Elsevier

Journal of Pediatric Surgery

Volume 39, Issue 11, November 2004, Pages 1632-1637
Journal of Pediatric Surgery

Surfactant replacement therapy on ECMO does not improve outcome in neonates with congenital diaphragmatic hernia1

https://doi.org/10.1016/j.jpedsurg.2004.07.005Get rights and content

Abstract

Background purpose

Respiratory failure in neonates with congenital diaphragmatic hernia (CDH) may in part be caused by a primary or secondary surfactant deficiency. Knowledge of the optimal approach to surfactant replacement in neonates with CDH and respiratory failure is limited. The aim of this study was to determine if surfactant replacement on extracorporeal membrane oxygenation (ECMO) results in improved outcomes in neonates ≥35 weeks’ gestation with unrepaired CDH.

Methods

Using the CDH Study Group Registry, the authors identified 448 neonates with CDH who were ≥35 weeks’ gestation, had no major anomalies, were treated with ECMO within the first 7 days of life, and underwent repair on or after ECMO therapy. Patients in 2 groups were compared: group 1 (− Surf, n = 334) consisted of patients who received no surfactant and group 2 (+ Surf, n = 114) consisted of patients who received at least 1 dose of surfactant while on ECMO. An analysis of all patients in both groups was performed. Additionally, subgroup analyses stratified by gestational age were performed for patients 351/7 to 366/7 weeks’ gestation and for patients ≥37 weeks’ gestation. Primary end-points for the study were survival and length of ECMO run. Secondary end-points were length of intubation, need for supplemental oxygen at 30 days of life, and at discharge to home. Demographic, clinical, and outcome variables were examined using Fisher’s Exact tests for categorical variables and using unpaired t tests for continuous variables. Odds ratios were calculated for categorical end-point variables.

Results

Demographic and clinical variables were similar between groups. Analyses of aggregate data showed no significant differences between groups in length of ECMO run, survival, number of days intubated, and percent of patients requiring supplemental oxygen at 30 days or discharge. Subgroup stratification by gestational age did not show significant differences between groups in any of the outcome variables.

Conclusions

The data from this study suggest that surfactant replacement on ECMO for neonates with congenital diaphragmatic hernia does not provide significant benefit in the infant’s clinical course with respect to survival, length of ECMO course, length of intubation, or subsequent need for supplemental oxygen.

Section snippets

Materials and methods

An invitation to contribute to a CDH registry (Appendix) was sent to all ECMO centers and to members of the American Pediatric Surgical Association, the Society for Pediatric Research, and the Perinatal Section of the American Academy of Pediatrics. Centers collected data on all liveborn infants with CDH beginning January 1, 1995. There were 83 centers in North America, Europe, and Australia who participated in the registry. Data were collected until death or discharge from the hospital. These

Demographic and clinical variables

There were no significant differences in demographic variables between the 2 groups. Then mean birth weight, estimated gestational age (EGA), and hours from birth until ECMO cannulation were similar between groups. The percentage of patients who were inborn at an ECMO center, were male, had 1- or 5-minute Apgar scores of ≤3, were prenatally diagnosed, or had a left-sided defect was similar between groups. Subgroup analyses by gestational age found no differences between group 1 (−Surf) and

Discussion

This analysis of CDH Study Group Registry data finds no significant difference in survival, length of ECMO run, days intubated or oxygen use at 30 days, or discharge in surfactant-versus nonsurfactant-treated groups. These results suggest that at least 1 dose of surfactant on ECMO does not afford a significant improvement in any of the outcome measures. We demonstrated in this large, multicenter, retrospective review that the patients in the surfactant-treated and nonsurfactant-treated groups

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    1

    This manuscript was prepared by the following investigators who assume responsibility for the overall content: Christopher E. Colby, Kevin P. Lally, Susan R. Hintz, Pamela A. Lally, Dick Tibboel, Fernando R. Moya, and Krisa P. VanMeurs.

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