Is Surfactant Treatment at Birth Associated With Severe Bronchopulmonary Dysplasia?

An observational study reviews a contemporary cohort of preterm infants.

Recently, Leif D. Nelin, MD, division chief of neonatology at Nationwide Children’s and a professor of pediatrics at The Ohio State University College of Medicine, and a team of doctors in the Bronchopulmonary Dysplasia (BPD) Collaborative Registry speculated that the use of surfactant treatment in newborns with respiratory distress was associated with an increased risk of developing severe (grade 3) BPD.

Surfactant therapy aims to reduce surface tension in the lungs’ alveoli (air sacs), helping them remain open and improving oxygen exchange. Surfactant is administered directly into the infant’s lungs via an endotracheal tube. The surfactant allows the lungs to expand more easily and reduces the need for mechanical ventilation.

“Surfactants were approved for newborn treatment in the early 1990s. At that time, doctors thought that surfactant would prevent BPD in treated preterm infants,” Dr. Nelin explains. “Today, doctors know that surfactant treatment doesn’t prevent BPD. We also know that some children with BPD experience ongoing respiratory issues and follow-up care is often needed to monitor lung function and overall health.”

In addition, neonatology practice has changed over time with the advent of new less invasive treatments for newborns that serve as alternatives to surfactants or intubation. Dr. Nelin and team wondered if in a contemporary cohort of preterm newborns, who had received these alternative treatments, may experience less severe or no BPD when compared to newborns receiving surfactant treatment. The team developed an observational study using patient data from the BPD Collaborative Registry. The results were recently published in the Journal of Perinatology.

They reviewed records of 971 preterm patients who developed BPD from 18 pediatric hospitals. Of them, 864 (89%) had received surfactant in the first 72 hours of life, and the remainder had not. Infants with BPD who hadn’t received surfactant treatment experienced less severe BPD, while patients who had received surfactant treatment had more severe BPD. In addition, infants who had received two or more doses of surfactant had a greater likelihood of grade 3 BPD.

“These results tell us that the lack of surfactants in preterm infants aren’t the only cause of BPD. Other perinatal factors are clearly very important. However, the receipt of surfactant therapy could be an important biomarker for doctors to use in predicting future lung disease in children,” Dr. Nelin says.

Surfactant treatment is still a safe and necessary treatment for newborns with respiratory distress in the first 72 hours of life to improve lung function. Dr. Nelin stresses that more studies should be done to determine whether less invasive treatments correlate with the development of BPD in the same way as surfactant treatment and to better understand how surfactant treatment can be used to predict future disease. This is a crucial area of research that could significantly impact the care of preterm infants.

Reference:

Mueller C, Shepherd EG, Kielt MJ, Conroy S, Jensen EA, Bamat NA, Panitch H, Levin J, Cuevas MG. Surfactant treatment at birth in a contemporary cohort of preterm infants with bronchopulmonary dysplasia. Journal of Perinatology. Published online July 17, 2024. doi:10.1038/s41372-024-02061-8

Image credit: Nationwide Children’s