Abstract
Abstract
Objective
Describe characteristics of preterm infants exposed to inhaled nitric oxide (iNO) in Kaiser Permanente Southern California.
Study design
Case review of preterm infants <34-weeks exposed to iNO during 2010–2020 including respiratory and echocardiographic status, NICU course, and 12-month follow-up.
Results
270 infants, 2.63% of births<34 weeks, (median, range: 26.1, 225/7–336/7 weeks gestation) were exposed to iNO. Median FiO2 at iNO initiation was 1.0 (IQR 0.94-1.0). Pulmonary hypertension (PH) was not associated with risk-adjusted 2 h oxygenation response or improved survival. Mortality to NICU discharge was 37.4%. Median cost of iNO was $7,695/patient. Discharged survivors experienced frequent rehospitalization (34.9%), use of supplemental oxygen, sildenafil, diuretics, bronchodilators, and steroids. Four infants had persistent PH. Five infants died after NICU discharge.
Conclusions
Preterm infants receiving iNO have high mortality and 1st year morbidity. As currently used, iNO may be an indicator of respiratory disease severity rather than mediator of improved outcomes.
Funder
U.S. Department of Health & Human Services | NIH | Eunice Kennedy Shriver National Institute of Child Health and Human Development
Publisher
Springer Science and Business Media LLC
Reference31 articles.
1. Barrington KJ, Finer N, Pennaforte T, Altit G. Nitric oxide for respiratory failure in infants born at or near term. Cochrane Database Syst Rev. 2017;1:CD000399.
2. Cole FS, Alleyne C, Barks JD, Boyle RJ, Carroll JL, Dokken D, et al. NIH consensus development conference: inhaled nitric oxide therapy for premature infants. NIH Consens State Sci Statements. 2010;27(5):1–34.
3. Kumar P, Committee on F, Newborn, American Academy of P. Use of inhaled nitric oxide in preterm infants. Pediatrics 2014;133(1):164–70.
4. Ellsworth MA, Harris MN, Carey WA, Spitzer AR, Clark RH. Off-label use of inhaled nitric oxide after release of NIH consensus statement. Pediatrics. 2015;135(4):643–8.
5. Chandrasekharan P, Lakshminrusimha S, Chowdhury D, Van Meurs K, Keszler M, Kirpalani H, et al. Early hypoxic respiratory failure in extreme prematurity: mortality and neurodevelopmental outcomes. Pediatrics. 2020;146(4):e20193318.