The limitations of these data must be understood by HCPs and parents. They include: small sample sizes with wide confidence intervals at 22 and 23 weeks GA, an unknown number of children with one versus multiple impairments, variation in the definition and labelling of NDD by HCPs (especially ‘severe’ versus ‘moderate’) that may not reflect parents’ views or reality, no information on mild or other types of impairment (., behavioural) and the lack of correlation between degree of NDD and QOL  . One example demonstrates such limitations clearly: A child with severe cognitive impairment and severe cerebral palsy and a child with isolated uncorrectable deafness would both be classified as having severe NDD.
In a multicentre RCT with 651 infants, Kendig et al  showed that there was no clinically significant difference in outcome between immediate administration of prophylactic surfactant and administration at 10 min after birth after a brief period of stabilization (evidence level 1b). However, giving the surfactant as soon as possible once stabilization has occurred seems to be important. The open study of infants at high risk of or with respiratory insufficiency – the role of surfactant (OSIRIS)  demonstrated that the combined incidence of death or BPD was reduced by about 11% when surfactant was given at a mean postnatal age of 2 h rather than 3 h (RR=, 95% CI to , evidence level 1b), showing that even fairly short delays in therapy worsen outcomes (evidence level 1b).