The suggestion of O'Boyle et al.1 for the need to develop earlier criteria for assisted ventilation in infants with hyaline membrane disease (HMD) is important and deserves further comment. The use of continuous distending pressure (CDP) whether applied as a positive pressure airway (CPAP) or as a negative pressure around the chest (CNP) has significantly improved the prognosis in HMD. Overwhelming support for the use of these measures in every sick infant with HMD comes from a number of centers.2-4

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