Objective To compare the clinical effects of nasal intermittent positive pressure ventilation (NIPPV) and nasal continuous positive airway pressure (NCPAP) on the treatment of different degrees of neonatal respiratory distress syndrome (NRDS) in preterm infants,in order to provide evidence for clinical treatment of NRDS. Methods A randomized, controlled, single-center study was performed on 221 premature infants with NRDS in Liaocheng Women and Children Health Care Hospital from March 2012 to June 2017.And these premature infants were classified into Ⅰ,Ⅱ,Ⅲ,Ⅳ grades according to X-ray results, then randomly assigned to receive NIPPV and NCPAP.Effect and complications were compared between the two groups. Results The effective rates of Ⅱ,Ⅲ grades in NIPPV group were higher than those in NCPAP group(P＜0.05).The proportion of pulmonary surfactant use, mechanical intubation, apnea in the NIPPV group among Ⅱ,Ⅲ grades was significantly lower than those in NCPAP group(P＜0.05).However, no significant differences were found on the incidence of patent ductus arteriosus, intracranial hemorrhage,air leak syndrome between the two groups.There was no significant difference on therapeutic effect of NRDS children among Ⅰ,Ⅱ grades(P>0.05). Conclusions As an initial respiratory support for the treatment of NRDS preterm infants, NIPPV has similar efficacy with in the treatment of I-grade NRDS.In terms of Ⅱ and Ⅲ grade of RDS, NIPPV has an advantage over NCPAP.Neither NIPPV nor NCPAP is effective for Ⅳ grade of NRDS.