There are numerous pulmonary conditions in which qualitative or quantitative 
anomalies of the surfactant system have been demonstrated. In premature newborns 
with immature lungs, a functional deficit in surfactant is the main 
physiopathologic mechanism of the neonatal respiratory distress syndrome (RDS). 
Since the landmark pilot study of Fujiwara, published more than 20 years ago, 
the efficacy of exogenous surfactant for the treatment of neonatal RDS has been 
established by numerous controlled studies and meta-analyses. Enlightened by a 
growing insight into both the structure and function of the different surfactant 
components, a new generation of synthetic surfactants has been developed. 
Various complementary approaches have confirmed the fundamental role of the two 
hydrophobic proteins, SP-B and SP-C, in the surfactant system, thus opening the 
way to the design of analogues, either by chemical synthesis or expression in a 
prokaryotic system. An example of these peptide-containing synthetic surfactant 
preparations, lucinactant (Surfaxin), has been recently tested in comparison to 
a synthetic surfactant that does not contain protein as well as to animal 
derived surfactant preparations. Major clinical outcomes between lucinactant and 
animal-derived surfactant preparations were fund similar in two randomized 
controlled trials, opening the way to a new generation of synthetic surfactants 
in the near future.