This study is an exploratory randomized controlled trial conducted in the neonatal intensive care unit to compare the safety and efficacy of different cannula with long and narrow tubing interfaces for delivery of non invasive ventilation in preterm neonates. Preterm neonates with birth weight more than 1000 grams who require non invasive ventilation as primary respiratory support will be enrolled after obtaining informed consent. Eligible neonates will be randomized to receive non invasive ventilation using either RAM cannula or Optiflow Junior nasal cannula. Both groups will be managed according to standard NICU protocols.

The primary outcome is non invasive ventilation failure within 72 hours of initiation. Secondary outcomes include treatment failure after 72 hours, effectiveness of pressure delivery, incidence and severity of nasal injury, ease of use of the interface by nursing staff, need for surfactant, complications of prematurity, duration of respiratory support, length of hospital stay, and mortality before discharge. The study aims to generate pilot data comparing two commonly used cannula interfaces and to guide future larger multicenter trials and standardization of interface selection in neonatal intensive care units.