Group I (Intervention group): Fifty five preterm infants with direct weaning from HFOV (high frequency oscillatory ventilation) to CPAP (continuous positive airway pressure).

Group II (Control group): Fifty five preterm infants with weaning from HFOV (high frequency oscillatory ventilation) to conventional mechanical ventilation (CMV) then to CPAP (continuous positive airway pressure) .

weaning preterm neonates with RDS from HFOV directly to CPAP

Failure of weaning will be considered if the infant develops respiratory distress again requiring re-intubation within 72 hours after extubation due to any of the following:

1. Severe hypercapnia (PaCO2 > 60 mmHg) .

2. Hypoxemia ( PaO2 < 50 mm Hg).

3. Frequent apnea (6 apnea episodes within 6-hour period or 1 apneic episode requiring bag and mask positive pressure ventilation).

   Or escalation of respiratory support as following:

4. Titration of CPAP level out of the assigned range (CPAP pressure > 8 cmH2O).

5. Escalation to an alternate mode of non-invasive respiratoy support such as non-invasive positive pressure ventilation (NIPPV).