Early Surfactant Administration at FiO₂ >0.25 Under NIPPV for RDS in Very Preterm Infants

Exclusion Criteria

• •1. Invasive mechanical ventilation during delivery or transport to NICU.
• •2. Structural upper airway abnormalities precluding non-invasive ventilation.
• •3. Confirmed diagnosis of major congenital malformations
• •4. Endotracheal intubation for indications unrelated to NRDS (e.g., surgery, sepsis management)
• •5. Initiation of non-invasive ventilation \>3 hours post-birth.
• •6. Voluntary discharge or treatment withdrawal within 72 hours post-enrollment.
• •7. Parental/guardian refusal to Sign informed consent or Authorize surfactant administration
• •8. Incomplete clinical records or missing key outcome variables
• •\-