* imminent expected death within 24 hours * specific contraindications to surfactant administration (e.g. known allergy, pneumothorax, pulmonary haemorrhage) * known or suspected pregnancy * stage 4 severe chronic kidney disease or requiring dialysis (i.e., egfr \< 30) * liver failure * anticipated transfer to another hospital, which is not a study site within 72 hours. * current participation or participation in another study within the last month that in the opinion of the investigator would prevent enrollment for safety purposes. * consent declined

* imminent expected death within 24 hours * specific contraindications to surfactant administration (e.g. known allergy, pneumothorax, pulmonary haemorrhage) * known or suspected pregnancy * stage 4 severe chronic kidney disease or requiring dialysis (i.e., egfr \< 30) * liver failure * anticipated transfer to another hospital, which is not a study site within 72 hours. * current participation or participation in another study within the last month that in the opinion of the investigator would prevent enrollment for safety purposes. * consent declined

imminent expected death within 24 hours specific contraindications to surfactant administration (e.g. known allergy, pneumothorax, pulmonary haemorrhage) known or suspected pregnancy stage 4 severe chronic kidney disease or requiring dialysis (i.e., egfr < 30) liver failure anticipated transfer to another hospital, which is not a study site within 72 hours. current participation or participation in another study within the last month that in the opinion of the investigator would prevent enrollment for safety purposes. consent declined

imminent expected death within 24 hours specific contraindications to surfactant administration (e.g. known allergy, pneumothorax, pulmonary haemorrhage) known or suspected pregnancy stage 4 severe chronic kidney disease or requiring dialysis (i.e., egfr < 30) liver failure anticipated transfer to another hospital, which is not a study site within 72 hours. current participation or participation in another study within the last month that in the opinion of the investigator would prevent enrollment for safety purposes. consent declined

- imminent expected death within 24 hours - specific contraindications to surfactant administration (e.g. known allergy, pneumothorax, pulmonary haemorrhage) - known or suspected pregnancy - stage 4 severe chronic kidney disease or requiring dialysis (i.e., egfr < 30) - liver failure - anticipated transfer to another hospital, which is not a study site within 72 hours. - current participation or participation in another study within the last month that in the opinion of the investigator would prevent enrollment for safety purposes.

- imminent expected death within 24 hours - specific contraindications to surfactant administration (e.g. known allergy, pneumothorax, pulmonary haemorrhage) - known or suspected pregnancy - stage 4 severe chronic kidney disease or requiring dialysis (i.e., egfr < 30) - liver failure - anticipated transfer to another hospital, which is not a study site within 72 hours. - current participation or participation in another study within the last month that in the opinion of the investigator would prevent enrollment for safety purposes.