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anything sweet him and then it just it fast. I'd like to start by taking Armstrong Medical name together The study day. I've been asked to speak and alternative methods off survival situation and everybody's nose asked to do this on a cool over of the European consent sky. It's a party. So the fact that therapy has been around for some tight it's a 1980. The early trial showed that it was a life saving drug compared with the glands in the eighties, there was researched up, some of it involved in the world. Eternity, which still issue. That's your factor was like saving that the year you treated with right under the during the 19 eighties, it was established. Natural surfactant were superior to send extra fact, it's the studies would shoot prophylactic extracted seem to be better than rescue Surfak. Whenever I was and and see Joe, we were tough with going down into all the reason best of 36 station plantation for proof. Fix it, and the reason that this was because of the time it's was evidence to practice. This is a common of usual to the bottom. You can see all the studies were so funny. Prophylaxis is heard with Ask you if I don't. We've been together a pretty fast Onglyza well to the letter of unity. And you could say, with collection, that little antics. In fact, in the lives I must be in line that during the era of babies that weren't in surfactant, were actually had oxygen and the studies. They were like two grand and get quite before they were rescued with around the 1000. That coin trunk came along and it was a stop stop, it seem probably initiated from birth. I'm going began to question that all babies needed proof Electrified. Several studies were in between 4010, which showed that, if prophylactic fact and compared to nation of steam up, then resurface active. When you put the studies together and that on this list this is published in 2012, you can see the forest for most guys to the of the line of unity. Favoring control are so perhaps, if you using power than in treating with proof of actual factor, they do or heart good. You can see how European guidelines have mold over this time. The first version I live in 2007. We suggest that we should be given prophylaxis. Bactine toe all babies less than 27 extra station By 2010. This has dropped the giving prophylactics packed into toe all these last 26 station and then it switched in 2013 to remove a prolactin sort of factors for recommendations done since yesterday. She use in really rescue sir fact on this away that time since. But you must remember then all these pretty some trials Mr as Blois by the field shoot for by a period of my calculation know that prophylaxis using this method doing more harm than good, but isn't this factor that's causing the problem orders of the ventilation that's causing a problem. But he started, takes floor and show other methods getting so fat in debates, perhaps without extreme too. Yeah, so these methods was the ensure method. That's where you have a baby in treatment. In the bonuses of active, you bag it in and you immediately extra. They're least five rounds control trials comparing insure with 130 kg and you can see if it's called cover from 2000 and seven that there willing to ensure that will reduce the need for mechanical back urination. You juice the instance area and you won't use from the lung disease, which in those days was different this oxygen dependency and 20 s so using ensure comparative fact, better nation reduces the need ventilation. And what about the fact that when you do ensure you actually bag this for a fact in this isn't the interesting study Every term sheet with probably 1997 which excluded effect of a short period control bagging has on the development to pre term sheet on half of them got, you know, bagging brass and the few them didn't bang breast somebody the sort of breaths would be doing. We're doing the job. Asians we actually have to sort of by baby and preoxygenated. And you can see in this diagram here in the left, this's preterm lands were in surfactant. You can see the word by had a response. It is a factor. The ones who were I had almost zero response to serve fact and this was hurts to last. You you were given the surf act before the first president ever buy you have to these term lines. Lungs. Under the preschool, you could see the effect of buying was the love Destroy bread. There is inflammation lettuces meeting. Except so that's a voiding and buy all be a good idea as well. Let me get surfactant. Didn't with using an antibiotic eating chew. Well, yes, there's different ways of fact. Without any tea, there's the parent either. My hair away. If I run a G L D position affected the current, the tree and the last visit of fact in administration me. And then there's a fire that be easier, starting with an N a suite we're all familiar at amazed from resuscitation training out of the finest used to using the stick. Your raise issues with medical, they're raised. The first trial off and on Easter find was published by North of Internally Sylvan Biology in 2005. It's relatively large babies here that he asked people the sugar ever a YouTube issue or after three hours off by a candy see, that is a response to the fire. Then we'll reasoning In 2018 hours a random actual trial from America. Numbers are 100 maybe 28 to 35 weeks gestation. Remember, 12 50 grounds and less in the sticks are sold be required or 30% oaks. And they were randomized. A minister fact introduced to 20 on the outcome of them will have this required preventive issues. That first week you can see over all the AL um, a Surfak did show a significant reduction in any prevent a shin. And if it was more marked in the last two treatments, 28 of the flu next station remember 32 to 34 weeks gestation. So this was sentenced in the signature. This wasn't on, but overall the there. But the thing is that, um, a r about designed for the ties babies, perhaps to spend from the baby's a greater than 12 50 grounds are really a terribly high risk getting ppd. And therefore one would ask why you need to keep these babies off with a ventilation. Actually, don't get it. Do this. So by parent deals, reactant the early animal studies doing that. Just give all this is Officer Factor into the to the up smooth. They really should work. There's I around much human baby, so she's exploring. That's the goal of just putting a global factor and navies Martha Senate's Born Before You Started the Resuscitation. The PA part trial is finished. Recruitment 152 babies at 29. Just it's sitting at pharyngeal, so active CPAP versus seen paddle. Unfortunately, it's not get placement bird meaning themselves just trial just to be very nice to see, get responsible. And then there's this new method of less invasiveness to recommend administration. It's called less invasive because there's no cure chewed on. There's no burning, but you still have to do our own gas for being on with a baby maintained of continuous breathing on CPAP. This this sisters these were on GL see with involved. But this the animal a gist is putting a catheter to babies, a rubber in preparation for slow innovation off surfactant ones, baby in spontaneous breathing. There have been a number of relatively small randomized control pounds, not part of outcomes like bpd. Every when you put them together and metal assists, you can see that the didn't least, uh, other seem to reduce the need from a common combination on you get the same comparative ensure on people Ms and the inflammations factor. You can see that he suspected. It seems to reduce the, um there for me, please. 36 weeks. So leaks that is better than intervention or ensure opportunity preventively done. Reducing of the reason we said is current European guy. Glad's first, he said. For Prolactin is hasn't been stuck in randomized control trials, but some said it's have adopted this method. So this is better from a unit. The ANA, which is 2003. They adopted routine prophylactically sitting on the street Ishan for smallest babies last three weeks and you see come in demented ease of protocols. Right, Smallest, maybe 23. 25 sticks. We just station. They took the survival up to 68% from 42%. In the story of rules, they had less severe. I really itch, and they reduce the combat outcome of death of blown disease. So says that are doing it already are no longer and everybody's and probably we want to recruit babies in trials and it's becoming much more except in the night for people Do do you very released a treatment with using the decent actually based somebody so evidence we see these cool stuff is impossible to be this comfort thing. So this is a full first five, maybe five station. Well, all studies of the immunizations are dramatically unsatisfied. The nebulized simply work good enough on the the fact of just all congested that shipping on these Martha the needle and lungs. But in recent years, the relation technologies and moving on, they know I've been your memory nebulizing, which she won't be able to effectively our our supplies factor. And there have been several clinical trial, which have explored the technique. Rest of these to poke holes that cure it and study from Western Mystery and published in Archives 2000 and 18 to Billy's off 29 to 30 minutes to station using a parody flu nebulizer randomized to receiving Developed is a shin heard with Just See on You could be at the data here set for the babies that was around 40 of them were 29 to 31 weeks. Not my fact agree. More mature infants of 30 to 36 reading the have a reduction in the need for my medication with the I have almost a question. Do we need to keep 32 30. The second babies off the ventilator because he's getting article off Better ET and then very, really a relief from the USA is much larger. Stadium off a little eyes. Call if Actonel for your bones with the spirit of assess At 22 neck use participated. 457 babies were ruled on this. He was designed to see in a population of babies with any kind of already s Oh, really? And gestation Age on. They used a three doses of nephews cold fact and your nebulizer, which, like a dummy in the mouth with nobody's coming out at the end compared with this keeping, then we'll see up on. Then they intubated him. If the uh huh okay, Doctor and afternoon wasn't happy with the tube in with your factor. There was no really fame. Right ear ear used Adams they to steer giving him the ice for a fact. But Indians the patient and then this the they have been 26% 15%. So it was statistically significant action in the need for intubation. But again, one ask the question. Why do we need him? He's relatively sure baby's off medical information using lots of fact. And whenever this prevalence really don't see without much from the adverse effect of any change in what we need is to me that very smallest season tickets, even after this stuff back best yet about the rule of thumb is Asian baby is already s. So current recommendations for European RDS guidance, of course, which they gave me, these are asked, and that'll surfactant should have a policy of a rescue. But there are occasions when it should be given it to every room, such as the baby to require shooting for stabilization. We should give fact, and early in the course of our TS on the testing protocol would be the treaties who are worsening when they're at five AM to exceed 30%. To see our pressure with the six cents said is the preferred is the fact that administration for babies on CPAP by the conditions are experienced. With the technique, we should use a second that sometimes even the third dose of surfactant that there's ongoing efforts. A body yes, is a persistent oxygen departed. Another process of being excluded to the thank you bridge for your attention will be taking questions and the panel discussion after Thank you