Background: Continuous Positive Airway Pressure (CPAP) is a noninvasive, gentle method of providing respiratory support to spontaneously breathing neonates. Objective: To compare the effectiveness of bubble CPAP (B-CPAP) over conventional CPAP (C-CPAP) in view of improvement in the severity of respiratory distress in preterm neonates with hyaline membrane disease (HMD). Methods: The targeted populations were all preterm and late preterm neonates admitted in neonatal intensive care unit (NICU) with HMD and respiratory distress, requiring noninvasive ventilation. Neonates who met the inclusion criteria were randomly allocated to either B-CPAP or C-CPAP using random table method. CPAP was started at the earliest signs of respiratory distress and postextubation. Result: Respiratory distress was assessed before and after initiation of CPAP based on Downe's score. The decrease in Downes score was statistically significant in the B-CPAP group compared to C-CPAP group. Primary CPAP failure was 23% (7/30) in the B-CPAP group compared to 10% in the C-CPAP group (3/30) (p = 0.16). The number of days on CPAP, oxygen therapy and NICU stay showed no significant difference. Complications of CPAP were not significantly different. Conclusions: B-CPAP is as effective as C-CPAP in improving respiratory distress. However, CPAP failure rates are higher in B-CPAP group with preterm of extreme low birth weight babies (<1000 g). B-CPAP is one of the most effective and economical mode of noninvasive respiratory support for preterm neonates with HMD.