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On replacing the surfactant.

Ever since it was realized that hyaline membrane disease was the consequence of surfactant deficiency, replacing the missing surface-active alveolar lining layer has been a tantalizing prospect. The report of Fujiwara et al1 is the first demonstration in the human of consistent and dramatic success after a single instillation of an artificial surfactant by way of an endotracheal tube. The prompt restoration of a stable alveolar lining layer and the impressive improvement in blood gases are well documented. The problem of the widely patent ductus producing difficulties in the subsequent days is expected and of course could be approached by other interventions.