Extremely preterm infants experienced good comfort with various nasal respiratory support techniques delivered with masks.

Extremely preterm neonates often need ongoing support for chronic pulmonary insufficiency of prematurity.1 The simplest support is continuous positive airway pressure (CPAP). More complex techniques are bilevel positive airway pressure (BiPAP), non-invasive positive pressure ventilation (NIPPV) and non-invasive high-frequency oscillatory ventilation (NHFOV). During BiPAP the patient breathes freely while receiving two pressure levels. NIPPV is conventional, time-cycled, pressure-controlled and usually unsynchronised ventilation. NHFOV comprises oscillations generated by an actively vibrating membrane, with supraphysiologic frequencies and a continuous flow providing constant pressure. These techniques differ in terms of patient-ventilator interaction, pressure levels and waveforms and we investigated if they affected patient comfort.