Surfactant does not improve survival rate in preterm infants with congenital diaphragmatic hernia☆
Section snippets
Materials and methods
The CDH Study Group is a voluntary collaboration of tertiary referral centers providing care for CDH patients. All live-born infants with CDH who are born at or transferred to a participating center are entered into the database. Data were collected prospectively until death or discharge from the hospital on all live-born patients with CDH starting in 1995 in 82 participating hospitals (appendix). We used data from patients born between January 1995 and December 2002. Information was entered
Results
At the time of this report, there were 2,376 patients entered into the CDH registry from a total of 82 centers. Most centers were in the United States, but information was submitted from 9 other countries. Overall survival rate for all patients was 67%. There were 510 infants less than 37 weeks’ gestation entered in the registry. Eighty patients had a major chromosomal or cardiac anomaly and were excluded from analysis. Information on surfactant use and outcome was available for 424 of the
Discussion
The extent that a primary surfactant deficiency contributes to respiratory failure in the neonate with congenital diaphragmatic hernia remains controversial. Although some studies have suggested surfactant deficiency in humans, others dispute this. No difference was seen in phospholipid and fatty acid composition of phosphatidycholine and phosphatidylglycerol or lecithin to sphingomyelin (L/S) ratios in bronchoalveolar lavage of neonates with CDH when compared with age-matched controls.23
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Supported in part by a grant from the Surgical Section of the American Academy of Pediatrics.
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The following investigators, who assume responsibility for the overall content, prepared this manuscript: Kevin P. Lally, Pamela A. Lally, Max R. Langham, Ronald Hirschl, Fernando R. Moya, Dick Tibboel, and Krisa Van Meurs.