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Surfactant replacement therapy in preterm infants with congenital heart disease: Physiological concepts and

Arvind Sehgal1,2, Patrick J McNamara3,4, Samuel Menahem5

  • 1Monash Children's Hospital, Monash University, Melbourne, VIC, Australia. Arvind.Sehgal@monash.edu.

Journal of Perinatology : Official Journal of the California Perinatal Association
|April 20, 2026
PubMed

Insights

Congenital heart disease in preterm infants requires tailored surfactant therapy. This review explores optimal oxygenation and ventilation, addressing unique circulatory needs and knowledge gaps for better infant outcomes.

Area of Science:

  • Neonatal Physiology
  • Pediatric Cardiology
  • Respiratory Medicine

Background:

  • Congenital heart disease (CHD) affects 8.8/1000 live births.
  • Preterm infants often receive surfactant for respiratory distress syndrome (RDS).
  • The interaction between CHD, prematurity, and surfactant therapy is not well understood.

Purpose of the Study:

  • To describe optimal oxygen saturation and mechanical ventilation in preterm infants with CHD.
  • To discuss potential circulatory imbalances post-surfactant administration in this cohort.
  • To provide physiology-based recommendations for managing surfactant therapy in preterm infants with CHD.

Main Methods:

  • Physiology-based narrative review.
  • Discussion of haemodynamic vulnerability in preterm infants.
  • Analysis of surfactant's circulatory impact in infants with and without structural heart disease.

Main Results:

  • Preterm infants with CHD may benefit from higher oxygen saturation thresholds during surfactant therapy.
  • Surfactant administration can influence circulatory dynamics, especially in duct-dependent lesions and parallel circulations.
  • Understanding these interactions is crucial for clinical decision-making.

Conclusions:

  • Tailored approaches to oxygenation and ventilation are necessary for preterm infants with CHD receiving surfactant.
  • Further research is needed to address the knowledge gap regarding surfactant therapy in this population.
  • Physiology-based guidance can aid clinicians in managing these complex cases.

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