Aerosolized surfactant in neonatal respiratory distress syndrome: Phase I study.

•Use of non-invasive respiratory support in the delivery room can avoid the need for intubation in ~50% of preterm infants.•Infants requiring intubation after failure of primary NIV receive delayed surfactant and have higher rates of morbidity.•A combination of early non-invasive respiratory support with early surfactant may lead to further improvement in outcomes.•We have demonstrated the feasibility of administering aerosolized surfactant to spontaneously breathing preterm infants.•These results will inform the design of future trials to identify the most effective strategy for aerosolized surfactant.