TY - JOUR
T1 - Early hypoxic respiratory failure in extreme prematurity
T2 - Mortality and neurodevelopmental outcomes
AU - NRN STEERING COMMITTEE
AU - Chandrasekharan, Praveen
AU - Lakshminrusimha, Satyan
AU - Chowdhury, Dhuly
AU - van Meurs, Krisa
AU - Keszler, Martin
AU - Kirpalani, Haresh
AU - Das, Abhik
AU - Walsh, Michele C.
AU - McGowan, Elisabeth C.
AU - Higgins, Rosemary D.
N1 - Funding Information:
FUNDING: The National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (U10 HD27871, U10 HD53119, UG1 HD21364, UG1 HD21373, UG1 HD21385, UG1 HD27851, UG1 HD27853, UG1 HD27856, UG1 HD27880,UG1 HD27904, UG1 HD34216, UG1 HD36790, UG1 HD40492, UG1 HD40689, UG1 HD53089, UG1 HD53109, UG1 HD68244, UG1 HD68270, UG1 HD68278, UG1 HD68263, UG1 HD68284, UG1 HD87226, UG1 HD87229) and the National Center for Advancing Translational Sciences (NCATS) (UL1 TR6, UL1 TR41, UL1 TR42, UL1 TR77, UL1 TR93, UL1 TR442, UL1 TR454, UL1 TR1117) provided grant support through cooperative agreements for the Neonatal Research Network. Eunice Kennedy Shriver National Institute of Child Health and Human Development staff provided input into the study design, conduct, analysis, and article drafting; National Center for Research Resources and NCATS cooperative agreements provided infrastructure support to the Neonatal Research Network. Funded by the National Institutes of Health (NIH).
PY - 2020/12/1
Y1 - 2020/12/1
N2 - OBJECTIVES: To evaluate the survival and neurodevelopmental impairment (NDI) in extremely low birth weight (ELBW) infants at 18 to 26 months with early hypoxemic respiratory failure (HRF). We also assessed whether African American infants with early HRF had improved outcomes after exposure to inhaled nitric oxide (iNO). METHODS: ELBW infants #1000 g and gestational age #26 weeks with maximal oxygen $60% on either day 1 or day 3 were labeled as “early HRF” and born between 2007 and 2015 in the Neonatal Research Network were included. Using a propensity score regression model, we analyzed outcomes and effects of exposure to iNO overall and separately by race. RESULTS: Among 7639 ELBW infants born #26 weeks, 22.7% had early HRF. Early HRF was associated with a mortality of 51.3%. The incidence of moderate-severe NDI among survivors was 41.2% at 18 to 26 months. Mortality among infants treated with iNO was 59.4%. Female sex (adjusted odds ratio [aOR]: 2.4, 95% confidence interval [CI]: 1.8–3.3), birth weight $720 g (aOR: 2.3, 95% CI: 1.7–3.1) and complete course of antenatal steroids (aOR: 1.6, 95% CI: 1.1–2.2) were associated with intact survival. African American infants had a similar incidence of early HRF (21.7% vs 23.3%) but lower exposure to iNO (16.4% vs 21.6%). Among infants with HRF exposed to iNO, intact survival (no death or NDI) was not significantly different between African American and other races (aOR: 1.5, 95% CI: 0.6–3.6). CONCLUSIONS: Early HRF in infants #26 weeks’ gestation is associated with high mortality and NDI at 18 to 26 months. Use of iNO did not decrease mortality or NDI. Outcomes following iNO exposure were not different in African American infants.
AB - OBJECTIVES: To evaluate the survival and neurodevelopmental impairment (NDI) in extremely low birth weight (ELBW) infants at 18 to 26 months with early hypoxemic respiratory failure (HRF). We also assessed whether African American infants with early HRF had improved outcomes after exposure to inhaled nitric oxide (iNO). METHODS: ELBW infants #1000 g and gestational age #26 weeks with maximal oxygen $60% on either day 1 or day 3 were labeled as “early HRF” and born between 2007 and 2015 in the Neonatal Research Network were included. Using a propensity score regression model, we analyzed outcomes and effects of exposure to iNO overall and separately by race. RESULTS: Among 7639 ELBW infants born #26 weeks, 22.7% had early HRF. Early HRF was associated with a mortality of 51.3%. The incidence of moderate-severe NDI among survivors was 41.2% at 18 to 26 months. Mortality among infants treated with iNO was 59.4%. Female sex (adjusted odds ratio [aOR]: 2.4, 95% confidence interval [CI]: 1.8–3.3), birth weight $720 g (aOR: 2.3, 95% CI: 1.7–3.1) and complete course of antenatal steroids (aOR: 1.6, 95% CI: 1.1–2.2) were associated with intact survival. African American infants had a similar incidence of early HRF (21.7% vs 23.3%) but lower exposure to iNO (16.4% vs 21.6%). Among infants with HRF exposed to iNO, intact survival (no death or NDI) was not significantly different between African American and other races (aOR: 1.5, 95% CI: 0.6–3.6). CONCLUSIONS: Early HRF in infants #26 weeks’ gestation is associated with high mortality and NDI at 18 to 26 months. Use of iNO did not decrease mortality or NDI. Outcomes following iNO exposure were not different in African American infants.
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U2 - 10.1542/peds.2020-010595
DO - 10.1542/peds.2020-010595
M3 - Article
C2 - 32943536
AN - SCOPUS:85092682135
VL - 146
JO - Pediatrics
JF - Pediatrics
SN - 0031-4005
IS - 4
M1 - e20193318
ER -