The letter of Mr Lutchman from Abbott Laboratories South Africa concisely and effectively summarizes 2 of the major issues raised in the discussion of our article. There are indeed several unanswered questions on surfactant replacement therapy. The issues of the different surfactant preparations and of the preparation volume are very interesting ones. Information on surfactant kinetics in humans is scarce, and even less is known on how different exogenous preparations are retained and improve lung function of the preterm infant with respiratory distress syndrome. We speculate that the role of the surfactant proteins, which varies greatly between the available surfactant preparations,2,3  may be proven in future studies to be very important. When addressing the issue of surfactant volume there is even less information, and the issue remains highly speculative. On a purely theoretical ground, the larger the volume, the better the distribution; however, the larger the...

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