Comparison of Three Non-invasive Ventilation Interfaces in Preterm and Term Neonates: A Retrospective Cohort Study

Non-invasive ventilation (NIV) is the primary mode of support for neonatal respiratory distress; however, nasal injury remains a frequent complication. The optimal interface strategy for minimizing nasal injury while maintaining respiratory efficacy remains uncertain. This retrospective cohort study of 187 neonates compared three interface strategies: nasal prongs (n = 63), nasal mask (n = 61), and an alternating prongs/mask protocol (n = 63). Primary outcomes included NIV failure and nasal injury severity. NIV failure rates were comparable across groups (p = 0.72); however, the alternating group demonstrated a significant reduction in moderate-to-severe nasal injury (9.5%) compared with continuous prongs (23.8%, p = 0.03) and continuous masks (18.0%, p = 0.19). Furthermore, the alternating strategy was associated with significantly improved oxygenation and shorter median durations of continuous positive airway pressure (CPAP) (15 vs. 18 vs. 20 h, p = 0.04). Systematic interface rotation every 2-4 h minimizes iatrogenic injury without compromising efficacy and should be integrated into standard neonatal care.