Surfactant Therapy in Congenital Diaphragmatic Hernia and Fetoscopic Endoluminal Tracheal Occlusion

• Published in: The Journal of surgical research Vol. 296; pp. 239 - 248
• Main Authors: Sevilmis, Y. Deniz, Olutoye, Oluyinka O., Peiffer, Sarah, Mehl, Steven C., Belfort, Michael A., Rhee, Christopher J., Garcia-Prats, Joseph A., Vogel, Adam M., Lee, Timothy C., Keswani, Sundeep G., King, Alice
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2024
• Subjects: Congenital diaphragmatic hernia (CDH); Extracorporeal membrane oxygenation (ECMO); Fetal intervention; Fetal surgery; FETO; Fetoscopic endoscopic tracheal occlusion; Surfactant; Congenital diaphragmatic hernia (CDH); Fetal intervention; Extracorporeal membrane oxygenation (ECMO); Fetal surgery; FETO; Surfactant; Fetoscopic endoscopic tracheal occlusion
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2023.12.003

Congenital diaphragmatic hernia (CDH) is a complex pathology with severe pulmonary morbidity. Administration of surfactant in CDH is controversial, and the advent of fetoscopic endoluminal tracheal occlusion (FETO) has added further complexity. While FETO has been shown to improve survival outcomes, there are risks of prematurity and potential surfactant deficiency. We aim to evaluate the characteristics and outcomes of surfactant administration for CDH infants and elucidate potential benefits or risks in this unique population. A single-center retrospective cohort review of patients with unilateral CDH from September 2015 to July 2022 was performed. Demographics, prognostic perinatal imaging features, and outcomes were collected. Patients were stratified by surfactant administration and history of FETO. Data were analyzed with descriptive statistics, two-sample t-tests, chi-squared analyses, and logistic regression. Of 105 included patients, 19 (18%) underwent FETO and 25 (24%) received surfactant. Overall, surfactant recipients were born at earlier gestational ages and lower birthweights regardless of FETO history. Surfactant recipients possessed significantly worse prenatal prognostic features such as observed to expected total fetal lung volume, observed to expected lung to head ratio, and percent liver herniation. In CDH patients without FETO history, surfactant recipients demonstrated worse outcomes than nonrecipients. This association is notably absent in the FETO population, where surfactant recipients have more favorable survival and comparable outcomes. When controlling for defect severity or surfactant usage, as a proxy for respiratory status, surfactant recipients that underwent FETO trended toward improved survival and decreased ECMO use. Surfactant administration is not associated with increased morbidity and mortality and may be beneficial in CDH patients that have undergone FETO. •Surfactant administration is not associated with increased morbidity and mortality and may provide benefit to CDH patients that have undergone fetoscopic endoluminal tracheal occlusion.