Intratracheal Vitamin A Administration With Surfactant for Newborn Respiratory Distress Syndrome

Inclusion Criteria: * 1.Newborn infants with birth weight \>500 gm. * 2.Gestational age \>24 completed weeks. * 3.Intention to manage the infant with non-invasive respiratory support (i.e. no endotracheal tube), where either: 1) the infant is within the first 7 days of life and has never been intubated or has received less than 24 hours of total cumulative intubated respiratory support; 2)the infant is within the first 28 days of life, has been managed with intubated respiratory support for 24 hours or more and is a candidate for extubation followed by non-invasive respiratory support. * 4.No known lethal congenital anomaly or genetic syndromes. * 5.Signed parental informed consent Exclusion Criteria: * 1.Considered non-viable by clinician (decision not to administer effective therapies) * 2.Life-threatening congenital abnormalities including congenital heart disease (excluding patent ductus arteriosis) * 3.Infants known to require surgical treatment * 4.Abnormalities of the upper and lower airways * 5.Neuromuscular disorders * 6.Infants who are \>28 days old and continue to require mechanical ventilation with an endotracheal tube