{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T20:04:21Z","timestamp":1790193861276,"version":"4.1.0"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"11","funder":[{"name":"SSM Cardinal Glennon Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:p>\n            Objective\u2003Early bubble continuous positive airway pressure (bCPAP) in the delivery room (DR) reduces early intubation, mechanical ventilation, and bronchopulmonary dysplasia. The RAM cannula, adopted for ease of patient care, is a high resistance nasal interface that, when used with bCPAP, only transmits a portion of set pressures and attenuates the bubble effects. This study aimed to review early bCPAP pressures and bCPAP failure with the RAM cannula interface over a 6-year period.<\/jats:p><jats:p>\n            Study Design\u2003Retrospective, single-center study of infants delivered &lt;1,250\u2009g from 2013 to 2018 (n\u2009=\u2009735) begun on bCPAP in the DR with the RAM cannula. In vitro testing of bCPAP pressure transmission was also performed for multiple nasal interfaces and nasal occlusion percentages.<\/jats:p><jats:p>\n            Results\u2003The percentage of infants intubated in the DR decreased over time (59 to 42%), while the average bCPAP pressure increased from 5.3 to 6.8\u2009cmH2O. A total of 355 infants (48%) were admitted to the neonatal intensive care unit (NICU) from the DR on BCPAP. The failure rate for bCPAP in NICU within 72\u2009hours decreased from 45 to 24% as the maximum CPAP increased from 5.8 to 7.6\u2009cmH2O. Pneumothorax rates did not change. CPAP pressure transmission decreased with all sizes of the RAM cannula.<\/jats:p><jats:p>\n            Conclusion\u2003When utilizing the RAM cannula for bCPAP, higher CPAP levels were associated with decreases in DR intubations and CPAP failure within the first 72\u2009hours. If clinicians choose to use the RAM cannula for bCPAP, they will need higher set pressures to achieve lung inflation and the beneficial oscillatory effect will be diminished.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0040-1710557","type":"journal-article","created":{"date-parts":[[2020,5,23]],"date-time":"2020-05-23T22:31:01Z","timestamp":1590273061000},"page":"1167-1173","source":"Crossref","is-referenced-by-count":15,"title":["Use of the RAM Cannula with Early Bubble Continuous Positive Airway Pressure Requires Higher Pressures: Clinical and In vitro Evaluations"],"prefix":"10.1055","volume":"38","author":[{"given":"Colleen C.","family":"Claassen","sequence":"additional","affiliation":[{"name":"Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9998-3948","authenticated-orcid":false,"given":"Marya L.","family":"Strand","sequence":"additional","affiliation":[{"name":"Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard L.","family":"Williams","sequence":"additional","affiliation":[{"name":"SSM Health Systems, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah H.","family":"Hillman","sequence":"additional","affiliation":[{"name":"Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,5,23]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.siny.2016.02.009","article-title":"Continuous positive airway pressure: physiology and comparison of devices","volume":"21","author":"S Gupta","year":"2016","journal-title":"Semin Fetal Neonatal Med"},{"issue":"24","key":"ref2","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1056\/NEJM197106172842401","article-title":"Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure","volume":"284","author":"G A Gregory","year":"1971","journal-title":"N Engl J Med"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"371","DOI":"10.4187\/respcare.03432","article-title":"Volume oscillations delivered to a lung model using 4 different bubble CPAP systems","volume":"60","author":"J A Poli","year":"2015","journal-title":"Respir Care"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1164\/rccm.200609-1368OC","article-title":"Bubble continuous positive airway pressure enhances lung volume and gas exchange in preterm lambs","volume":"176","author":"J J Pillow","year":"2007","journal-title":"Am J Respir Crit Care Med"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1203\/PDR.0b013e3181f985f0","article-title":"Effective gas exchange in paralyzed juvenile rabbits using simple, inexpensive respiratory support devices","volume":"68","author":"R M Diblasi","year":"2010","journal-title":"Pediatr Res"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"F343","DOI":"10.1136\/adc.2004.062588","article-title":"Nasal continuous positive airway pressure: does bubbling improve gas exchange?","volume":"90","author":"C J Morley","year":"2005","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1159\/000493156","article-title":"Comparison of bubble CPAP devices using RAM cannula for extubation failure in very low birth weight infants: randomized and cohort studies","volume":"115","author":"C C Claassen","year":"2019","journal-title":"Neonatology"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.clp.2018.01.011","article-title":"Preventing continuous positive airway pressure failure: evidence-based and physiologically sound practices from delivery room to the neonatal intensive care unit","volume":"45","author":"C J Wright","year":"2018","journal-title":"Clin Perinatol"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1038\/sj.jp.7210904","article-title":"Early bubble CPAP and outcomes in ELBW preterm infants","volume":"23","author":"V Narendran","year":"2003","journal-title":"J Perinatol"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"f5980","DOI":"10.1136\/bmj.f5980","article-title":"Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis","volume":"347","author":"G M Schm\u00f6lzer","year":"2013","journal-title":"BMJ"},{"issue":"06","key":"ref11","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1164\/rccm.200701-051OC","article-title":"Brief, large tidal volume ventilation initiates lung injury and a systemic response in fetal sheep","volume":"176","author":"N H Hillman","year":"2007","journal-title":"Am J Respir Crit Care Med"},{"issue":"05","key":"ref12","doi-asserted-by":"crossref","first-page":"e1351","DOI":"10.1542\/peds.2013-1880","article-title":"Avoiding endotracheal ventilation to prevent bronchopulmonary dysplasia: a meta-analysis","volume":"132","author":"H S Fischer","year":"2013","journal-title":"Pediatrics"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.jpeds.2016.07.053","article-title":"Neonatal resuscitation with an intact cord: a randomized clinical trial","volume":"178","author":"A Katheria","year":"2016","journal-title":"J Pediatr"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"F535","DOI":"10.1136\/archdischild-2018-315838","article-title":"Assessment of resistance of nasal continuous positive airway pressure interfaces","volume":"104","author":"E A Green","year":"2019","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"01","key":"ref15","first-page":"CD002977","article-title":"Devices and pressure sources for administration of nasal continuous positive airway pressure (NCPAP) in preterm neonates","author":"A G De Paoli","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1002\/ppul.23197","article-title":"Factors influencing delivered mean airway pressure during nasal CPAP with the RAM cannula","volume":"51","author":"J S Gerdes","year":"2016","journal-title":"Pediatr Pulmonol"},{"issue":"08","key":"ref17","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1055\/s-0038-1675330","article-title":"Does the RAM cannula provide continuous positive airway pressure as effectively as the Hudson prongs in preterm neonates?","volume":"36","author":"N Singh","year":"2019","journal-title":"Am J Perinatol"},{"issue":"09","key":"ref18","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1038\/jp.2015.61","article-title":"Neonatal nasal intermittent positive pressure ventilation efficacy and lung pressure transmission","volume":"35","author":"A Mukerji","year":"2015","journal-title":"J Perinatol"},{"issue":"10","key":"ref19","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.4187\/respcare.05978","article-title":"Comparison of interfaces for the delivery of noninvasive respiratory support to low birthweight infants","volume":"63","author":"G S Drescher","year":"2018","journal-title":"Respir Care"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0140-6736(03)13397-1","article-title":"CRIB II: an update of the clinical risk index for babies score","volume":"361","author":"G Parry","year":"2003","journal-title":"Lancet"},{"issue":"03","key":"ref21","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.clp.2019.05.005","article-title":"Is nasal high flow inferior to continuous positive airway pressure for neonates?","volume":"46","author":"K A Hodgson","year":"2019","journal-title":"Clin Perinatol"},{"key":"ref22","first-page":"1","article-title":"A randomized trial comparing the short binasal prong to the RAM cannula for noninvasive ventilation support of preterm infants with respiratory distress syndrome","author":"I K Gokce","year":"2019","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"05","key":"ref23","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1038\/s41372-019-0333-x","article-title":"Tidal volume transmission during non-synchronized nasal intermittent positive pressure ventilation via RAM\u00ae cannula","volume":"39","author":"D N Matlock","year":"2019","journal-title":"J Perinatol"},{"issue":"03","key":"ref24","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.jpeds.2005.04.062","article-title":"Variables associated with the early failure of nasal CPAP in very low birth weight infants","volume":"147","author":"A Ammari","year":"2005","journal-title":"J Pediatr"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1186\/s12887-019-1518-3","article-title":"Prospective observational study of early respiratory management in preterm neonates less than 35\u2009weeks of gestation","volume":"19","author":"F R Moya","year":"2019","journal-title":"BMC Pediatr"},{"issue":"01","key":"ref26","doi-asserted-by":"crossref","first-page":"e20153985","DOI":"10.1542\/peds.2015-3985","article-title":"Incidence and outcome of CPAP failure in preterm infants","volume":"138","author":"P A Dargaville","year":"2016","journal-title":"Pediatrics"},{"issue":"05","key":"ref27","doi-asserted-by":"crossref","first-page":"F343","DOI":"10.1136\/adc.2010.205898","article-title":"Predictors of early nasal CPAP failure and effects of various intubation criteria on the rate of mechanical ventilation in preterm infants of <29 weeks gestational age","volume":"96","author":"H Fuchs","year":"2011","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"03","key":"ref28","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1038\/s41372-017-0009-3","article-title":"Continuous positive airway pressure delivery during less invasive surfactant administration: a physiologic study","volume":"38","author":"G Jourdain","year":"2018","journal-title":"J Perinatol"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0040-1710557.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,24]],"date-time":"2021-08-24T22:47:45Z","timestamp":1629845265000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0040-1710557"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,23]]},"references-count":28,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,8,24]]},"published-print":{"date-parts":[[2021,9]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0040-1710557","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,23]]}}}