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ARTICLES: Euming Chong, Jay Greenspan, Sharon Kirkby, Jennifer Culhane, and Kevin Dysart Changing Use of Surfactant Over 6 Years and Its Relationship to Chronic Lung Disease Pediatrics 2008; 0: peds.2007-3193v1-921 [Abstract] [Full text] [PDF]

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Changing incidence of chronic lung disease cannot be attributed to surfactant use alone.

Ambalika Das, Raoul M. Blumberg   (25 November 2008)

Changing incidence of chronic lung disease cannot be attributed to surfactant use alone. 25 November 2008
Ambalika Das, Consultant Neonatologist (Locum) Department of Paediatrics and Neonatology, Whittington Hospital, Magdala Avenue. London N19 5NF, Raoul M. Blumberg Send letter to journal: Re: Changing incidence of chronic lung disease cannot be attributed to surfactant use alone. ambalika.das{at}whittington.nhs.uk Ambalika Das, et al.	Dear Editor, The article by Chong et al attracted our interest as we anticipated it might influence our practice.(1) The main findings of this retrospective data analysis were a decreasing use of surfactant over the study period and an increased incidence of chronic lung disease in the surfactant treated group. As the authors conclude, these findings are difficult to reconcile at face value. We believe that this paper creates misleading generalisations because of missing data and incomplete analysis of sub-groups. We are dismayed that in a study of extremely premature infants of birth weight < 1000g there is no comparative data of the patients who died, nor is any rationale for this omission offered. This exclusion from the analysis makes the validity of the study questionable. We understand that more than 1235 Neonatal Units contribute to the Alere database and acknowledge that part of the strength of such an analysis could lie in the number of infants studied. However, no information is presented regarding the criteria for surfactant administration, the dose of surfactant, ventilation strategies or any indication of the comparative performance of the various neonatal units. Data of neonatal co-morbidities are displayed in Table 3; however details and statistics are inadequate to compare surfactant treated and untreated sub-groups. We believe that patent arterial duct (PDA) has a more direct relevance to the development of chronic lung disease and should be analysed independently of the other co-morbidities.(2) We strongly disagree with the authors’ comment, “It is also concerning that common neonatal morbidities such as PDA, IVH, ROP and sepsis were associated with surfactant use”. These complications are more prevalent in preterm populations of lesser gestation, particularly in the group where clinicians would choose to use surfactant prophylactically. Implying a causative association between these pathologies and surfactant is an over interpretation of available data. Although the authors make brief mention of maternal chorioamnionitis in their concluding paragraph, there is no attempt to analyse this or any other antenatal factors relevant to chronic lung disease. We are uncertain why Figure 5, which graphically displays the relationship of chronic lung disease in the surfactant treated and untreated groups, uses different scales on the ordinates of the Bar charts A and B; this is visually misleading. This study includes a large cohort of infants and we suggest the available data could be analysed more comprehensively, or that more comparable data from a smaller number of neonatal units is examined. References: 1. Chong E et al. Changing use of Surfactant over 6 years and its relationship to Chronic Lung Disease. Pediatrics 2008:122:e917-921 2. Bancalari E. Changes in the pathogenesis and prevention of chronic lung disease of prematurity. Am J Perinatol. 2001; 18(1): 1-9. Conflict of Interest: None declared