Work

Pulmonary comorbidities and response to surfactant in late preterm infants: a multicenter cohort study

Year: 2025

Type: article

Abstract: BACKGROUND: Surfactant (SRT) therapy is well-established for respiratory distress syndrome (RDS) in very preterm infants, but its effectiveness in late preterms (≥ 34 weeks' gestation) is less defined. We evaluated post-SRT oxygenation responses in late preterm infants in relation to pulmonary comorbidities. METHODS: In this multicenter prospective cohort, 350 late preterm infants received SRT according to European RDS guidelines. Pulmonary comorbidities-including persistent pulmonary hypertension (PPHN), meconium aspiration, air leaks, pulmonary hemorrhage, and pneumonia-were documented. Oxygen saturation to inspired oxygen ratios (S/F ratios) were recorded over 48 h. A good response was defined as a ≥ 50% increase in the S/F ratio or an S/F ≥ 428 (SpO₂ ≥90% in room air) at 6 h post-treatment. RESULTS: Sixty-four percent of infants demonstrated a good response; 81% of these maintained sustained improvement. In a mixed-effects model evaluating factors influencing post-SRT improvement in oxygenation, PPHN (p < 0.001) and air leaks (p = 0.001) were significantly associated with less improvement. Meconium aspiration (p = 0.066) and pulmonary hemorrhage (p = 0.100) showed a negative trend, whereas congenital pneumonia showed no association. Responders received SRT earlier than nonresponders (median 7.2 vs. 15.6 h; p = 0.003). CONCLUSION: Surfactant improves oxygenation in late preterm infants, though response depends on timing and comorbidities. Suboptimal response may indicate PPHN. IMPACT: Surfactant therapy improves oxygenation in late preterm infants, but comorbidities such as PPHN and air leaks significantly reduce its effectiveness. Early administration is associated with a better response; treatment delays may contribute to poorer outcomes. Suboptimal response should prompt investigation for underlying conditions. Surfactant use should not be withheld solely based on gestational age.

Source: Pediatric Research

DOI: 10.1038/s41390-025-04634-5