Pulmonary surfactants (class)

Surfactants are medicines that replace the natural lung coating that preterm babies may lack. They are given into the windpipe of a baby with breathing trouble. The SUPPORT trial compared giving surfactant early with starting CPAP, and the 2025 European consensus guidelines advise considering early surfactant through a thin catheter, to try to avoid a breathing tube.

Drug
In this atlas

Overview

Technical summary

Drug, level class. The label of a surfactant product describes surfactant as lowering surface tension in the air sacs and keeping them from collapsing, and says the product makes up for the deficiency in preterm infants. The class page holds the European consensus claim (an abstract-level statement) and points to SUPPORT, which compared early intubation and surfactant with CPAP started in the delivery room. Claims about one product or substance sit on that product's page, not here. Other surfactant products (Infasurf, Survanta) are not recorded.

About this drug

Level: Class
Mechanism: Replaces deficient natural pulmonary surfactant, which lowers surface tension in the air sacs and keeps them from collapsing (a surfactant product label).

Claims and evidence

Context Preterm babies with respiratory distress (European consensus guidelines on RDS, 2025 edition)

Recipient: Newborn
Population: Babies with respiratory distress syndrome, as covered by the seventh version of the European Guidelines for the Management of RDS, written by a panel of European neonatologists and an expert perinatal obstetrician from the literature up to mid-2025. The abstract gives no gestational age or birth weight limits.
Care setting: Delivery room and neonatal care in Europe (panel of European neonatologists); the abstract names no settings.
Geography: Europe (the panel's origin; the abstract names no countries)
Life stage: Preterm babies with respiratory distress
Gestational age: Not reported
Postnatal age: Not reported
Follow-up: Not applicable (guidance context)

Eligibility: 1 inclusion criterion; exclusion criteria not stated

Included: Babies with respiratory distress syndrome
Excluded: None stated

Recommendation Guidance Certainty not assessed

The 2025 European consensus guidelines on respiratory distress syndrome say that delivery room protocols should include keeping the baby's temperature normal, trying to promote spontaneous breathing before the cord is clamped, using non-invasive respiratory support where possible and considering early surfactant given through a thin catheter in an attempt to avoid intubation. They add that continuing non-invasive support and judicious use of surfactant by techniques that avoid intubation will help improve outcomes.
Applies to Newborn
- Babies with respiratory distress syndrome, as covered by the seventh version of the European Guidelines for the Management of RDS, written by a panel of European neonatologists and an expert perinatal obstetrician from the literature up to mid-2025. The abstract gives no gestational age or birth weight limits.
- Delivery room and neonatal care in Europe (panel of European neonatologists); the abstract names no settings.
- Europe (the panel's origin; the abstract names no countries)
- Preterm babies with respiratory distress
- Gestational age Not reported
- Postnatal age Not reported
Follow-up Not applicable (guidance context)
Certainty method
Not assessed

Limitations
Only the PubMed abstract was read. The PMC copy of the guideline is CC BY-NC and was not used; a later 2026 PubMed item with a similar title is a comment with no abstract. The abstract gives no strength of recommendation or certainty grade and no numbers. It says to consider early thin-catheter surfactant, not to give it to every baby. It is a consensus statement of a panel, not a trial.

Last checked
2026-10-15

Next evidence check due
Not scheduled
Sources and citations (2)
1. Supports European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2025
  
  Publication · Neonatology · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2026-03-09 · DOI: 10.1159/000551062 · PMID: 41802129 · PMCID: PMC13038240
  
  Locator
  Abstract, sentences 4 and 5
  
  How it applies
  Delivery room advice and surfactant technique.
  
  Retrieved
  2026-10-15T13:49:21Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  d7ac1165f6c557de74a248cd14b2e816d73b8425613c1517f08c3a4322cc7150
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
2. Background European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2025
  
  Publication · Neonatology · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2026-03-09 · DOI: 10.1159/000551062 · PMID: 41802129 · PMCID: PMC13038240
  
  Locator
  Abstract, sentence 2
  
  How it applies
  Who wrote the guideline and the literature cut-off.
  
  Retrieved
  2026-10-15T13:49:21Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  d7ac1165f6c557de74a248cd14b2e816d73b8425613c1517f08c3a4322cc7150
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

Claim, not a settled fact European consensus (2025): consider early surfactant by thin catheter to avoid intubation: Respiratory distress syndrome in preterm babies (Recommended for)
Applies to Newborn
- Babies with respiratory distress syndrome, as covered by the seventh version of the European Guidelines for the Management of RDS, written by a panel of European neonatologists and an expert perinatal obstetrician from the literature up to mid-2025. The abstract gives no gestational age or birth weight limits.
- Delivery room and neonatal care in Europe (panel of European neonatologists); the abstract names no settings.
- Europe (the panel's origin; the abstract names no countries)
- Preterm babies with respiratory distress
- Gestational age Not reported
- Postnatal age Not reported
Follow-up Not applicable (guidance context)
The 2025 European consensus guidelines on respiratory distress syndrome say that delivery room protocols should include keeping the baby's temperature normal, trying to promote spontaneous breathing before the cord is clamped, using non-invasive respiratory support where possible and considering early surfactant given through a thin catheter in an attempt to avoid intubation. They add that continuing non-invasive support and judicious use of surfactant by techniques that avoid intubation will help improve outcomes.
Limitations. Only the PubMed abstract was read. The PMC copy of the guideline is CC BY-NC and was not used; a later 2026 PubMed item with a similar title is a comment with no abstract. The abstract gives no strength of recommendation or certainty grade and no numbers. It says to consider early thin-catheter surfactant, not to give it to every baby. It is a consensus statement of a panel, not a trial.

Record details

Record id: maternal:pulmonary-surfactants
Content hash: 2b4ebe8fdb34997a48570993f8ef9d532ca0fea8fbd24bc0b3fe6b6c65c311a0