- imminent expected death within 24 hours - specific contraindications to surfactant administration (e.g. known allergy, pneumothorax, pulmonary haemorrhage) - known or suspected pregnancy - stage 4 severe chronic kidney disease or requiring dialysis (i.e., egfr < 30) - liver failure - anticipated transfer to another hospital, which is not a study site within 72 hours. - current participation or participation in another study within the last month that in the opinion of the investigator would prevent enrollment for safety purposes.

- imminent expected death within 24 hours - specific contraindications to surfactant administration (e.g. known allergy, pneumothorax, pulmonary haemorrhage) - known or suspected pregnancy - stage 4 severe chronic kidney disease or requiring dialysis (i.e., egfr < 30) - liver failure - anticipated transfer to another hospital, which is not a study site within 72 hours. - current participation or participation in another study within the last month that in the opinion of the investigator would prevent enrollment for safety purposes.