Objective To compare the efficacy and safety of bubble continuous positive airway pressure (CPAP) with infant flow driver (IFD) CPAP for the treatment of respiratory distress syndrome (RDS) in preterm babies following extubation.

Design/Methods Babies 24 to 29 weeks’ gestation, ventilated for RDS were eligible for the study. They were randomly assigned to receive either IFD or bubble CPAP, and stratified according to the duration of initial ventilation (⩽2 weeks or >2 weeks). Study protocol was used for extubation and subsequent management on CPAP. The primary outcome was successful extubation maintained for 72 h. Secondary outcomes included duration of CPAP and complications of prematurity. No crossover was allowed.

Results 140 babies were randomly assigned (71 on bubble CPAP and 69 on IFD). The mean gestational ages were 27.5 weeks versus 27.3 weeks, p = 0.429 for bubble CPAP and IFD, respectively. There was no difference in the proportion of babies (95% CI) achieving successful extubation for 72 h between the two study groups (83 (74–92)% on bubble CPAP vs 72 (62–83)% on IFD; p = 0.130). In babies ventilated for ⩽14 days, extubation failure was significantly lower on bubble CPAP compared with IFD (14.1% vs 28.6%; p = 0.046). Duration of CPAP support was also significantly shorter on bubble CPAP, median (95% CI) 2 (1 to 3) days on bubble CPAP versus 4 (2 to 6) days on IFD; p = 0.031. There were four deaths in the bubble CPAP group and no difference in complications associated with prematurity.

Conclusions Bubble CPAP is as effective as IFD for postextubation management of babies with RDS. Bubble CPAP significantly reduced the duration of CPAP support when compared with IFD CPAP.