Introduction: Respiratory distress syndrome (RDS) is often accompanied by low blood pressure and fluctuations in brain perfusion in premature infants. The present study aimed to assess the effectiveness and validity of concurrent cerebral and pulmonary near-infrared spectroscopy (NIRS) monitoring in the management of RDS. Methods: The study included 24 premature infants <34 weeks who were diagnosed with RDS (of the infants, 5 died [RDS non-survivors] and 19 survived [RDS survivors]) and 7 infants <34 weeks without RDS were enrolled. The infants were continuously monitored by cerebral and lung NIRS for the first 72 postnatal hours. Trends of regional pulmonary oxygen saturation (rSO 2L) and cerebral regional tissue oxygenation (rSO 2C) were analyzed. Additionally, rSO 2L values before and after surfactant treatment were compared. Results: In the RDS non-survivors, rSO 2C was significantly lower than that of the control group between the 14 th and 26 th postnatal hours, without any difference in the RDS survivors. Mean rSO 2C in the RDS non-survivors at this period was 66%±8.4. The rSO 2L values after surfactant treatment were significantly higher than that of the pre-administration values (p=0.04) in the RDS survivors, but no difference was observed in the RDS non-survivors. Conclusions: Concurrent cerebral and lung NIRS is a useful adjunct monitoring modality in RDS, especially in predicting short-term outcomes (notably in predicting mortality) and in the management of surfactant treatment and possibly other clinical interventions.