This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. This research is looking at two basic questions: which of two lung treatments used with premature babies is better for the babys lungs;and what is the appropriate level of oxygen in the blood in premature infants. The two lung treatments are CPAP [positive air pressure to help keep the lungs inflated] and intubation, which involves placement of a breathing tube in the infant?s airway with early administration of a medication called surfactant through this breathing tube. Research has shown, regardless of which treatment is used, that all babies who need help with breathing are at risk of developing a type of chronic, or long lasting, lung disease called Bronchopulmonary Dysplasia, or BPD for short. Since 1990 a medication, called surfactant has been available to help premature babies breathe easier, but a tube must be placed in the airway to give this medicine. Oxygen is also used whenever a baby is not able to get enough oxygen into his/her blood by breathing room air. Doctors know that it is important to be sure a baby is getting enough, but not too much oxygen. One possible complication of too much oxygen is an eye disease called ?Retinopathy of Prematurity,? or ?ROP,? that may result in poor vision or even blindness. All of these treatments have been carefully studied and all are used in Newborn ICUs. This is the first study to carefully compare the use of all of these methods starting from the first moments after birth and following the babies until at least 18 months after they would have been born, if they had not been premature. In this study, infants who receive delivery room CPAP and who have specific guidelines for having a breathing tube placed will be compared to infants who have a breathing tube placed and surfactant given in the delivery room or very soon after birth. The study will also compare keeping a lower range [85-89%] or a higher range [91-95%] of oxygen levels in the blood [saturation]. While it is known that higher oxygen ranges are associated with more eye disease, the safest oxygen range is still unknown. We hope to find out if a lower range results in less ROP [Retinopathy of Prematurity].