Background: Preterm infants have a risk of the respiratory distress syndrome (RDS). Helpful effects of high-frequency ventilators have been shown within management of RDS as well as the use of these ventilators as the initial mode of support or as a rescue treatment once failure of standard mechanical ventilation. Objective: This study aimed to compare between the nasal high-frequency oscillatory ventilation (nHFOV) and nasal continuous positive airway pressure (NCPAP) in the treatment of preterm infants with RDS in. Patients and methods: A study included 62 neonates with respiratory distress syndrome and was conducted at neonatal intensive care unit, Pediatrics Department, Zagazig University Hospital. Cases were divided into; group (A) was managed with non-invasive high frequency nasal ventilation and group (B) was managed with nasal continuous positive airway pressure. All cases were subjected to full medical history, clinical assessment, laboratory investigations and Silverman Score for respiratory distress grading. Results: There was statistically non-significant difference between the studied groups regarding occurrence of nasal injury, oxygen supply after study and need for use of surfactant. There was statistically non-significant difference between the studied groups regarding x ray findings before or by the end of the study. There was statistically significant relation between gestational age groups and need for surfactant in NHFV group. Conclusion: Noninvasive high frequency ventilation (NHFV) represent a better primary non-invasive mode than NCPAP in treatment of preterm infants with RDS.