Abstract 1910

Background. Lung hypoplasia and hypertension are the landmarks of CDH, but a coexistent SF dysfunction has been described. Nevertheless, only anecdotal reports of exogenous SF therapy in cases of CDH have been published.

Aim. To collect demographic, disease severity, and outcome data on infants with early onset CDH treated with exogenous surfactant in Units of the Collaborative European Surfactant Study Group.

Patients and Methods. Retrospectively, data of a case series of 58 infants with severe CDH treated with SF were obtained from a questionnaire. Three cases with chromosomal anomalies were excluded.

Results. Mean (SD) birth weight and gestational age (GA) were 2,681(860) g, and 37(4) wks. The 38% of babies had a prenatal diagnosed of CDH, and 75% had a left-sided hernia. All babies were intubated and placed on IMV by age 6 hrs. Initial arterial pH=7.16(0.23), PaCO2=63(26)mmHg, PaO2=66(52) mmHg, and median FiO2=1.0 (range 0.25-1.0). Survival at discharge was 37%. First dose of SF 100mg/Kg (range 40-200) was given at a median age of 5 h (range 0-2,928), and at >24 hrs in 15 (27%). Analysis of cases treated with SF at <24 hrs (n=40) showed that, if SF was given from 0-6 hrs, there was a significant increase in a/APO2 from 0.12 (0.09) to 0.18 (0.17). No improvement of oxygenation was seen in babies treated at >6 hrs. Thirteen babies (24%) were born prematurely, but oxygenation response was independent of GA. Survival was associated with birth weight, 1-min Apgar score, level of oxygenation and ventilatory settings before and after surgery.

Conclusion. Early exogenous SF administration may prove to be useful in the management of babies with CDH. A randomized trial of prophylactic SF therapy should be performed.

*European Collaborative Surfactant Study Group: J. Lopez-Heredia, L. Roman, M. Samaniego, X. Krauel, S. Martinez-Santana, J. Martinez-Orgado (Spain), L. Kirchner, B. Urlesberger, H. Zotter (Austria), E. Herting, K. Hanns, L. Schrold, H. Boenisch, C. Speer, K. Walter, P. Groneck (Germany), S. Gothberg, KE. Edberg, L. Bjorklund (Sweden), G. Marraro (Italy), D. Sweet (Northern Ireland), C. Papagaroufalis (Greece), J Dinger, G. Greisen (Denmark), J. Matis, J. Messer, J. Laugier (France), MRG. Carrapato (Portugal), H. Fiori (Brasil).