Surfactant does not improve survival rate in preterm infants with congenital diaphragmatic hernia

Kevin P. Lally, Pamela A. Lally, Max Langham, Ronald Hirschl, Fernando R. Moya, Dick Tibboel, Krisa Van Meurs

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Background Use of exogenous surfactant in congenital diaphragmatic hernia (CDH) patients is routine in many centers. The authors sought to determine the impact of surfactant use in the premature infant with CDH. Methods Data on liveborn infants with CDH from participating institutions were collected prospectively. Surfactant use and timing and outcome data were analyzed retrospectively. The authors evaluated the prenatal diagnosis patients as well. The outcome variable was survival to discharge. Odds ratios with confidence intervals were calculated. Results Five hundred ten infants less than 37 weeks' gestation were entered in the CDH registry. Infants with severe anomalies (n = 80) were excluded. Information on surfactant use was available for 424 patients. Infants receiving surfactant (n = 209) had a greater odds of death than infants not receiving surfactant (n = 215, odds ratio, 2.17, 95% CI: 1.5 to 3.2; P < .01). In prenatally diagnosed infants with immediate distress, there was a trend toward worse survival rates among those receiving surfactant at 1 hour (52 patients) versus those that did not (93 patients; odds ratio, 1.93, 95% CI: 0.96 to 3.9; P < .07). Conclusions Surfactant, as currently used, is associated with a lower survival rate in preterm infants with CDH. The use of surfactant replacement in premature infants with CDH can be recommended only within the context of a randomized clinical trial.

Original languageEnglish (US)
Pages (from-to)829-833
Number of pages5
JournalJournal of Pediatric Surgery
Volume39
Issue number6
DOIs
StatePublished - Jun 1 2004
Externally publishedYes

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Premature Infants
Surface-Active Agents
Survival Rate
Odds Ratio
Congenital Diaphragmatic Hernias
Prenatal Diagnosis
Registries
Randomized Controlled Trials
Confidence Intervals
Pregnancy
Survival

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Surfactant does not improve survival rate in preterm infants with congenital diaphragmatic hernia. / Lally, Kevin P.; Lally, Pamela A.; Langham, Max; Hirschl, Ronald; Moya, Fernando R.; Tibboel, Dick; Van Meurs, Krisa.

In: Journal of Pediatric Surgery, Vol. 39, No. 6, 01.06.2004, p. 829-833.

Research output: Contribution to journalArticle

Lally, Kevin P. ; Lally, Pamela A. ; Langham, Max ; Hirschl, Ronald ; Moya, Fernando R. ; Tibboel, Dick ; Van Meurs, Krisa. / Surfactant does not improve survival rate in preterm infants with congenital diaphragmatic hernia. In: Journal of Pediatric Surgery. 2004 ; Vol. 39, No. 6. pp. 829-833.
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