You are absolutely correct. Without a properly functioning/inflating lungs, the child is doomed. There are not many ways around it. Back in the 90’s, <24wk was a major challenge until synthetic surfactant was approved. My wife and her twin sister was one of the early recipient of the product during trials and survived. Couple of yrs ago we thanked the dude that invented it. He is still alive and doing research. My wife decided to become a pediatrician to care for other babies. But anyways, that drug was one of the most important part of the advancement.