Back ground :respiratory distress syndrome (RDS) is the most common cause of respiratory failure and requirement for mechanical ventilation (MV) of newborns.L- carnitine is essential for the processes underlying fetal maturation such as surfactant synthesis ,Aim of work: to study the effect of early carnitine supplementation on respiratory, nutritional, hematological parameters in preterm neonates with respiratory distress syndrome,Methodology: This study was conducted on 60 preterm infants 30 – 33weeks of gestation presenting with RDS divided randomly into 2 groups: group A comprised 30 preterm infants who received I.V. L- carnitine at a dose of 30mg/Kg/day until oral intake was established; then it was given orally at the same dose, group B comprised 30 preterm infants who did not receive L-carnitine.Laboratory and radiological investigations were done to confirm RDS,to evaluate and tofollow up growth pattern,hematological,and respiratory outcome in those neonates,Results :L-Carnitine supplementation resulted in significant increase in weight gain ,decreased period of stay on mechanical ventilator and duration of hospital stay as well as improved discharge status in group A ,Conclusion and recommendtions: L-carnitine could be routinely used for preterm neonates suffering from RDS to decrease the needs of mechanical ventilation and oxygen requirements in addition to its role on growth but its role on hematological parameters should be traced in further research work.