We have a 32 week gestation 1.6kg baby referred from another hospital at 60 hours of age. No antenatal steroids given. CXR on day 1 and 2 show established RDS. On arrival, baby on SIMV 24/5 rate 50/minute Ti 0.35 FiO2 60%. Would you suggest surfactant administration at this age? Cost of surfactant is a big issue and I would give only if it is likely to be beneficial. Please opine.

Despite the fact that we can use surfactant as we need to, we would most likely not admin surf at this late stage. In addition, the baby has a relatively long gestational age. I'd suggest your management is focused on gentle ventilation and weaning.

prophylactic within 15 min

early within 2h

late till 2days