Is surfactant therapy beneficial in the treatment of the term newborn infant with congenital diaphragmatic hernia?

Objectives To determine the impact of surfactant replacement on survival, need for extracorporeal membrane oxygenation (ECMO), and chronic lung disease in tens infants with prenatally diagnosed congenital diaphragmatic hernia (CDH). Study design Prenatally diagnosed infants born at greater than or equal to37 weeks' gestation with immediate distress at delivery and no other major congenital anomalies, who were enrolled in the CDH Registry, were analyzed. For univariate analvsis, 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 terns infants with a prenatal diagnosis of isolated CDH.