Little Lungs Study

This clinical trial is being done to evaluate the safety and clinical response of late surfactant treatment with budesonide in extremely preterm infants requiring mechanical ventilation at 7-14 days of age.

Neonate Inclusion Criteria: * Gestational age 22 0/7 to 28 6/7 weeks at birth * Age 7-14 days * Need invasive mechanical ventilatory support and a Fraction of Inspired Oxygen (FiO2) greater than or equal to 0.3 Birthing Parent Inclusion Criteria: * Have a baby who meets neonate eligibility criteria and enrolls in the study. Neonate Exclusion Criteria: * Major congenital anomalies including congenital lung malformations and congenital diaphragmatic hernia and/or genetic disorders * Alternative, acute clinical etiology of respiratory deterioration or increased ventilatory requirements (e.g., sepsis, pneumonia, etc.) * History of pulmonary hemorrhage * Antibiotic use within 48 hours * Indomethacin or Ibuprofen use within 72 hours * Prior treatment with corticosteroids for prevention of lung disease * Not expected to survive for greater than 7 days at enrollment * Determined to be unstable by the clinical team * Enrolled in a conflicting clinical trial * Have a birth parent aged less than 18 years * Parent/guardian is unable to provide parental permission in English or Spanish