Is surfactant therapy beneficial in the treatment of the term newborn infant with congenital diaphragmatic hernia?
OBJECTIVE
To determine the impact of surfactant replacement on survival, need for extracorporeal membrane oxygenation (ECMO), and chronic lung disease in term infants with prenatally diagnosed congenital diaphragmatic hernia (CDH).


METHODS
Prenatally diagnosed infants born at > or =37 weeks' gestation with immediate distress at delivery and no other major congenital anomalies, who were enrolled in the CDH Registry, were analyzed. For univariate analysis, chi 2 tests were used for categoric variables and unpaired t tests for nominal variables. Multiple logistic regression was used to calculate adjusted odds ratios.


RESULTS
Eligible infants (n = 522) were identified. Demographic variables were similar between the surfactant-treated (n = 192) and nonsurfactant-treated (n = 330) groups, with the exception of race (white, 88.0% vs 71.2%; P =.0007). The use of ECMO and incidence of chronic lung disease were higher (59.8 vs 50.6, P =.04; 59.9 vs 47.6, P =.0066) and survival lower in the surfactant-treated cohort (57.3 vs 70.0, P =.0033). Adjusted logistic regression for use of ECMO, survival, and chronic lung disease resulted in odds ratios inconsistent with an improved outcome associated with surfactant use.


CONCLUSIONS
This analysis shows no benefit associated with surfactant therapy for term infants with a prenatal diagnosis of isolated CDH.
Van Meurs
Krisa
K
Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, 750 Welch Road, Palo Alto, CA 94304, USA. vanmeurs@stanford.edu
D001034:Apgar Score; D001723:Birth Rate; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D011296:Prenatal Diagnosis; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012042:Registries; D016019:Survival Analysis; D016896:Treatment Outcome
D011663:Pulmonary Surfactants