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).
Patients requiring oral corticosteroids should be weaned slowly from systemic corticosteroid use after transferring to Advair Diskus. Prednisone reduction can be accomplished by reducing the daily prednisone dose by mg on a weekly basis during therapy with Advair Diskus. Lung function (mean forced expiratory volume in 1 second [FEV 1 ] or morning peak expiratory flow [AM PEF]), beta-agonist use, and asthma symptoms should be carefully monitored during withdrawal of oral corticosteroids. In addition, patients should be observed for signs and symptoms of adrenal insufficiency, such as fatigue, lassitude, weakness, nausea and vomiting, and hypotension.