Published online September 29, 2008
PEDIATRICS (doi:10.1542/peds.2007-3193)
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ARTICLE

Changing Use of Surfactant Over 6 Years and Its Relationship to Chronic Lung Disease

Euming Chong, MDa, Jay Greenspan, MDa,b, Sharon Kirkby, MSNc, Jennifer Culhane, PhDd and Kevin Dysart, MDa,b

a Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania
b Nemours Children's Clinic, Alfred I. du Pont Hospital for Children, Wilmington, Delaware
c Alere (formerly ParadigmHealth), Upper Saddle River, New Jersey
d Department of Obstetrics and Gynecology, Drexel Medical College, Philadelphia, Pennsylvania

OBJECTIVES. Our goals were to identify the trend of surfactant use over a 6-year period and to determine whether a relationship exists between the incidence of chronic lung disease in infants born weighing <1000 g who receive surfactant and those who do not.

METHODOLOGY. Data regarding surfactant use, incidence of chronic lung disease, nasal continuous positive airway pressure use and duration, and demographic data were collected from the Alere (formerly ParadigmHealth) database from 2001 to 2006 (n = 3086). Groups were compared by using {chi}2 test, analysis of variance, or Student's t test.

RESULTS. Use of surfactant has decreased over time from 67% in 2001 to 59.9% in 2006. Infants who received surfactant were more likely to develop chronic lung disease. Those who received >1 dose of surfactant were more likely to develop chronic lung disease when compared with infants treated with only 1 dose. Chronic lung disease rates have risen over time from 47.8% in 2001 to 57.8% in 2006. There was no difference in survival between groups.

CONCLUSIONS. Despite the findings that surfactant use decreased during the study period and the rate of chronic lung disease increased, the data do not support a connection. Infants who receive surfactant are more likely to develop chronic lung disease, and chronic lung disease rates are stable in those infants not treated with surfactant. It is concerning, however, that 60% of infants not receiving surfactant developed chronic lung disease.

Key Words: prematurity • morbidity • lung disease • surfactant

Abbreviations: CPAP—continuous positive airway pressure • CLD—chronic lung disease • PDA—patent ductus arteriosus • IVH—intraventricular hemorrhage • ROP—retinopathy of prematurity • SGA—small for gestational age

Accepted Jun 4, 2008.


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eLetters:

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Changing incidence of chronic lung disease cannot be attributed to surfactant use alone.
Ambalika Das, et al.
Pediatrics Online, 25 Nov 2008 [Full text]