nCPAP Versus High-Flow Nasal Cannula in Preterm Infants With RDS

This randomized controlled trial aims to compare the efficacy and safety of nasal continuous positive airway pressure versus high-flow nasal cannula as initial non-invasive respiratory support in preterm infants with respiratory distress syndrome.

Inclusion Criteria: * \- Preterm infants with gestational age 28 to 36 weeks and 6 days * Clinical diagnosis of respiratory distress syndrome * Spontaneous breathing without immediate need for invasive mechanical ventilation * Requirement for non-invasive respiratory support * Written informed consent from parent or legal guardian Exclusion Criteria: * \- Infants requiring immediate endotracheal intubation and mechanical ventilation * Major congenital anomalies affecting the respiratory or cardiovascular systems * Congenital diaphragmatic hernia * Significant congenital heart disease * Severe perinatal asphyxia requiring prolonged resuscitation * Severe hemodynamic instability * Prolonged mechanical ventilation before enrollment