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Preterm birth is a major public health concern with an estimated 11% of all live births affected globally. There is a rapid increase in the incidence of preterm births in many industrialized countries in the past decade. Pulmonary surfactant is a phospholipid/ protein complex mixture reducing surface tension at the air-liquid interface in the alveoli. Defective surfactant metabolism can worsen the prognosis for infants born prematurely. Extremely preterm infants appear to have a greater risk of respiratory distress syndrome, leading to a longer duration of mechanical ventilation, which, in turn, increases the risk of bronchopulmonary dysplasia. Bronchopulmonary dysplasia remains the most common adverse outcome of preterm birth. Early exogenous-surfactant administration plays a pivotal role in the management of preterm infants with respiratory distress syndrome, reducing morbidity and mortality. This literature review summarizes current knowledge on the physiological effects of pulmonary surfactant, its composition, and various routes of administration. This systematic review describes the most common method of surface-active agent administration – INSURE, thin catheter techniques, surfactant aerosolization, and surfactant administration via laryngeal or supraglottic airway (SALSA). The literature search was conducted using the following keywords: preterm birth, lasting effects of premature birth, pulmonary surfactant, exogenous surfactant, preterm infants, bronchopulmonary dysplasia. A detailed systematic analysis of current domestic and international literature on surfactant use was conducted. A total of 64 scientific publications were selected for analysis. Databases of eLibrary, Scopus, PubMed, and MEDLINE were used.