Regular use of surfactant in the treatment of respiratory distress syndrome started in Norwegian neonatal intensive care units in 1992. The authors present the results for the first 70 babies with respiratory distress syndrome who were treated with natural surfactant from 1991 to 1994 at two level II hospitals. Median time of administration dropped from eight hours after birth in 1991 to three hours in 1994. Treatment soon after birth leads to a greater reduction in oxygen requirement. 12 children died, all of them very immature after complicated pregnancies. The total mortality in babies with a birth weight of less than 1,500 grams was 7%. The incidence of severe bronchopulmonary dysplasia was markedly reduced and the total number of days on a ventilator was reduced by 50%. Use of surfactant was not associated with more complications. Severe respiratory distress syndrome should be prevented with antenatal steroids, and treated early postnatally with natural surfactant.