We advocate for well-designed preclinical and explanatory clinical studies to investigate the use of surfactant for pediatric (PARDS) and neonatal (NARDS) acute respiratory distress syndrome.

Given the accumulating knowledge on ARDS biology, it is likely that surfactant therapies might be beneficial for PARDS and NARDS.

Moreover, there is wide room for improving these therapies with the addition of drugs enhancing surfactant activity and/or reducing lung inflammation.

It is also likely that previous inconsistent results would have been due to our lack of knowledge and misleading study designs.

This field is an example of how preclinical knowledge can inform the clinical research pathway and how explanatory trials are needed to prevent losing promising therapies.

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