Comments This paper proposes a safe and seemingly effective method for the treatmentof severe MAS. However, the apparent benefits over current best practiceshould be taken in the context of the study's limitations.In particular, only a small number of patients were involved and theoutcome of treatment was assessed retrospectively by comparison with historic controls. Furthermore, it is difficult to know to what extent thesignificant improvements reported were the result of the lavage per se,

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... pposed to the residual surfactant. A multicentre randomized controlledtrial is needed to further validate the efficacy of this treatment.