Background Both prophylactic and early surfactant replacement therapy, reduce mortality and pulmonary complications in ventilated infants with respiratory distress syndrome (RDS). The proper time of surfactant administration constitutes another issue of argument in the literature.

Objective To evaluate the necessity of prophylactic administration of surfactant for the prevention of RDS and the consequences on survival of very premature neonates.

Methods The study enrolled 142 neonates with gestational ages between 25 and 32 weeks. Surfactant of porcine type was administered (200 mg/kg, Curosurf), in less than 20 minutes after birth. A second dose of surfactant was required only for 32/142 (22.5%). Clinical/radiological classification of RDS, oxygenation indexes, needs and duration of FiO₂, duration of mechanical ventilation and hospitalisation and the survival rate were estimated.

Results The duration of mechanical ventilation for neonates who survived (n  =  136/142) was 92.01 ± 47.71 h. The radiological estimation of neonates, 6 h after surfactant administration revealed RDS of 3rd–4th degree in 3/142 neonates. Interestingly, we noticed that one of the above-mentioned neonates incurred chorioamnionitis of its mother and the other two were extremely low birth weight. The oxygenation estimation indexes improved significantly after surfactant administration. New type bronchopulmonary dysplasia was noted in 26 neonates (18.3%). Only six neonates died, three due to intrauterine asphyxia and the other three due to sepsis.

Conclusions Although our study was not designed as a double-blind study due to ethical considerations, it indicates that prophylactic surfactant administration in neonates with gestational age ⩽32 weeks improves morbidity and reduces mortality. These promising results are in accordance with most of recent references.