Background. Meconium aspiration syndrome (MAS) is defined as respiratory distress in a neonate born through meconium-stained amniotic fluid (MSAF) with characteristic radiological changes. Meconium could inactivate endogenous surfactant and decrease the activity of surfactant action and decrease its production. Bolus surfactant therapy will replace endogenous surfactant inactivated by meconium while surfactant lavage has been associated with removal of meconium from the lungs. Objective. To evaluate the effectiveness of surfactant lavage for aterm neonate with meconium aspiration syndrome. Result. Surfactant lavage can decrease mortality and progressive respiratory failure requiring ECMO with RR 0.33 (95% CI 0.11-0.96). There is no significant difference of the occurrence of pneumothorax (RR 0.38 95% CI 0.08-1.90). Side effects of this procedure include desaturation and bradycardia. Conclusion. Surfactant lavage is associated with decrease mortality rate in neonate with MAS. Side effect of this procedure such as hypoxemia and bradycardia are temporary and will resume to normal.