Surfactant replacement therapy (SRT) by nebulization to spontaneously breathing patients has been regarded as the Holy Grail since surfactant deficiency was first identified as the cause for neonatal respiratory distress syndrome. It avoids neonatal endotracheal intubation, a procedure that is often difficult and occasionally harmful. Unapproved alternatives to endotracheal tube placement for liquid surfactant instillation, such as LISA (thin catheter intubation) and SALSA (supraglottic airway insertion) have significant merit but are still invasive, leaving nebulized SRT as the only truly non-invasive method. In the past 60 years, we have learned much about the potential - and limitations - of nebulized SRT. In this review, we examine the promises and pitfalls of nebulized SRT, discuss what we know about neonatal aerosol drug delivery and recap some of the most recent randomized clinical trials of nebulized SRT. We conclude with a discussion of what is known and the next steps needed if this type of SRT is to become a regular part of clinical care.

自表面活性剂缺乏首次被确定为新生儿呼吸窘迫综合征的原因以来，通过雾化对自主呼吸患者进行表面活性剂替代疗法（SRT）一直被视为圣杯。它避免了新生儿气管插管，这一过程通常很困难，有时甚至有害。用于液体表面活性剂滴注的气管内插管的未经批准的替代方案，例如 LISA（细导管插管）和 SALSA（声门上气道插入）具有显着的优点，但仍然是侵入性的，因此雾化 SRT 是唯一真正的非侵入性方法。在过去 60 年中，我们对雾化 SRT 的潜力和局限性有了很多了解。在这篇综述中，我们探讨了雾化 SRT 的前景和缺陷，讨论了我们对新生儿气雾剂给药的了解，并回顾了雾化 SRT 的一些最新随机临床试验。最后，我们讨论了已知的情况以及如果此类 SRT 成为临床护理的常规部分所需采取的后续步骤。