AIM(S) & OBJECTIVES: To assess the efficacy and safety of HHHFNC compared with NCPAP for noninvasive respiratory support to neonates in a tertiary care hospital. METHODS: a prospective, unblinded, noncross over study in 70 neonates who required non invasive(HHHFNC OR NCPAP) mode of respiratory support either as primary or secondary(post extubation). Primary outcome was defined as failure if there is a need for intubation within 72hr. RESULTS: There was no difference in early failure for HHHFNC (11/35) vs CPAP (13/35) requiring intubation within first 72 hours of support (χ²=0.254,p =0.615). There was no significant difference found in days of NIV, need for delayed intubation, pneumothorax, sepsis, feed intolerance, , time to full enteral feed, days of oxygen therapy, days of stay, mortality in both groups. But neonates had less nasal trauma in HHHFNC (2/35) vs CPAP (11/35)(p=0.013) and had low mean pain score HHHFNC (2.65±0.96) vs CPAP (4.45±1.01)(p=0.001). HHHFNC(7/35) group had more episodes of apnoea as compared to CPAP(3/35)(p=0.30). CONCLUSION: HHHFNC appears to be as effective as CPAP as non invasive modality of respiratory support in neonates, HHFNC is more comfortable with less nasal trauma.