{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T05:55:37Z","timestamp":1790920537344,"version":"4.1.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020218","name":"Chiesi USA","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100020218","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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\u2013specific SRT rates among U.S. live-born infants and assess temporal trends over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 2016 to 2024, the observed SRT rate increased from 0.48% (95% CI, 0.48%\u20130.49%) to 0.51% (95% CI, 0.50%\u20130.51%), an absolute difference of approximately 0.03 percentage points, corresponding to a model-estimated cumulative relative increase of 7.60% [95% CI, 6.00%\u20139.22%; APC, 0.92% (95% CI, 0.73%\u20131.11%)], with a transient deviation in 2021. The increase was most pronounced among late preterm infants born at 34\u201336 weeks (APC, 0.90% [95% CI, 0.45%\u20131.36%]) and term infants born at 37 weeks or later (APC, 3.31% [95% CI, 2.82%\u20133.79%]). 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%\u201311.54%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Across 2 national data sources, SRT rates increased among infants born at 34 weeks\u2019 gestation or later. These findings suggest evolving patterns of neonatal respiratory care and inform surveillance and interpretation of national birth data.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1907867","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T05:36:20Z","timestamp":1790919380000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Temporal trends in surfactant replacement therapy among U.S. infants, 2016\u20132024"],"prefix":"10.3389","volume":"14","author":[{"given":"Xuezheng","family":"Sun","sequence":"first","affiliation":[{"name":"Medical Affairs, Chiesi USA Inc","place":["Cary, NC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhao","family":"Wang","sequence":"additional","affiliation":[{"name":"Medical Affairs, Chiesi USA Inc","place":["Cary, NC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Fuentes","sequence":"additional","affiliation":[{"name":"Medical Affairs, Chiesi USA Inc","place":["Cary, NC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1038\/pr.2016.203","article-title":"Evolution of surfactant therapy for respiratory distress syndrome: past, present, and future","volume":"81","author":"Sardesai","year":"2017","journal-title":"Pediatr Res"},{"key":"B2","doi-asserted-by":"publisher","first-page":"S47","DOI":"10.1038\/jp.2008.50","article-title":"Surfactants: past, present and future","author":"Halliday","year":"2008","journal-title":"J Perinatol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1159\/000528914","article-title":"European consensus guidelines on the management of respiratory distress syndrome: 2022 update","volume":"120","author":"Sweet","year":"2023","journal-title":"Neonatology"},{"key":"B4","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1136\/archdischild-2021-322890","article-title":"Surfactant therapy in late preterm and term neonates with respiratory distress syndrome: a systematic review and meta-analysis","volume":"107","author":"Ramaswamy","year":"2022","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1259","DOI":"10.1080\/14767058.2017.1313828","article-title":"Effects of surfactant treatment in late preterm infants with respiratory distress syndrome","volume":"31","author":"Dani","year":"2018","journal-title":"J Matern Fetal Neonatal Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"527","DOI":"10.2217\/cer-2020-0018","article-title":"Surfactant therapy for meconium aspiration syndrome in neonates: a systematic overview of systematic reviews and recent clinical trials","volume":"9","author":"Abdelaal","year":"2020","journal-title":"J Comp Eff Res"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1348","DOI":"10.1002\/14651858.CD008155.pub2","article-title":"Surfactant for bacterial pneumonia in late preterm and term infants","volume":"2012","author":"Tan","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1188","DOI":"10.1038\/s41390-022-02265-8","article-title":"Should less invasive surfactant administration (LISA) become routine practice in US neonatal units?","volume":"93","author":"Kakkilaya","year":"2023","journal-title":"Pediatr Res"},{"key":"B9","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1038\/s41372-023-01778-2","article-title":"Less invasive surfactant administration methods: who, what and how","volume":"44","author":"Guthrie","year":"2024","journal-title":"J Perinatol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"F122","DOI":"10.1136\/archdischild-2011-301314","article-title":"Minimally-invasive surfactant therapy in preterm infants on continuous positive airway pressure","volume":"98","author":"Dargaville","year":"2013","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"B11","first-page":"23","article-title":"Trends in surfactant use in the United States: changes in clinical practice","volume":"1","author":"Trembath","year":"2011","journal-title":"EJ Neonatology Res"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1001\/jamapediatrics.2021.1921","article-title":"Changes in use of respiratory support for preterm infants in the US, 2008\u22122018","volume":"175","author":"Hatch","year":"2021","journal-title":"JAMA Pediatr"},{"key":"B13","doi-asserted-by":"publisher","first-page":"14","DOI":"10.51362\/neonatology.today\/20231811-1418","article-title":"Assessing the shifts: a 5-year analysis of surfactant and assisted ventilation trends in neonatal care in the United States (2016\u22122020)","volume":"18","author":"Vidavalur","year":"2023","journal-title":"Neonatology Today"},{"key":"B14","first-page":"1","article-title":"Expanded health data from the new birth certificate, 2006","volume":"58","author":"Osterman","year":"2009","journal-title":"Natl Vital Stat Rep"},{"key":"B15","year":""},{"key":"B16","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1111\/j.1541-0420.2006.00528.x","article-title":"Estimating average annual percent change for disease rates without assuming constant change","volume":"62","author":"Fay","year":"2006","journal-title":"Biometrics"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15620\/cdc\/175204","article-title":"Births: final data for 2023","volume":"1","author":"Osterman","year":"2025","journal-title":"Natl Vital Stat Rep"},{"key":"B18","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1089\/pop.2017.0017","article-title":"Using statewide data on health care quality to assess the effect of a patient-centered medical home initiative on quality of care","volume":"21","author":"Shippee","year":"2018","journal-title":"Popul Health Manag"},{"key":"B19","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1097\/AOG.0000000000005497","article-title":"Validity of birth certificate data compared with hospital discharge data in reporting maternal morbidity and disparities","volume":"143","author":"Gemmill","year":"2024","journal-title":"Obstet Gynecol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"182","DOI":"10.21037\/tp.2019.07.01","article-title":"Vermont Oxford network: a worldwide learning community","volume":"8","author":"Edwards","year":"2019","journal-title":"Transl Pediatr"},{"key":"B21","doi-asserted-by":"publisher","first-page":"E2118904","DOI":"10.1001\/jamanetworkopen.2021.18904","article-title":"Assessment of neonatal intensive care unit practices, morbidity, and mortality among very preterm infants in China","volume":"4","author":"Cao","year":"2021","journal-title":"JAMA Netw Open"},{"key":"B22","first-page":"437","article-title":"Levels of neonatal care","volume-title":"Neonatal Care: A Compendium of AAP Clinical Practice Guidelines and Policies","year":"2019"},{"key":"B23","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1007\/s12098-014-1585-2","article-title":"The pediatrix BabySteps\u00ae data warehouse \u2014 a unique national resource for improving outcomes for neonates","volume":"82","author":"Spitzer","year":"2015","journal-title":"Indian Journal of Pediatrics, the"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1055\/a-2717-3951","article-title":"The association between maternal\u2013fetal medicine physician density and pregnancy outcomes","volume":"43","author":"Kawakita","year":"2025","journal-title":"Am J Perinatol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1055\/s-0037-1604414","article-title":"Increased neonatal respiratory morbidity associated with gestational and pregestational diabetes: a retrospective study","volume":"34","author":"Kawakita","year":"2017","journal-title":"Am J Perinatol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.preghy.2020.01.006","article-title":"Maternal hypertension, preeclampsia, and risk of neonatal respiratory disorders in a large-prospective cohort study","volume":"19","author":"Tian","year":"2020","journal-title":"Pregnancy Hypertens"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15620\/cdc:118018","article-title":"Trends and characteristics in gestational diabetes: united States, 2016\u22122020","volume":"71","author":"Gregory","year":"2022","journal-title":"Natl Vital Stat Rep"},{"key":"B28","doi-asserted-by":"publisher","first-page":"585","DOI":"10.15585\/mmwr.mm7117a1","article-title":"Hypertensive disorders in pregnancy and mortality at delivery hospitalization \u2014 united States, 2017\u20132019","volume":"71","author":"Ford","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"B29","first-page":"1","article-title":"Increases in prepregnancy obesity: united States, 2016\u22122019","volume":"392","author":"Driscoll","year":"2020","journal-title":"NCHS Data Brief"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2023.2287981","article-title":"Impact of advanced maternal age on neonatal morbidity: a systematic review","volume":"36","author":"Rodrigues","year":"2023","journal-title":"J Matern Fetal Neonatal Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1080\/09513590.2016.1232543","article-title":"Risk factors vary early preterm birth and perinatal complications after assisted reproductive technology","volume":"32","author":"Chistyakova","year":"2016","journal-title":"Gynecol Endocrinol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"230","DOI":"10.2478\/s11536-011-0139-5","article-title":"Cesarean delivery and respiratory distress in late preterm and term infants","volume":"7","author":"Baumert","year":"2012","journal-title":"Cent Eur J Med"},{"key":"B33","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1542\/peds.2013-3443","article-title":"Surfactant replacement therapy for preterm and term neonates with respiratory distress","volume":"133","author":"Polin","year":"2014","journal-title":"Pediatrics"},{"key":"B34","doi-asserted-by":"publisher","first-page":"CD2054","DOI":"10.1002\/14651858.CD002054.pub3","article-title":"Surfactant for meconium aspiration syndrome in term and late preterm infants","volume":"12","author":"El Shahed","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1055\/a-2453-6883","article-title":"A survey of minimally invasive surfactant use in the United States","volume":"42","author":"Ahn","year":"2025","journal-title":"Am J Perinatol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1038\/s41372-018-0302-9","article-title":"The use of less invasive surfactant administration (LISA) in the United States with review of the literature","volume":"39","author":"D","year":"2019","journal-title":"J Perinatol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1177\/003335491513000108","article-title":"Validation of selected items on the 2003 U.S. Standard certificate of live birth: new York city and Vermont","volume":"130","author":"Dietz","year":"2015","journal-title":"Public Health Rep"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1907867\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T05:36:22Z","timestamp":1790919382000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1907867\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,2]]},"references-count":37,"alternative-id":["10.3389\/fped.2026.1907867"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1907867","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,2]]},"article-number":"1907867"}}