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

J Pediatr Surg. 2004 Jun;39(6):829-33. doi: 10.1016/j.jpedsurg.2004.02.011.


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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Bias
  • Female
  • Gestational Age
  • Hernia, Diaphragmatic / drug therapy
  • Hernia, Diaphragmatic / mortality
  • Hernias, Diaphragmatic, Congenital*
  • Hospital Mortality
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Male
  • Patient Discharge / statistics & numerical data
  • Prenatal Diagnosis
  • Pulmonary Surfactants / therapeutic use*
  • Registries
  • Retrospective Studies
  • Survival Analysis
  • Treatment Failure
  • Treatment Outcome


  • Pulmonary Surfactants