Surfactant replacement therapy for preterm and term neonates with respiratory distress

Pediatrics. 2014 Jan;133(1):156-63. doi: 10.1542/peds.2013-3443. Epub 2013 Dec 30.


Respiratory failure secondary to surfactant deficiency is a major cause of morbidity and mortality in preterm infants. Surfactant therapy substantially reduces mortality and respiratory morbidity for this population. Secondary surfactant deficiency also contributes to acute respiratory morbidity in late-preterm and term neonates with meconium aspiration syndrome, pneumonia/sepsis, and perhaps pulmonary hemorrhage; surfactant replacement may be beneficial for these infants. This statement summarizes the evidence regarding indications, administration, formulations, and outcomes for surfactant-replacement therapy. The clinical strategy of intubation, surfactant administration, and extubation to continuous positive airway pressure and the effect of continuous positive airway pressure on outcomes and surfactant use in preterm infants are also reviewed.

Keywords: antenatal steroids; congenital diaphragmatic hernia; meconium aspiration syndrome; neonatal pneumonia; neonatal sepsis; persistent pulmonary hypertension; preterm; pulmonary hemorrhage; respiratory distress syndrome; surfactant; term.

Publication types

  • Practice Guideline

MeSH terms

  • Combined Modality Therapy
  • Continuous Positive Airway Pressure
  • Drug Administration Schedule
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Intubation, Intratracheal
  • Pulmonary Surfactants / therapeutic use*
  • Respiratory Distress Syndrome, Newborn / drug therapy*
  • Respiratory Distress Syndrome, Newborn / therapy
  • Treatment Outcome


  • Pulmonary Surfactants