Background: The present study aimed to determine whether the use of nasal intermittent positive pressure ventilation (NIPPV) during neonatal endotracheal intubation increases the rate of successful intubation without physiological instability during all intubation attempts. Material and Methods: The present study was designed as a prospective, multicenter, randomized, controlled study conducted with neonates undergoing endotracheal intubation. The infants were assigned randomly to either the NIPPV group or the standard care group. The primary outcome was successful intubation without physiological instability (defined as ≥20% decline in the peripheral oxygen saturation [SpO 2] from pre-intubation value or bradycardia with a heart rate of <100 beats per minute) during all intubation attempts. Results: A total of 150 infants were enrolled (75 for the NIPPV group and 75 for the standart-care group). The infants had a mean postmenstrual age of 32.5 weeks and a median weight of 1552 g at the time of intubation. The incidence of successful intubation without physiological instability during all intubation attempts was significantly higher in the NIPPV group (64%) compared to the standard-care group (42.7%) (p = 0.009). This difference was particularly significant when inexperienced practitioners were involved. In the NIPPV group, the rate of bradycardia and severe desaturation was significantly lower, while the lowest SpO 2 level and the lowest heart rate level were significanlty higher. Conclusion: NIPPV during endotracheal intubation increases the incidence of successful intubation without physiological instability during all intubation attempts in neonates, while reducing the rate of hypoxia and bradycardia.