Non invasive positive pressure ventilation that is NIPPV is a widely used respiratory support modality in neonates, particularly in the management of respiratory distress syndrome and during post extubation care. The choice of interface plays a critical role in the effectiveness, safety, and tolerance of NIPPV. . Non invasive positive pressure ventilation is a form of non invasive respiratory support that is a combination of continuous positive airway pressure and intermittent higher pressures which are delivered via a nasal mask or nasal prongs or cannulas. The interfaces used for delivering non invasive ventilation play an important role in avoidance of intubation by determining the reduction in pressures from in the delivery circuit to those transmitted to the patient s airway. Two commonly used interfaces in neonatal care are RAM Cannula and nasal mask .Numerous studies have compared the efficacy of nasal masks versus short binasal prongs and other studies of RAM Cannula versus binasal prongs.

There are only a few studies directly comparing the efficacy of different interfaces for the delivery of NIPPV. There is limited high quality comparative data on the clinical effectiveness and complication rates of RAM Cannula vs nasal mask in neonates receiving NIPPV. This study aims to compare the effectiveness, safety and tolerance of RAM Cannula vs nasal mask in neonates requiring NIPPV, thereby guiding evidence based selection of interfaces in neonatal intensive care units.