninvasive Positive Pressure Ventilation: An Open-Label, Randomized Controlled Trial

Abstract

Objective

To compare the efficacy of nasopharyngeal (NP) prongs and RAM cannula in preventing the need for invasive ventilation among preterm neonates receiving noninvasive positive pressure ventilation (NIPPV).

Study design

This was an open-label, randomized controlled trial conducted in the neonatal intensive care unit of a tertiary care hospital in India. A total of 150 neonates born at 28^0/7 to 36^6/7 weeks of gestation who required NIPPV were randomized to receive NIPPV via either NP prongs or a RAM cannula. Randomization was stratified by gestation at birth and timing of support (primary or postextubation). The primary outcome was the proportion of neonates requiring invasive ventilation within 72 hours of randomization. Secondary outcomes included the need for invasive ventilation from 72 hours to 7 days after NIPPV initiation, as well as the incidence of nasal trauma.

Results

Baseline characteristics, including birth weight, gestational age, and respiratory morbidities, were comparable between groups. Invasive ventilation within 72 hours of NIPPV initiation was required in 33% of neonates in the NP prongs group and 28% in the RAM cannula group (relative risk: 1.17, 95% CI: 0.72-1.89; P = .44). No significant interaction was observed between the primary outcome and the stratification variables. The incidence and severity of nasal injury, duration of respiratory support, and other secondary outcomes were also similar across groups.

Conclusions

Among preterm neonates receiving NIPPV, NP prongs and a RAM cannula showed comparable efficacy in preventing the need for invasive ventilation. Further research is warranted to confirm these findings in larger and more diverse populations.

Trial registration

Clinical Trial Registry of India (CTRI/2023/07/055835).