31 - Surfactant Therapy Rates of Preterm Infants in the United States, 2020–2024: Evidence from CDC WONDER Natality and the Premier Healthcare Database

Publication Number: 4030.31

Wenhao Wang, Chiesi USA, Marietta, GA, United States; Daniel Fuentes, Chiesi USA, Cary, NC, United States; Xuezheng Sun, Chiesi USA, Cary, NC, United States

Background: Exogenous surfactant is standard therapy for neonatal respiratory distress syndrome. In the United States, few studies have utilized national-scale real-world datasets to systematically describe gestational age-specific trends in surfactant therapy among preterm infants.

Objective: To describe U.S. surfactant therapy rates among preterm infants overall and by GA groups using two sources, CDC WONDER Natality and the Premier Healthcare Database (PHD).

Design/Methods: We analyzed preterm births ( < 37 weeks) from 2020 to 2024 using two RWE databases: CDC WONDER Natality (national birth certificate records with a surfactant indicator) and the PHD (all-payer chargemaster data from ~25% of U.S. hospitals). GA-specific temporal trends were estimated with log-linear models to obtain annual percent change (APC) and 95% confidence intervals (CI). Region-specific ratios of CDC to PHD rates were calculated to quantify cross-source differences.

Results: From 2020 to 2024, the PHD included 364,724 preterm infants (identified by ICD codes P07.2x-P07.3x) and 40,822 received surfactant therapy (11.19%, identified from billing items); the CDC included 1,880,120 preterm infants, and 75,790 received surfactant (4.03%). Surfactant rates among 34-36 weeks increased significantly in both CDC and PHD [APC: CDC, +2.3% (0.4%-4.3%); PHD, +1.6% (0.8%-2.4%]. Rates in the earlier GA groups changed little, and the APCs were not statistically significant (CDC vs PHD: < 28 weeks,0.5% (-0.4%-1.4%) vs 0.6% (-5.1%-6.8%); 28-31 weeks, -1.0% (-3.7%-1.8%) vs -0.1% (-4.1%-4.0%); 32-33 weeks, -0.6% (-2.2%-1.0%) vs 0.9% (-3.3%-5.2%)) (Figure 1). Surfactant rates were systematically higher in PHD (Table 1). The CDC-to-PHD rate ratio declined with increasing GA (0.45, 0.39, 0.36, 0.27 for < 28, 28-31, 32-33, and 34-36 weeks, respectively). Regional variation was evident: ratios were lowest in the South (0.19-0.34) and highest in the Northeast (0.49-0.68).

Conclusion(s): Two national datasets show similar temporal trends in surfactant use rates, with a monotonic increase among late-preterm infants and a stable pattern among earlier gestational age groups. The differences in surfactant rates between PHD and CDC were consistent over time, but varied by GA and regions, likely due to different data sources and collection approaches (hospital bill vs birth certificate).

Gestational-Age-Specific Rates of Surfactant among births (2020-2024): Comparison of CDC and Premier  
Percentage of births receiving surfactant by gestational age groups. CDC WONDER indicator (dashed) vs Premier (solid), 2020 to 2024.

CDC‑to‑PHD ratio of surfactant therapy rate by GA group and U.S. Census region
CDC WONDER to Premier rate ratios across gestational age groups and U.S. Census regions, births 2020 to 2024.