Treatment outcomes of surfactant therapy in neonates with lung parenchymal disease-induced persistent pulmonary hypertension of the newborn
Keywords:
Persistent pulmonary hypertension of the newborn, PPHN, SurfactantAbstract
Background: Persistent pulmonary hypertension (PPHN) significantly contributes to morbidity and mortality in the newborn. There is evidence of surfactant deficiency in severe lung diseases that lead to PPHN. Surfactant therapy would decrease the risk of death in neonates with lung parenchymal disease-induced persistent pulmonary hypertension of the newborn.
Objective: To evaluate the treatment outcomes of surfactant therapy in neonates with lung parenchymal disease-induced persistent pulmonary hypertension of the newborn and to determine its association with the mortality
Method: A retrospective study was conducted in neonates born ≥ 34 weeks gestation with lung parenchymal disease-induced moderate to severe persistent pulmonary hypertension of the newborn (oxygenation index ≥ 15) between 1 October 2018 and 30 April 2025. Infants were categorized into surfactant and control groups. The primary outcome was the mortality rate. Chi-square tests and three binary logistic regression models were used.
Result: There were 84 infants in each group. Mortality rate was lower in the surfactant group than in the control group (26.2% vs. 53.6%, p value <0.001). In crude analysis, surfactant therapy was associated with reduced odds of death (OR = 0.31, 95% CI 0.16-0.59, p value < 0.001). After adjustment for gestational age, initial oxygenation index, age at diagnosis, and outborn status, surfactant remained independently associated with lower mortality rate (adjusted OR = 0.21, 95% CI 0.10-0.45, p value <0.001). The association persisted after additional adjustment for primary diagnosis (adjusted OR = 0.23, 95% CI 0.10-0.50, p value <0.001).
Conclusion: Neonate with moderate to severe PPHN, exogenous surfactant therapy was significantly associated with lower mortality. Prospective studies with standardized treatment protocols are warranted.
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