The outcome for newborns with respiratory distress syndrome has significantly improved since introducing surfactant therapy along with the initiation of bi-level positive airway pressure or continuous positive airway pressure. It has not been established yet regarding the best mode of respiratory assistance for pre-term neonates with respiratory distress syndrome. This investigation aims to evaluate the application of bilevel-positive airway pressure as a management approach for preterm newborns who have undergone surfactant therapy and compare it to other commonly used respiratory support methods. Our data suggests a positive trend towards a higher percentage of full-term births and a gradual decrease in preterm births over the evaluated period. This trend highlights notably the significance of surfactant therapy in the care of preterm infants. The use of CPAP has dropped tremendously, while the practice of BiPAP has shown a magnificent upsurge. Preterm newborns who received CPAP had higher levels of measured mean values of carbon dioxide compared to those treated with BIPAP. The lower carbon dioxide values in BIPAP-treated infants suggest that BIPAP may be a more effective form of respiratory support in maintaining proper carbon dioxide levels. In conclusion, the data analysis reveals a noticeable decrease in total newborns and the expansion of the use of BIPAP over CPAP for respiratory support. Our data suggests that BiPAP may be more effective in diminishing the necessity for intubation and the required time of ventilation for preterm newborns with respiratory issues.