Clinical Research Directory

Inclusion Criteria: * Gestational age ≤ 35 weeks with 1. Respiratory distress syndrome. 2. Need surfactant administration based on European RDS consensus: (Sweet et al., 2019) 3. If intubation is required as part of stabilization. 4. Clinically presenting with increased work of breathing including (tachypnea, nasal flaring, grunting, retractions, and cyanosis, with decreased air entry on auscultation. 5. Babies who are worsening when FiO2 \>0.30 on CPAP pressure of at least 6 cm H2O to maintain normal saturations. Exclusion Criteria: Preterm neonates with evidence of any of the following will be excluded: 1. Chromosomal anomaly or Congenital heart defect 2. Hemodynamically significant patent ductus arteriosus. 3. Early-onset sepsis or bacterial infection 4. Congenital pneumonia 5. Intra ventricular hemorrhage (IVH) 6. Parenteral refusal to participate.