Background The early administration of continuous positive airway pressure (CPAP) has been shown to benefit infants with respiratory distress syndrome (RDS). Historically, in our unit, all spontaneously breathing infants with RDS receive early CPAP, beginning from birth and receive rescue surfactant if required. Prophylactic surfactant therapy has been shown to reduce mortality and air leaks. Prophylactic surfactant, given ⩽30 minutes of birth, with immediate extubation to CPAP was initiated in our unit from September 2005.

Objective The aim of this retrospective cohort study was to evaluate whether this change in treatment strategy resulted in improved outcomes.

Methods Medical records of <29-week gestation infants born between 1 October 2004 and 30 September 2006 were reviewed for timing of surfactant, need and duration of ventilation, oxygen requirement, air leaks, chronic lung disease and mortality.

Results 78 infants meeting the study criteria were identified and relevant data were extracted and analysed. 40 infants receiving prophylactic surfactant comprised the study group, with the remaining 38 infants forming the control group. The baseline characteristics in the two groups were comparable. Significant reduction in air leaks was observed in the study group compared with controls (5% vs 24%, respectively, p = 0.02). No differences were noted in the incidence of chronic lung disease, length of hospital stay or mortality rate.

Conclusion In our population of <29-week gestation infants treated with early CPAP, administration of prophylactic surfactant significantly reduced the incidence of air leaks. However, it did not appear to offer any additional advantage.