While rejoicing in the publication of the OSIRIS trial of surfactant therapy for RDS, the largest randomised trial in neonatology so far, we were sorry to see echoed in the results an apparent reluctance to use a cheap and effective intervention designed to prevent the problem in the first place. The results accord with our finding after review of the data obtained in the course of a collaborative trial in the UK Northern Region Health Authority. We refer to the sad fact that only 15-20% of babies had been offered the protective effect of antenatal steroids despite the fact that it is 20 years since the publication of the first trial to show the effectiveness of this treatment.1