Abstract / Summary
Objective Surfactant replacement therapy (SRT) remains a cornerstone of neonatal respiratory management, but contemporary national data on temporal trends in SRT use across gestational age groups in the United States remain limited. We aimed to characterize gestational age–specific SRT rates among U.S. live-born infants and assess temporal trends over time. Study design We conducted a serial cross-sectional analysis using the U.S. Centers for Disease Control and Prevention WONDER Natality Expanded database from 2016 to 2024. Findings were examined in parallel using a cohort of preterm infants from the Premier Healthcare Database from 2020 to 2024. In CDC WONDER, SRT was defined using the birth certificate item for surfactant replacement therapy. In the Premier Healthcare Database, SRT was defined as receipt of exogenous surfactant during the birth hospitalization identified from billing records. Annual percentages of infants receiving SRT were estimated by gestational age group. Temporal trends were summarized as annual percent change (APC) using Poisson regression. Results From 2016 to 2024, the observed SRT rate increased from 0.48% (95% CI, 0.48%–0.49%) to 0.51% (95% CI, 0.50%–0.51%), an absolute difference of approximately 0.03 percentage points, corresponding to a model-estimated cumulative relative increase of 7.60% [95% CI, 6.00%–9.22%; APC, 0.92% (95% CI, 0.73%–1.11%)], with a transient deviation in 2021. The increase was most pronounced among late preterm infants born at 34–36 weeks (APC, 0.90% [95% CI, 0.45%–1.36%]) and term infants born at 37 weeks or later (APC, 3.31% [95% CI, 2.82%–3.79%]). Similar upward patterns were observed in the Premier Healthcare Database among preterm infants. The calibrated SRT rate among preterm births in 2024 was 11.39% (95% CI, 11.23%–11.54%). Conclusion Across 2 national data sources, SRT rates increased among infants born at 34 weeks’ gestation or later. These findings suggest evolving patterns of neonatal respiratory care and inform surveillance and interpretation of national birth data.