Journal article
Short-term and long-term outcomes of preterm neonates with acute severe pulmonary hypertension following rescue treatment with inhaled nitric oxide
Archives of disease in childhood. Fetal and neonatal edition, Vol.102(6), pp.F508-F514
11/2017
DOI: 10.1136/archdischild-2016-312409
PMID: 28483819
Abstract
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.
Retrospective cohort studyover a 6 year period.
Tertiary neonatal intensive care unit.
89 neonates <35 weeks gestational age (GA) who received rescue iNO for aPHT, including 62 treated at ≤3 days of age (early aPHT).
iNO ≥ 1 hour.
Positive responders (reduction in fraction of inspired oxygen (FiO
) ≥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.
Mean (SD) GA and birth weight was 27.7 (3.0) weeks and 1077 (473) gm, respectively. Median (IQR) pre-iNO FiO
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).
A positive response to rescue iNO in preterm infants with aPHT is associated with survival benefit, which is not offset by long-term disability.
Details
- Title: Subtitle
- Short-term and long-term outcomes of preterm neonates with acute severe pulmonary hypertension following rescue treatment with inhaled nitric oxide
- Creators
- Michelle Baczynski - Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, CanadaShannon Ginty - Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, CanadaDany E Weisz - Department of Paediatrics, University of Toronto, Toronto, CanadaPatrick J McNamara - Physiology, University of Toronto, Toronto, CanadaEdmond Kelly - Department of Paediatrics, Mount Sinai Hospital, Toronto, CanadaPrakeshkumar Shah - Lunnenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, CanadaAmish Jain - Lunnenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
- Resource Type
- Journal article
- Publication Details
- Archives of disease in childhood. Fetal and neonatal edition, Vol.102(6), pp.F508-F514
- DOI
- 10.1136/archdischild-2016-312409
- PMID
- 28483819
- ISSN
- 1359-2998
- eISSN
- 1468-2052
- Language
- English
- Date published
- 11/2017
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology; Internal Medicine
- Record Identifier
- 9984093597302771
Metrics
23 Record Views