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Arch Dis Child Fetal Neonatal Ed. 2017 Nov;102(6):F508-F514. doi: 10.1136/archdischild-2016-312409. Epub 2017 May 8.

Short-term and long-term outcomes of preterm neonates with acute severe pulmonary hypertension following rescue treatment with inhaled nitric oxide.

Baczynski M1, Ginty S1, Weisz DE2,3, McNamara PJ3,4,5, Kelly E3,6, Shah P3,6,7, Jain A3,5,6,7.

Author information

1
Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, Canada.
2
Department of Newborn and Developmental Paediatrics, Sunnybrook Health Science Center, Toronto, Canada.
3
Department of Paediatrics, University of Toronto, Toronto, Canada.
4
Division of Neonatology, Hospital for Sick Children, Toronto, Canada.
5
Physiology, University of Toronto, Toronto, Canada.
6
Department of Paediatrics, Mount Sinai Hospital, Toronto, Canada.
7
Lunnenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada.

Abstract

OBJECTIVE:

To describe short-term and long-term outcomes of preterm neonates with severe acute pulmonary hypertension (aPHT) in relation to response to rescue inhaled nitric oxide (iNO) therapy.

DESIGN:

Retrospective cohort studyover a 6 year period.

SETTING:

Tertiary neonatal intensive care unit.

PATIENTS:

89 neonates <35 weeks gestational age (GA) who received rescue iNO for aPHT, including 62 treated at ≤3 days of age (early aPHT).

INTERVENTIONS:

iNO ≥ 1 hour.

MAIN OUTCOME MEASURES:

Positive responders (reduction in fraction of inspired oxygen (FiO2) ≥0.20 within 1 hour of iNO) were compared with non-responders. Primary outcome was survival without moderate-to-severe disability at 18 months of age.

RESULTS:

Mean (SD) GA and birth weight was 27.7 (3.0) weeks and 1077 (473) gm, respectively. Median (IQR) pre-iNO FiO2 was 1.0 (1.0, 1.0). Positive response rate to iNO was 46%. Responders showed improved survival without disability (51% vs 15%; p<0.01), lower mortality (34% vs 71%; p<0.01) and disability among survivors (17% vs 50%; p=0.06). Higher GA (adjusted OR: 1.44 (95% CI 1.10 to 1.89)), aPHT in context of preterm prolonged rupture of membranes (6.26 (95% CI 1.44 to 27.20)) and positive response to rescue iNO (5.81 (95% CI 1.29 to, 26.18)) were independently associated with the primary outcome. Compared with late cases (>3 days of age), early aPHT had a higher response rate to iNO (61% vs 11%; p<0.01) and lower mortality (43% vs 78%; p<0.01).

CONCLUSION:

A positive response to rescue iNO in preterm infants with aPHT is associated with survival benefit, which is not offset by long-term disability.

KEYWORDS:

hypoxic respiratory failure; neurodevelopmental outcomes; preterm prolonged rupture of membranes; sepsis

[Indexed for MEDLINE]

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