The key feature of respiratory distress syndrome (RDS) is the insufficient 
production of surfactant in the lungs of preterm infants. As a result, 
researchers have looked into the possibility of surfactant replacement therapy 
as a means of preventing and treating RDS. We sought to identify the role of 
surfactant in the prevention and management of RDS, comparing the various types, 
doses, and modes of administration, and the recent development. A PubMed search 
was carried out up to March 2012 using phrases: surfactant, respiratory distress 
syndrome, protein-containing surfactant, protein-free surfactant, natural 
surfactant, animal-derived surfactant, synthetic surfactant, lucinactant, 
surfaxin, surfactant protein-B, surfactant protein-C.Natural, or animal-derived, 
surfactant is currently the surfactant of choice in comparison to protein-free 
synthetic surfactant. However, it is hoped that the development of 
protein-containing synthetic surfactant, such as lucinactant, will rival the 
efficacy of natural surfactants, but without the risks of their possible side 
effects. Administration techniques have also been developed with nasal 
continuous positive airway pressure (nCPAP) and selective surfactant 
administration now recommended; multiple surfactant doses have also reported 
better outcomes. An aerosolised form of surfactant is being trialled in the hope 
that surfactant can be administered in a non-invasive way. Overall, the 
advancement, concerning the structure of surfactant and its mode of 
administration, offers an encouraging future in the management of RDS.