Journal article
Clinical and echocardiography predictors of response to inhaled nitric oxide in hypoxemic term and near-term neonates
Pediatric pulmonology, Vol.56(5), pp.982-991
05/01/2021
DOI: 10.1002/ppul.25252
PMID: 33434418
Abstract
Approximately 40% of hypoxemic term/near-term neonates are nonresponders to inhaled nitric oxide (iNO). Phenotypic characterization of patients less likely to respond may improve diagnostic precision and therapeutic decisions. We conducted a retrospective cohort study of neonates born >= 35 weeks gestation with hypoxemia who received iNO in the first 72 h of life and classified them into responders and nonresponders according to changes in the fraction of inspired oxygen, saturations and/or arterial partial pressure of oxygen after 1 h of administration. Comprehensive targeted neonatal echocardiography (TnECHO) data were collected when performed up to 6 h prior or 24 h after iNO initiation. Descriptive statistics, univariate analysis, and binary logistic regression were used to compare the groups. There were 183 patients included (63% responders) and TnECHO was performed in 54 infants. The presence of lung disease, and particularly meconium aspiration syndrome (p = .004), was associated with nonresponse to iNO. Nonresponders were characterized by a higher need for rescue high-frequency ventilation (p < .001), longer duration of mechanical ventilation (p < .001), and need for oxygen support (p = .003). Pulmonary hypertension documented on TnECHO was present in 96.3% of the patients but there was no difference in frequency or severity of pulmonary hypertension, or rates of low cardiac output between the groups. Moderate-to-severe right ventricular systolic dysfunction (p > .05) and lower left ventricular strain (p < .05) were more likely in the nonresponder group. In summary, response to iNO is influenced by lung disease, choice of ventilation strategy, and perhaps underlying cardiovascular physiology. Prospective pre- and post-iNO echocardiography data may provide novel physiologic insights.
Details
- Title: Subtitle
- Clinical and echocardiography predictors of response to inhaled nitric oxide in hypoxemic term and near-term neonates
- Creators
- Adrianne R. Bischoff - University of IowaRegan E. Giesinger - University of IowaElaine Neary - Liverpool Women's HospitalDany E. Weisz - Sunnybrook Health Science CentreJaques Belik - Hospital for Sick ChildrenPatrick J. McNamara - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Pediatric pulmonology, Vol.56(5), pp.982-991
- Publisher
- Wiley
- DOI
- 10.1002/ppul.25252
- PMID
- 33434418
- ISSN
- 8755-6863
- eISSN
- 1099-0496
- Number of pages
- 10
- Language
- English
- Date published
- 05/01/2021
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology; Internal Medicine
- Record Identifier
- 9984353935302771
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