Background: Respiratory distress syndrome is a critical respiratory illness that affects premature newborns and can lead to very severe, unfavorable consequences as a result of hypoxia, Aim: To assess the relationship between Ischemia Modified Albumin (IMA) and the prognosis of RDS in preterm patients, Patients and methods: This was prospective case control study performed on 90 newborn infants in the NICU of Al-Zahra University Hospital, Faculty of Medicine for Girls, and Tala General Hospital in Menoufia governorate from November 2020 to November 2021. Patients were divided into two groups: Preterm group (n=45, GA=36 weeks) and full term group (n=45, GA>36 weeks). They followed up by clinical examination and laboratory investigational study until their outcome either discharge either death. Results: IMA was significantly higher among patients who needed mechanical ventilation. Duration of mechanical ventilation correlated positively with IMA levels, with statistical significance difference. Increased IMA levels were associated with an increased total hospital stay duration. Regarding outcome, IMA levels were significantly higher among patients who died, with a statistically significant difference. At a cut-off value equal to 222.8, IMA had 100% sensitivity and 98.3% specificity to predict a poor outcome for pre-term infants with respiratory distress, Conclusion: Ischemia-modified albumin could be used as a diagnostic modality for respiratory distress syndrome among premature neonates with high reliability and reproducibility. It could also be utilized as a predictor of disease outcome. Key words: Ischemia Modified Albumin; Respiratory Distress Syndrome; Preterm Patients