The preterm surfactant-deficient lung is highly susceptible to tissue injury with the initiation of ventilation. The respiratory management of preterm infants in the delivery room may be the key to minimizing acute lung injury and its sequelae, including chronic lung disease. Volume-targeted ventilation, optimization of the alveolar recruitment with positive end-expiratory pressure and prophylaxis with surfactant in infants with small volumes of lung gas and delicate lung tissue might help in limiting acute damage during resuscitation in the delivery room. It is desirable to monitor oxygen saturation and tailor oxygen supplementation when resuscitating premature infants.