Objective Nasal trauma is a recognised complication of nasal continuous positive airway pressure (CPAP) therapy. There are different devices for CPAP delivery, but there are no data on the comparison of nasal injuries in controlled clinical trials. This prompted us to compare the incidence and severity of nasal injury on bubble CPAP and infant flow driver (IFD) CPAP.

Methods Preterm infants <30 weeks gestation and/or <1500 g at birth were randomly assigned to IFD or bubble CPAP after extubation. Babies were followed while on CPAP to assess the incidence and severity of nasal injury. Data on all babies were recorded prospectively 6–8 hourly on a nasal injury scoring chart devised for this study. The severity of nasal injury was graded as mild (1–4), moderate (5–8) or severe (⩾9). Data were analysed using SPSS 12.0 software.

Results Records were obtained on 85 infants (IFD 46, bubble CPAP 39). There was no difference in the gestational age (27.7 weeks in IFD vs 27.6 weeks in bubble CPAP) and birth weight (1046 g in IFD vs 1024 g in bubble CPAP) between two study groups. Half of the study infants sustained moderate (31.8%) or severe (24.7%) nasal injuries. This was similar in two groups (54.3% on IFD vs 59.0% on bubble CPAP; p = 0.668). The time of worst nasal injury was also similar in the two study groups (IFD 4.2 ± 3.9 days vs bubble CPAP 4.5 ± 5.1 days, p = 0.813).

Conclusions Nasal trauma was a common occurrence in babies receiving CPAP treatment. The severity and time of worst nasal injury does not appear to be device related. Further intervention is required to reduce its frequency and severity.