Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Outcomes associated with surfactant in more mature and larger premature infants with respiratory distress syndrome

Journal of Perinatology volume 40, pages 1171–1177 (2020)Cite this article

Subjects

Abstract

Objective

Examine the effect of off-label surfactant on mortality and morbidity in more mature and larger premature infants diagnosed with respiratory distress syndrome (RDS).

Study design

Cohort study of premature infants born at 30–36 weeks, birth weight > 2 kg, and a diagnosis of RDS. We compared the odds of mortality and morbidity between infants who were exposed vs unexposed to surfactant. We used a treatment effects model to balance covariates between groups.

Results

Of 54,964 included infants, 25,278 (46%) were exposed to surfactant. The frequency of mortality and morbidities were higher in the exposed group in unadjusted analyses. Following adjustment with a doubly robust treatment effects model, we found no significant treatment effect of surfactant on mortality or morbidity.

Conclusion

Surfactant exposure is not associated with reduced or increased mortality or morbidity in more mature premature infants with RDS.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010;126:443–56.

    Article  Google Scholar 

  2. Hibbard JU, Wilkins I, Sun L, Gregory K, Haberman S, Hoffman M, et al. Respiratory morbidity in late preterm births. JAMA. 2010;304:419–25.

    Article  CAS  Google Scholar 

  3. Polin RA, Carlo WA. Surfactant replacement therapy for preterm and term neonates with respiratory distress. Pediatrics. 2014;133:156–63.

    Article  Google Scholar 

  4. Jobe AH. The new bronchopulmonary dysplasia. Curr Opin Pediatr. 2011;23:167–72.

    Article  Google Scholar 

  5. AbbVie, Inc. Survanta [package label] AbbVie Inc, North Chicago, IL; 2013.

  6. ONY, Inc. Infasurf [package label] ONY, Inc, Amherst, NY; 2011.

  7. Chiesi Farmaceutici. Curosurf [package label] Chiesi Farmaceutici, Parma, Italy; 2014.

  8. Koivisto M, Marttila R, Kurkinen-Raty M, Saarela T, Pokela ML, Jouppila P, et al. Changing incidence and outcome of infants with respiratory distress syndrome in the 1990s: a population-based survey. Acta Paediatr. 2004;93:177–84.

    Article  CAS  Google Scholar 

  9. Bhat R, Dziedzic K, Bhutani VK, Vidyasagar D. Effect of single dose surfactant on pulmonary function. Crit Care Med. 1990;18:590–5.

    Article  CAS  Google Scholar 

  10. Couser RJ, Ferrara TB, Ebert J, Hoekstra RE, Fangman JJ. Effects of exogenous surfactant therapy on dynamic compliance during mechanical breathing in preterm infants with hyaline membrane disease. J Pediatr. 1990;116:119–24.

    Article  CAS  Google Scholar 

  11. Gitlin JD, Soll RF, Parad RB, Horbar JD, Feldman HA, Lucey JF, et al. Randomized controlled trial of exogenous surfactant for the treatment of hyaline membrane disease. Pediatrics. 1987;79:31–7.

    CAS  PubMed  Google Scholar 

  12. Soll RF. Prophylactic natural surfactant extract for preventing morbidity and mortality in preterm infants. Cochrane database Syst Rev. 2000;2:Cd000511.

    Google Scholar 

  13. Suresh GK, Soll RF. Overview of surfactant replacement trials. J Perinatol. 2005;25 Suppl 2 :S40–4.

    Article  CAS  Google Scholar 

  14. Taylor G, Jackson W, Hornik CP, Koss A, Mantena S, Homsley K, et al. Surfactant administration in preterm infants: drug development opportunities. J Pediatr. 2019;208:163–8.

  15. Spitzer AR, Ellsbury DL, Handler D, Clark RH. The Pediatrix BabySteps Data Warehouse and the Pediatrix QualitySteps improvement project system–tools for “meaningful use” in continuous quality improvement. Clin Perinatol. 2010;37:49–70.

    Article  Google Scholar 

  16. Trembath A, Hornik CP, Clark R, Smith PB, Daniels J, Laughon M. Comparative effectiveness of surfactant preparations in premature infants. J Pediatr. 2013;163:955–60.e1.

    Article  CAS  Google Scholar 

  17. Soll RF, Blanco F. Natural surfactant extract versus synthetic surfactant for neonatal respiratory distress syndrome. Cochrane Database Syst Rev. 2001;2:Cd000144.

    Google Scholar 

  18. Yost CC, Soll RF. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev. 2000;2:Cd001456.

    Google Scholar 

  19. Soll R, Ozek E. Multiple versus single doses of exogenous surfactant for the prevention or treatment of neonatal respiratory distress syndrome. Cochrane Database Syst Rev. 2009;1:Cd000141.

    Google Scholar 

  20. Abdel-Latif ME, Osborn DA. Nebulised surfactant in preterm infants with or at risk of respiratory distress syndrome. Cochrane Database Syst Rev. 2012;10:Cd008310.

    PubMed  Google Scholar 

  21. Minocchieri S, Berry CA, Pillow JJ. Nebulised surfactant to reduce severity of respiratory distress: a blinded, parallel, randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2019;104:F313–9.

    Article  Google Scholar 

  22. Sood BG, Cortez J, Kolli M, Sharma A, Delaney-Black V, Chen X. Aerosolized surfactant in neonatal respiratory distress syndrome: phase I study. Early Hum Dev. 2019;134:19–25.

    Article  CAS  Google Scholar 

  23. Ballard RA, Keller RL, Black DM, Ballard PL, Merrill JD, Eichenwald EC, et al. Randomized trial of late surfactant treatment in ventilated preterm infants receiving inhaled nitric oxide. J Pediatr. 2016;168:23–9.e4.

    Article  CAS  Google Scholar 

  24. Laughon M, Bose C, Moya F, Aschner J, Donn SM, Morabito C, et al. A pilot randomized, controlled trial of later treatment with a peptide-containing, synthetic surfactant for the prevention of bronchopulmonary dysplasia. Pediatrics. 2009;123:89–96.

    Article  Google Scholar 

  25. Dani C, Mosca F, Vento G, Tagliabue P, Picone S, Lista G, et al. Effects of surfactant treatment in late preterm infants with respiratory distress syndrome. J Matern Fetal Neonatal Med. 2018;31:1259–66.

  26. Surmeli-Onay O, Korkmaz A, Yigit S, Yurdakok M. Surfactant therapy in late preterm infants: respiratory distress syndrome and beyond. Turk J Pediatr. 2012;54:239–46.

    PubMed  Google Scholar 

  27. Wang H, Gao X, Liu C, Yan C, Lin X, Dong Y, et al. Surfactant reduced the mortality of neonates with birth weight 1500g and hypoxemic respiratory failure: a survey from an emerging NICU network. J Perinatol. 2017;37:645–51.

  28. Saccone G, Berghella V. Antenatal corticosteroids for maturity of term or near term fetuses: systematic review and meta-analysis of randomized controlled trials. BMJ. 2016;355:i5044.

    Article  Google Scholar 

  29. Wang C, Guo L, Chi C, Wang X, Guo L, Wang W, et al. Mechanical ventilation modes for respiratory distress syndrome in infants: a systematic review and network meta-analysis. Crit Care. 2015;19:108.

    Article  Google Scholar 

  30. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome—2016 Update. Neonatology. 2017;111:107–25.

    Article  CAS  Google Scholar 

  31. Schmolzer GM, Kumar M, Pichler G, Aziz K, O'Reilly M, Cheung PY. Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis. BMJ. 2013;347:f5980.

    Article  Google Scholar 

  32. Kamath BD, Macguire ER, McClure EM, Goldenberg RL, Jobe AH. Neonatal mortality from respiratory distress syndrome: lessons for low-resource countries. Pediatrics. 2011;127:1139–46.

    Article  Google Scholar 

  33. Konishi M, Fujiwara T, Naito T, Takeuchi Y, Ogawa Y, Inukai K, et al. Surfactant replacement therapy in neonatal respiratory distress syndrome. A multi-centre, randomized clinical trial: comparison of high-versus low-dose of surfactant TA. Eur J Pediatr. 1988;147:20–5.

    Article  CAS  Google Scholar 

  34. Davis DJ, Barrington KJ, Canadian Pediatric Society, Fetus and Newborn Committee. Recommendations for neonatal surfactant therapy. Paediatr Child Health. 2005;10:109–16.

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, School of Medicine, The University of North Carolina at Chapel Hill, 101 Manning Drive, Room N4051, CB #7596, Chapel Hill, NC, 27599, USA

    Wesley Jackson, Genevieve Taylor & Matthew M. Laughon

  2. Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Nicolas A. Bamat

  3. Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA

    Kanecia Zimmerman, Rachel G. Greenberg & Christoph P. Hornik

  4. Duke Clinical Research Institute, Durham, NC, USA

    Kanecia Zimmerman, Rachel G. Greenberg & Christoph P. Hornik

  5. Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL, USA

    Reese Clark

  6. Department of Economics, Clemson University, Clemson, SC, USA

    Daniel K. Benjamin

Authors
  1. Wesley Jackson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Genevieve Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicolas A. Bamat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kanecia Zimmerman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Reese Clark
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniel K. Benjamin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Matthew M. Laughon
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rachel G. Greenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christoph P. Hornik
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

WJ, MML, DKB, and CPH conceived and designed the analysis. WJ and DKB performed the analysis and wrote the first draft of the manuscript. CPH, MML, GT, NAB, KZ, RC, and RGG reviewed and made significant edits to the manuscript.

Corresponding author

Correspondence to Wesley Jackson.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jackson, W., Taylor, G., Bamat, N.A. et al. Outcomes associated with surfactant in more mature and larger premature infants with respiratory distress syndrome. J Perinatol 40, 1171–1177 (2020). https://doi.org/10.1038/s41372-020-0625-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-020-0625-1

Search

Advanced search

Quick links