A number of alternatives to intratracheal administration of surfactant have been evaluated in clinical trials.25–32 These include use of aerosolized surfactant preparations, laryngeal mask airway-aided delivery of surfactant, instillation of pharyngeal surfactant, and administration of surfactant using thin intratracheal catheters. Theoretically, each of these methods could allow administration of surfactant without intubation in spontaneously breathing infants. In a recent study, Göpel et al25 randomized 220 preterm infants born at 26 to 28 weeks’ gestation to receive either surfactant administered via a thin plastic catheter (using laryngoscopy) or surfactant administered as a rescue therapy. All infants were maintained on CPAP. The administration of surfactant through a thin plastic catheter significantly reduced the need for mechanical ventilation and decreased the need for oxygen therapy at 28 days. More data are needed to recommend any of the alternative techniques for surfactant administration.