This case involves a premature infant delivered by cesarean section. The infants APGAR score was 9-9, but after 12 hours of life the baby became apneic and tachypneic with prominent grunting noticed by the nursing staff. The baby was started on 100% O2 and transferred to the special care nursery. The initial CXR showed coarse interstitial infiltrates consistent with RDS and hyaline membrane disease. Also during this time, an ABG was performed and was categorized as respiratory acidosis. It is important to note that surfactant had not been administered at the time CXR was taken. The patient was given his first dose of surfactant 37 hours after birth and a third CXR now showed a right-sided pneumothorax. It was at this point the first recommendation to transfer to a tertiary care center was discussed. Upon transfer the infant was given 2 additional doses of Survanta and was placed on JET for high frequency ventilation. The patient was noted to have a grade 1 intraventricular hemorrhage which resolved before discharge. Approximately two years later, the patient was admitted due to right arm weakness since birth and was seen by a physician who suggested Cerebral Palsy with possible stroke at birth.