(A) Before treatment, the baby was receiving CPAP with a fractional inspired oxygen concentration (FiO2) of 0.7. The classical radiographic findings showed hypoaerated lungs and air-filled bronchi, indicated by a light lung appearance with a fine granular pattern. (B) After intratracheal exogenous surfactant treatment, bilateral lung aeration improved with a reduction in FiO2 to 0.25. These improvements were reflected by darker lung appearance in the radiograph image. We thank Shoshana Newman-Lindsay and Francis Poulain at the University of California at Davis for providing these radiographic images, which were obtained with written informed consent.