RDS is a common cause of morbidity and mortality in preterm infants, with  severe diseases in smaller and more premature neonates. The objective of respiratory management of preterm infants with  risk of RDS is to maximize survival while minimizing potential adverse effects, such as bronchopulmonary dysplasia (BPD). The 2019 European Consensus Guidelines on the management of RDS recommend the early use of continuous positive airway pressure (CPAP) of at least 6 cm H2O in all babies at risk of RDS who do not need intubation for delivery room stabilization . Early initiation of CPAP potentially reduces the need for mechanical ventilation and surfactant replacement while improving clinical outcomes. RDS management has evolved dramatically over the last decade, almost half of the infants who are started on CPAP fail this therapy and are ultimately intubated . It should be noted that CPAP failure is associated with an increased risk of death and morbidities, including BPD and pneumothorax .Studies have shown that birth weight and male gender are risk factors for CPAP failure . To mitigate CPAP failure, and in parallel with technological advances in the field of neonatal ventilators, different modes of non-invasive ventilation (NIV) have been introduced, with nasal intermittent positive-pressure ventilation (NIPPV) being the most frequently used alternative. Multiple studies have studied CPAP failure but very few studies on NIPPV failure.