Table 5.

Surfactant therapy for neonates with congenital diaphragmatic hernia.

Surfactant therapy	Delivery method	Mechanical ventilation	Notes	Ref.
Natural substance derived from minced bovine lung	ETT	Yes	Important improvement in oxygenation	[162]
Infasurf®	ETT	N/A	A randomized controlled trial is needed	[163]
Survanta®	ETT	Yes	Less improvement because of factors other than surfactant deficiency Multicenter randomized controlled trial is needed	[164]
Surfacten®	ETT	Yes	Pulmonary hypoplasia accompanying CDH Improved oxygenation but controlled trials are needed	[165]
Alveofact® + iNO + ECMO	ETT	HFOV	Good survival rate and good neurodevelopmental outcome at 1 year of age	[166]
Survanta Exosurf® Curosurf® Others	N/A	N/A	Meta-analysis study Lower survival rate in CDH preterm infants Surfactant replacement in CDH can be used only within a randomized clinical trial	[167]
N/A	N/A	N/A	Meta-analysis study No benefit for term infants with a prenatal diagnosis of isolated CDH	[168]

CDH: Congenital diaphragmatic hernia; ECMO: Extracorporeal membrane oxygenation ETT: Endotracheal tube; HFOV: High frequency oscillatory ventilation; iNO: Inhaled nitric oxide.