Deficiency of pulmonary surfactant is one of the most important factors contributing to the development of respiratory RDS [1]. In immature lungs, the elevated surface tension resulting from surfactant deficiency leads to alveolar collapse at the end of expiration, atelectasis, uneven inflation and regional alveolar over distension. Improved use of antenatal steroids, labour room CPAP, trial of CPAP before intubation and caffeine have changed the way a preterm baby with RDS is managed in the last decade. Many babies with RDS who used to receive prophylactic or early rescue surfactant are now managed with CPAP alone, others are administered surfactant only if they fail CPAP. But, in this process of trial of CPAP, a few babies receive surfactant as “late rescue” after few hours of trial of CPAP. Objective: To evaluate factors determining long duration of respiratory support (CPAP/ventilation > 120 hours) in VLBW babies in Indian NICU.