Introduction: Surfactant is vital for the management of preterm babies. However, it is also useful for term babies with severe respiratory distress. Impending shortage of surfactant forced us to be stringent regarding surfactant use during the economic crisis in 2022. Objective: To describe the changes in trends of surfactant usage from 2021-2025 in a Level IIINeonatal Unit in Colombo Sri Lanka. Method: A retrospective study was conducted at the De Soysa Hospital for Women, Colombo between 01.01.2021 to 31.12.2025. Permission was obtained from the head of the institution. The decision to administer surfactant was taken by the consultant neonatologist(CN). An audit form is filled and signed by CN following each dose of surfactant administration. These forms that are archived by the chief pharmacist were used for data collection. Birth data was obtained from the institutional perinatal-mortality-monthly-statistics. The Microsoft Excel for Mac 2023 v16.77 .1 was used for descriptive analysis. Results: Babies requiring surfactant in 2021 and 2022 were 143 and 121 respectively . A sharp decline to 56, 63 and 59 was seen in 2023, 2024 and 2025 respectively . Percentage surfactant use per birth was seen to decline from 1.8 to 1.2 % from 2021-2025. Percentage surfactant use in term babies declined from 29-35% in 2021-2022 to 3% in 2025. Percentage use increased from 42% -78% from 2021-2025 for babies