Surfactant replacement therapy is one of the most common procedures performed in the neonatal intensive care unit for preterm neonates. Intubate, Surfactant, Extubate is the most commonly used technique, which involves intubation and may result in ventilator associated lung injury. Surfactant administration through laryngeal and supraglottic airways is a newer modality in which a supraglottic airway device is used to deliver surfactant, thus eliminating the need for intubation and its adverse effects. We plan to conduct this randomized control trial with non-inferiority study design. During the study, we anticipate enrolling at least 20 subjects in each group, consisting of preterm neonates with respiratory distress syndrome who receive surfactant through either of the two techniques. The primary outcome is success of surfactant therapy which is defined by the attainment of the following parameters within 60 minutes of administration of surfactant: FiO₂ <0.3, no/minimal retractions and respiratory rate <80 bpm. The Surfactant administration through laryngeal and supraglottic airways is anticipated to be non-inferior to conventional technique, however with certain other benefits like ease of delivery, lesser discomfort and instability of the neonate. The secondary outcome measures will be need for invasive ventilation within 72 hours of surfactant delivery, number of doses of surfactant required, total time taken to perform the procedure, gastric leakage of surfactant, cumulative duration of respiratory support (both invasive and non-invasive) during hospital stay, total duration of the following events during and within 10 minutes after delivery of surfactant - apnea, preductal oxygen saturation <85% and heart rate less than 100 bpm, incidence of pneumothorax, bronchopulmonary dysplasia and intraventricular hemorrhage, Neonatal pain assessment will be done using Neonatal-Pain Agitation and Sedation Scale and proceduralist stress score will be assessed by Likert scale.