Background: Respiratory distress syndrome (RDS) is a severe problem for premature babies. Non-invasive respiratory support techniques including high-flow nasal cannula (HFNC) and nasal continuous positive airway pressure (nCPAP) are frequently used, although clinical evidence remain insufficient.

Patients and Methods: A randomized controlled trial was conducted involving 100 preterm infants (28–36 weeks gestation) diagnosed with RDS. Patients were randomly assigned to receive either (HFNC; n=50) or (nCPAP; n=50) as primary respiratory support. Primary outcomes included the duration of respiratory support and supplemental oxygen therapy. Secondary outcomes encompassed feeding tolerance, length of hospital stay, complications, and mortality.

Results: Baseline characteristics were comparable between groups. HFNC group demonstrated significantly shorter duration of respiratory support (5.42±2.18 vs 6.87±3.12 days, p=0.045), supplemental oxygen therapy (10.54±4.12 vs 12.98±5.20 days, p=0.030), and hospital stay (8.36±3.63 vs 13.22±5.63 days, p<0.001). Earlier feeding initiation (2.1±0.9 vs 3.5±1.1 days, p=0.030) and faster progression to full feeds (9.2±3.4 vs 11.6±3.8 days, p=0.007) were observed with HFNC. Complication rates were consistently lower in the HFNC group, including nasal trauma (6% vs 16%), pneumonia (4% vs 12%), and bronchopulmonary dysplasia (10% vs 20%), though not statistically significant. Mortality rates were similar (12% vs 18%, p=0.401).

Conclusion: HFNC demonstrated superior outcomes compared to nCPAP in preterm infants with RDS, with significantly shorter respiratory support duration, hospital stay, and improved feeding tolerance while maintaining comparable safety profiles.

Keywords: High-flow nasal cannula, nasal continuous positive airway pressure, preterm infants, respiratory distress syndrome, non-invasive ventilation, feeding tolerance