DMH NICU is a 52 bedded, level III NICU. On an average 1000 newborns are admitted to the NICU every year for various clinical conditions. Sixty percent of these admission are out born – referred from nursing homes/NICUs in Pune or other districts within Maharashtra. Two third of admitted neonates have breathing difficulty of which 40% need ventilatory care. The NICU caters to babies born with gestation age ranging from 23 weeks to 44 weeks and the weight ranging from 500 g to 5 Kg. These smaller babies have unique needs and are managed as if they are growing in utero. Gentler care is utmost important for the survival and good quality life of these babies. Breathing difficulty is the primary problem these babies face, and its effective management decides survival as well as the further hospital course. Oxygen is a life saver in breathing related conditions however when it comes to newborn, it can harm the lungs, eyes, and brain. Hence it has to be used judiciously. Gentler ventilation, which is now available with the newer ventilators with advanced technology, help preventing ventilation associated lung trauma thereby faster weaning off the support, minimizing oxygen exposure. This helps in improving survival, preventing morbidities and in reducing the duration and cost of hospital stay. With increasing number of sick and tiny baby referrals, the demand for ventilators is high.