Background: The meconium aspiration syndrome (MAS) remains as one of the most frequent causes of respiratory distress in term newborns. Nearly half of these patients require mechanical ventilation; in this group mortality rises to 18%. Some studies have suggested that acute oxygenation parameters benefit when surfactant is used.Methods: We designed a multicenter randomized study to evaluate whether in term newborns with severe MAS, the use of natural surfactant reduces the number of days on mechanical ventilation when compared to placebo.Results and conclusions: No significant differences in any of the outcomes measured were evident. The four existing studies combined show a RR 0.70 (IC 95% 0.50-0.97) for extracorporeal membrane oxygenation (ECMO) requirement or death. With this evidence, deviating resources from the National Surfactant Program to treat MAS should be considered in the context of current healthcare priorities.