Preterm newborns are especially vulnerable to lung damage in the hours and days after birth. One of the known causes of bronchopulmonary dysplasia (BPD) in premature newborns is lung injury sustained while on a ventilator. Lung injury could be mitigated by noninvasive respiratory support (NIRS), and the management of NIRS provided early on could affect pulmonary outcomes. This research examined the effects of 3 distinct eras’ worth of shifts in early respiratory support management on the respiratory outcome and complications of preterm newborns over a period of 13 years. There was only 1 research site for this cohort study looked backward in time. Researchers looked back at the records of premature babies born at our hospital between 2007 and 2020 and found that the average gestational age was just 32 weeks. 2007-2009 was period A, 2013-2015 was period B, and 2018-2020 would be period C of the study period (period C). The 3-time intervals were compared based on how they affected the early management of respiratory support. Mortality, bronchopulmonary dysplasia, other serious newborn problems, initial respiratory assistance, and mechanical ventilation duration were assessed. This study included 1,880 clinical records, 358 from Period A, 825 from Period B, and 697 from Period C. Pregnancy-related corticosteroid use increased from 56.1% in period A to 56.7% in period B to 74.0% in period C (P<.001). From Period A’s 65.6% need, Period B’s 40.7% need, and Period C’s 45.9% need for surfactant were achieved. An increase in the use of NIRS was linked to a reduction in newborns requiring invasive mechanical breathing in the first 24 hours of life. From Period A’s 22.9% to Periods B and C’s 36.8% and 45.1% use of NIRS exclusively during hospitalization, the significance level for this rise is incredibly high (P<.001). Period A’s oxygen therapy lasted for 24.3 days, while periods B and C’s oxygen therapy lasted for just 14.4 and 17.2 days, respectively (P<.001). Over the 3 time periods, the incidence of bronchopulmonary dysplasia BPD was 32.4%, 23.9%, and 25.4%, respectively (P<.001). From Period A’s 12.8%, it dropped to Period B’s 7.9% and Period C’s 7.6% (P =.009), all referring to moderate to severe cases of BPD. Pneumothorax, pulmonary hemorrhage, chronic pulmonary hypertension of the infant, surgical necrotizing enterocolitis, intraventricular hemorrhage grades III/IV, and periventricular leukomalacia were not different in any of the time periods. From 2007 to 2020, there was a significant drop in the usage of invasive mechanical ventilation and a rise in the application of NIRS in respiratory treatment. As a result of alterations to the way respiratory support is administered in the early stages of care, the incidence of BPD has decreased, and respiratory outcomes have improved. Researchers’ efforts to lessen lung harm through better respiratory care almost certainly played a role in the positive outcome they saw.