Abstract: Background- Early versus delayed initiation of nasal continous positive airway pressure for treatment of respiratory distress syndrome in premature newborns. Aims- The prospective study was aimed to compare between early continuous positive airway pressure and late continuous positive airway pressure in premature newborns in case of respiratory distress syndrome. Methods and Materials- This was a randomized controlled trial where data of 72 preterm neonates with 28-37 weeks were admitted in NICU of Muzaffarnagar Medical College between January 2019- December 2019 were collected and analyzed. Infants were randomly assigned to early CPAP (initiated at half an hour after birth) or to the late CPAP (initiated after half an hour after birth) treatment groups. The primary outcome were need for surfactant administration and need for ventilator support after birth and secondary outcomes was intraventricular haemorrhage and death. Results- There was no significant difference between the two groups with regard to intraventricular haemorrhage and death. But the need for surfactant administration was significantly reduced in the early CPAP group (P=0.04). Infants in the early CPAP group less frequently required mechanical ventilation. Conclusion- Early CPAP is more effective than late CPAP for the treatment of respiratory distress syndrome and can be helpful in reducing the need for some invasive procedures such as intubation and mechanical ventilation.