Background Though preterm infants frequently receive NCPAP with either nasal prongs or a nasal mask, it is not clear which is more effective.

Objective To determine whether NCPAP given with nasal prongs compared to nasal mask reduces the rate of intubation and ventilation in preterm infants within 72 h of starting therapy.

Design/methods Infants <31 weeks gestation given NCPAP with the Infant Flow Driver or SiPAP (Viasys Healthcare, Yorba Linda CA, USA) were randomised to either nasal prongs or nasal mask. Randomisation was stratified for gestational age (<28 weeks, 28–30 weeks); and according to whether NCPAP was started as a primary treatment for respiratory distress or post-extubation. Infants were intubated and ventilated if they fulfilled two or more of the following criteria within 72 h: worsening signs of respiratory distress; recurrent apnea treated with mask ventilation; FiO2≥0.4 for >30 min; pH<7.2 on 2 blood gases >30 min apart; Pco₂>9 kPa on 2 blood gases >30 mins apart. The groups were treated the same in all other respects. We recorded relevant secondary outcomes and analyzed data using the intention-to-treat principle.

Results We enrolled 120 infants between August 2009 and November 2010 (see table 1). 32/62 (52%) of infants randomised to prongs were intubated <72 h, compared to 16/58 (28%) of those randomised to mask (p=0.007). There were no statistically significant differences in secondary outcomes between the groups (see table 2).

Conclusions NCPAP given via a nasal mask was more effective than NCPAP given via nasal prongs for preventing intubation and ventilation within 72 h of starting therapy.