Surfactant is a complex mixture of phospholipids, proteins, and neutral lipids produced by alveolar type II cells. Surfactant deficiency contributes to the pathophysiology of respiratory distress syndrome (RDS) in premature infants. Surfactant therapy reduces death and bronchopulmonary dysplasia in premature infants with RDS. In infants requiring mechanical ventilation for RDS, surfactant should be administered early, and more than one dose is occasionally required. Surfactant is cost-effective in developing countries, but it is also essential to optimize the use of antenatal steroids, continuous positive airway pressure (CPAP)/ventilatory management, and overall supportive care in order to observe the benefits of surfactant and improve outcomes.