Surfactant has traditionally been administered through an endotracheal tube either as bolus, in smaller aliquots,21 or by infusion through an adaptor port on the proximal end of the endotracheal tube.19 In an animal model, administration of surfactant as an intratracheal bolus while disconnected from the mechanical ventilator resulted in more uniform distribution than an infusion administered over 30 minutes through a side-hole adapter.22 However, a small clinical trial of human preterm infants showed no significant differences in clinical outcomes between methods.23 During surfactant administration, reflux into the endotracheal tube occurred more often when the infusion technique was used. Similar clinical outcomes were also found when surfactant was administered as a bolus or as a 1-minute infusion through a side-hole adapter.24 Because data are conflicting and limited, the optimal method of surfactant administration in preterm infants has yet to be clearly proven. Additionally, there is insufficient evidence to recommend the optimal number of fractional doses of surfactant or what body position is best when surfactant is administered.