Abstract Background: To evaluate diluted surfactant lung lavage as a therapy for severe meconium aspiration syndrome. Aim of Study: The aim of this study is to evaluate the efficacy and outcome of lung lavage using diluted surfactant compared to standard protocol for treatment of meconium aspiration syndrome. Patients and Methods: This was a prospective interven-tional study involved 24 patients with severe meconium aspiration syndrome divided into two equal groups one received the standard care in the form of high frequency ventilation and the second group received pulmonary lavage using diluted surfactant in addition to the standard care. Pulmonary lavage was done using of 15ml/kg of surfactant diluted to concentra-tion of 5mg of phospholipids/1ml of 0.9% NaCl divided into four equal aliquots. Results: On comparing both groups patients managed by pulmonary lavage using diluted surfactant showed significant improvement in PCO2 and mean airway pressure occurred 6 hours after lavage while improvement in PO2, oxygenation index and arterial-alveolar oxygen gradient occurred 24 hours after lavage. The duration of mechanical ventilation, oxygen therapy and hospital stay were shorter in the surfactant group. There was no difference between both groups in the incidence of complications, need for ECMO or death. Conclusion: Surfactant lung lavage is a safe and effective therapy for severe meconium aspiration syndrome.