Surfactant is a pivotal neonatal drug used both for respiratory distress syndrome due to surfactant deficiency and for more complex surfactant dysfunctions (such as in case of neonatal acute respiratory distress syndrome). Despite its importance, indications for surfactant therapy are often based on oversimplified criteria. Lung biology and modern monitoring provide several diagnostic tools to assess the patient surfactant status and they can be used for a personalized surfactant therapy. This is desirable to improve the efficacy of surfactant treatment and reduce associated costs and side effects. In this review we will discuss these diagnostic tools from a pathophysiological and multi-disciplinary perspective, focusing on the quantitative or qualitative surfactant assays, lung mechanics or aeration measurements, and gas exchange metrics. Their biological and technical characteristics are described with practical information for clinicians. Finally, available evidence-based data are reviewed, and the diagnostic accuracy of the different tools is compared. Lung ultrasound seems the most suitable tool for assessing the surfactant status, while some other promising tests require further research and/or development.

表面活性剂是一种关键的新生儿药物，既可用于治疗由于表面活性剂缺乏而导致的呼吸窘迫综合征，也可用于治疗更复杂的表面活性剂功能障碍（例如新生儿急性呼吸窘迫综合征）。尽管表面活性剂疗法很重要，但其适应症往往基于过于简单化的标准。肺生物学和现代监测提供了多种诊断工具来评估患者的表面活性剂状态，它们可用于个性化的表面活性剂治疗。这对于提高表面活性剂处理的功效并降低相关成本和副作用是有利的。在这篇综述中，我们将从病理生理学和多学科的角度讨论这些诊断工具，重点关注定量或定性表面活性剂测定、肺力学或通气测量以及气体交换指标。它们的生物学和技术特征被描述为临床医生的实用信息。最后，审查现有的循证数据，并比较不同工具的诊断准确性。肺部超声似乎是评估表面活性剂状态的最合适工具，而其他一些有希望的测试需要进一步研究和/或开发。