The consequences of a preterm birth are usually not secondary to a developmental abnormality but rather due to the immaturity of one or more organ systems. Because neonatal RDS is the most common and the most severe complication of a preterm delivery, a major emphasis has been placed on its prevention and/or treatment. Despite intensive research efforts directed at preventing or inhibiting preterm labor, to date there is no universally effective method that can be used in most patients. As a result, preterm birth will continue to occur and continue to challenge the health care provider. Several medications and hormones have been shown to stimulate endogenous surfactant production in the fetus. Their administration to women at risk of delivering preterm can decrease both the incidence and severity of neonatal RDS. The primary limiting factor with most agents is the need to delay birth for 48 to 72 hours to achieve maximum therapeutic effect. This mandates the obstetric health care provider not only identify parturients who will deliver preterm but also manage their intrapartum course to achieve maximum value from these pharmacologic agents. Lastly, in those patients in whom labor can be neither inhibited nor safely delayed, exogenous surfactant therapy offers real hope particularly to the very low birth weight baby. To obtain maximum benefit in the very premature infant, i.e., less than 30 weeks' gestation, therapy ideally should begin immediately after birth and before the first breath. However, to offer such therapy, patients need to be identified during the intrapartum period.(ABSTRACT TRUNCATED AT 250 WORDS)