Surfactant replacement therapy is currently approved by the United States Food and Drug Administration (FDA) for premature infants with respiratory distress syndrome (RDS) caused by surfactant deficiency due to immaturity. There is strong evidence that surfactant decreases mortality and air leak syndromes in premature infants with RDS. However, surfactant is also used “off-label” for respiratory failure beyond classic RDS. This review discusses current evidence for the use of off-label surfactant therapy for (1) term infants with lung disease such as meconium aspiration syndrome (MAS), pneumonia/sepsis, and congenital diaphragmatic hernia (2) premature infants after 72 h for acute respiratory failure, and (3) the use of surfactant lavage. At last, we briefly describe the use of surfactants for drug delivery and the current evidence on evaluating infants for surfactant deficiency.

表面活性剂替代疗法目前已获得美国食品和药物管理局（FDA）批准，用于治疗因尚未成熟而导致表面活性剂缺乏而导致呼吸窘迫综合征（RDS）的早产儿。有强有力的证据表明表面活性剂可降低患有 RDS 的早产儿的死亡率和漏气综合征。然而，除了经典的 RDS 之外，表面活性剂也被“标签外”用于治疗呼吸衰竭。本综述讨论了使用超适应证表面活性剂疗法治疗 (1) 患有肺病的足月儿，如胎粪吸入综合征 (MAS)、肺炎/败血症和先天性膈疝 (2) 急性发作 72 小时后的早产儿。呼吸衰竭，以及（3）使用表面活性剂灌洗。最后，我们简要描述了表面活性剂在药物输送中的应用以及评估婴儿表面活性剂缺乏的当前证据。