AimTo investigate whether Bi-level positive airway pressure (BiPAP), compared with nasal continuous positive airway pressure (CPAP), is a more effective therapeutic strategy in preterm infants 32 weeks. MethodsAll inborn infants between 26(+1) and 32(+6) weeks' gestation, admitted to the neonatal intensive care unit (NICU ) of Tongji Medical Hospital between 1 January, 2010 and 31 December, 2011 (the 2010-2011 cohort or CPAP cohort) and between 1 January, 2012 and 31 December, 2013 (the 2012-2013 cohort or BiPAP cohort), were retrospectively identified. The primary outcome was intubation in infants<72 h of age; secondary outcomes were mortality and the incidence of bronchopulmonary dysplasia (BPD). ResultsThere were 213 in the 2010-2011 cohort and 243 infants in the 2012-2013 cohort. There were fewer infants intubated within the first 72 h of age in the 2012-2013 cohort than in the 2010-2011 cohort (15% vs. 23%, P<0.05). Of the infants who received some form of positive airway pressure, 12/94 (13%) of infants on BiPAP versus 23/74 (31%) on CPAP were subsequently intubated (P<0.01). There was no difference in the incidence of moderate and severe BPD between the two groups (7% vs. 8%, P=0.52). ConclusionsIn this retrospective cohort study, we found BiPAP, compared with CPAP, reduced the need for intubation within the first 72 h of age.