Other authors have proposed the same approach with endotracheally administered budesonide, vehicled by surfactant [26] . Budesonide inhibits sPLA2 and has been associated with a decrease in the release of sPLA2induced pro-inflammatory cytokines [27] . Surfactant is the cornerstone of iRDS therapy and the sPLA2 inhibition could theoretically protect it, reducing the need for repeated doses and improving the long-term respiratory outcome.