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Am J Perinatol 2017; 34(05): 428-440
DOI: 10.1055/s-0036-1592346
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Early Use of Inhaled Nitric Oxide in Preterm Infants: Is there a Rationale for Selective Approach?

Praveen Chandrasekharan
1   Division of Neonatology, Department of Pediatrics, Women and Children's Hospital of Buffalo, Buffalo, New York
,
Rafal Kozielski
2   Department of Pathology, Women and Children's Hospital of Buffalo, Buffalo, New York
,
Vasantha H.S. Kumar
1   Division of Neonatology, Department of Pediatrics, Women and Children's Hospital of Buffalo, Buffalo, New York
,
Munmun Rawat
1   Division of Neonatology, Department of Pediatrics, Women and Children's Hospital of Buffalo, Buffalo, New York
,
Veena Manja
3   Department of Internal Medicine (Cardiology), University at Buffalo, Buffalo, New York
4   Department of Epidemiology, McMasters University, Hamilton, Ontario, Canada
,
Changxing Ma
5   Department of Biostatistics, School of Public Health, University at Buffalo, Buffalo, New York
,
Satyan Lakshminrusimha
1   Division of Neonatology, Department of Pediatrics, Women and Children's Hospital of Buffalo, Buffalo, New York
› Author Affiliations
Further Information

Publication History

18 April 2016

04 August 2016

Publication Date:
14 September 2016 (online)

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Abstract

Background Inhaled nitric oxide (iNO) is being increasingly used in preterm infants < 34 weeks with hypoxemic respiratory failure (HRF) and/or pulmonary hypertension (PH).

Objective To evaluate the risk factors, survival characteristics, and lung histopathology in preterm infants with PH/HRF.

Methods Retrospective chart review was conducted to determine characteristics of 93 preterm infants treated with iNO in the first 28 days and compared with 930 matched controls. Factors associated with survival with preterm HRF and smooth muscle actin from nine autopsies were evaluated.

Results Preterm neonates treated with iNO had a higher incidence of preterm prolonged rupture of membrane (pPROM ≥ 18 hours), oligohydramnios and delivered by C-section. In infants treated with iNO, antenatal steroids (odds ratio [OR],3.7; confidence interval [CI], 1.2–11.3; p = 0.02), pPROM (OR, 1.001; CI, 1.0–1.004; p = 0.3), and oxygenation response to iNO (OR, 3.7; CI, 1.08–13.1; p = 0.037) were associated with survival. Thirteen infants with all three characteristics had 100% (13/13) survival without severe intraventricular hemorrhage (IVH)/periventricular leukomalacia (PVL) compared with 48% survival (12/25, p = 0.004) and 16% severe IVH/PVL without any of these factors. Severity of HRF correlated with increased smooth muscle in pulmonary vasculature.

Conclusion Preterm infants with HRF exposed to antenatal steroids and pPROM had improved oxygenation with iNO and survival without severe IVH/PVL. Precisely targeting this subset may be beneficial in future trials of iNO.

Keywords

inhaled nitric oxide - hypoxemic respiratory failure - preterm prolonged rupture of membrane - pulmonary hypertension - smooth muscle area ratio
 

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