OBJECTIVE: To compare the effectiveness of nasal continuous positive airway pressure delivered by Nasal mask versus Nasal prongs with respect to continuous positive airway pressure failure. STUDY DESIGN: Randomized, controlled, open label, trial. SETTING: Tertiary care level III neonatal unit. PARTICIPANTS: 118 preterm infants-gestational age (27 to 34 weeks) requiring nasal continuous positive airway pressure as a primary mode for respiratory distress, who were treated with either nasal mask (n = 61) or nasal prongs (n = 57) as interface. PRIMARY OUTCOME: Need for mechanical ventilation within 72 h of initiating support. RESULTS: Nasal continuous positive airway pressure failure occurred in 8 (13%) of Mask group and 14 (25%) of Prongs group but was statistically not significant (RR 0.53, 95% CI 0.24 to 1.17) (p = 0.15). The rate of pulmonary interstitial emphysema was significantly less in the Mask group (4.9% versus 17.5%; RR 0.28, 95% CI 0.08 to 0.96; p = 0.03). Incidence of moderate nasal trauma (6.5% versus 21%) (p = 0.03) and overall nasal trauma (36% versus 58%) (p = 0.02) were significantly lower in mask group than in the prongs group. CONCLUSIONS: Nasal continuous positive airway pressure with mask as interface is as effective as prongs but causes less nasal trauma and pulmonary interstitial emphysema.

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