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

Arvind Sehgal; Patrick J McNamara; Samuel Menahem

doi:10.1038/s41372-026-02654-5

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

Journal article

Open access

Peer reviewed

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

Arvind Sehgal, Patrick J McNamara and Samuel Menahem

Journal of perinatology

04/20/2026

DOI: 10.1038/s41372-026-02654-5

PMID: 42009894

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Abstract

A prevalence rate of 8.8/1000 live-births for congenital heart disease has been reported. The clinical outlook of these infants is dependent on transition from intra-uterine life to postnatal life. Preterm infants are also commonly administered surfactant to manage respiratory distress syndrome. This physiology-based narrative describes optimal oxygen saturation, mechanical ventilation practices and circulatory imbalances that might happen after surfactant administration in preterm infants with congenital heart disease. Clinicians may consider higher oxygen requirement thresholds for surfactant therapy in this select cohort, in comparison to infants without congenital heart disease. The interplay between surfactant deficiency, surfactant replacement therapy, and the unique interaction with underlying congenital heart disease represents a knowledge gap. This perspectives article discusses the haemodynamic vulnerability of preterm infants and discusses the circulatory impact of surfactant in premature infants without and with structural heart disease. We provide physiology-based suggestions for duct-dependent lesions, parallel circulations and other structural heart disease.

Details

Title: Subtitle: Surfactant replacement therapy in preterm infants with congenital heart disease: Physiological concepts and therapeutic considerations
Creators: Arvind Sehgal - Monash Children’s Hospital
Patrick J McNamara - University of Iowa
Samuel Menahem - Monash Medical Centre
Resource Type: Journal article
Publication Details: Journal of perinatology
DOI: 10.1038/s41372-026-02654-5
PMID: 42009894
NLM abbreviation: J Perinatol
ISSN: 1476-5543
eISSN: 1476-5543
Publisher: Springer Nature
Grant note: CAUL
Open Access funding enabled and organized by CAUL and its Member Institutions.
Language: English
Electronic publication date: 04/20/2026
Academic Unit: Stead Family Department of Pediatrics; Neonatology
Record Identifier: 9985155646602771

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