SRT (Surfactant Replacement Therapy) has changed the course of disease and outcome of RDS. We undertook this study to audit outcome of surfactant therapy for RDS in preterms and study complications contributing to morbidity and mortality. This is a prospective observational study of all cases of RDS receiving SRT from October 2009 to July 2011. Overall incidence of RDS was 21% among preterms, varyimg inversely with gestational maturity. Survival was 71.3% among those who received SRT. Sepsis was the most common co- morbidity (43.5%). Downe score ≥6 at intubation (RR 7.25 ;95%CI 2.43-22.42 ;P<0.0001) and sepsis (RR 1.93 ;95%CI 1.09-3.41 ;P=0.022) were significant predictors of mortality. The survival of those given SRT improved with increasing gestational maturity and birth weight. Sepsis is an important complication and its presence, along with a high RDS score at intubation are significant predictors of mortality.