Surfactant, mechanical ventilation or CPAP for respiratory management of preterm infants?

Adaptation from in utero to extra-uterine life involves changes in physiology of every organ system. It is a complex process, but most babies born at term gestation have a smooth transition. However, babies born prematurely are different and are at a disadvantage because the changes required for extra-uterine adaptation puts extra demand on them which they may not be able to cope with. Of the physiological processes involved, cardio-respiratory adaptation is the most important and it can be detrimental if the changes after birth do not proceed according to plan. The factors which predispose to cardiopulmonary maladaptation in preterm infants include immaturity of respiratory drive, compliant chest wall and the surfactant deficiency resulting from immature lung development.