Raschetti R, et al. - In this prospective, pragmatic, blind, cohort study, researchers identified clinical factors influencing surfactant pool in preterm neonates, as well as, examined its link to continuous positive airway pressure (CPAP) failure. Participants were 125 preterm neonates with respiratory distress syndrome (RDS), from whom gastric aspirates were taken (within the first 6 h of life and before the first feeding). Using postnatal automated lamellar body count based on impedancemetry, without any pre-analytical treatment, they measured surfactant pool. Only gestational age had a significant impact on early postnatal lamellar body count on gastric aspirates in CPAP-treated preterm neonates with RDS. There was no link between lamellar bodies and CPAP failure. As a predictor of CPAP failure, only moderate reliability was offered by the endogenous surfactant pool available early in life.