A multicenter randomized trial compared the use of high-flow nasal cannula (HFNC) versus nasal CPAP for respiratory support in preterm infants greater than 28 weeks gestation with respiratory distress who had not received surfactant. Treatment failure was defined as an FiO2 greater than 0.4, respiratory acidosis, recurrent apnea or urgent need for intubation and ventilation. Infants placed on HFNC had a higher rate of treatment failure (26%) versus those placed on nasal CPAP (13%). Infants failing HFNC could be placed on rescue CPAP. However the rate of intubation within 72 h ours did not differ significantly between the two groups (16% vs 12%).