Inclusion Criteria:  Infants ≥29 weeks gestational age between 0-72 hours of life on CPAP for respiratory support who qualify for the LISA procedure as determined by the primary team using Parkland OPTISURF guidelines  Exclusion Criteria:  Infants requiring intubation prior to surfactant therapy Infants with known severe congenital anomalies (including complex congenital heart disease, airway, and central nervous system anomalies) Infants born to mothers with known opioid addiction or in a methadone treatment program