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

Praveen Chandrasekharan, Rafal Kozielski, Vasantha H.S. Kumar, Munmun Rawat, Veena Manja, Changxing Ma, Satyanarayana Lakshminrusimha

Research output: Contribution to journalArticle

16 Citations (Scopus)

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.

Original languageEnglish (US)
Article number160170
Pages (from-to)428-440
Number of pages13
JournalAmerican Journal of Perinatology
Volume34
Issue number5
DOIs
StatePublished - Apr 1 2017
Externally publishedYes

Fingerprint

Premature Infants
Nitric Oxide
Respiratory Insufficiency
Periventricular Leukomalacia
Odds Ratio
Confidence Intervals
Hemorrhage
Pulmonary Hypertension
Smooth Muscle
Steroids
Oligohydramnios
Lung
Respiratory Muscles
Actins
Rupture
Autopsy
Newborn Infant
Membranes
Incidence

Keywords

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

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Early Use of Inhaled Nitric Oxide in Preterm Infants : Is there a Rationale for Selective Approach? / Chandrasekharan, Praveen; Kozielski, Rafal; Kumar, Vasantha H.S.; Rawat, Munmun; Manja, Veena; Ma, Changxing; Lakshminrusimha, Satyanarayana.

In: American Journal of Perinatology, Vol. 34, No. 5, 160170, 01.04.2017, p. 428-440.

Research output: Contribution to journalArticle

Chandrasekharan, Praveen ; Kozielski, Rafal ; Kumar, Vasantha H.S. ; Rawat, Munmun ; Manja, Veena ; Ma, Changxing ; Lakshminrusimha, Satyanarayana. / Early Use of Inhaled Nitric Oxide in Preterm Infants : Is there a Rationale for Selective Approach?. In: American Journal of Perinatology. 2017 ; Vol. 34, No. 5. pp. 428-440.
@article{48e141bdf7fb422082f0de87097372a0,
title = "Early Use of Inhaled Nitric Oxide in Preterm Infants: Is there a Rationale for Selective Approach?",
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 = "hypoxemic respiratory failure, inhaled nitric oxide, preterm prolonged rupture of membrane, pulmonary hypertension, smooth muscle area ratio",
author = "Praveen Chandrasekharan and Rafal Kozielski and Kumar, {Vasantha H.S.} and Munmun Rawat and Veena Manja and Changxing Ma and Satyanarayana Lakshminrusimha",
year = "2017",
month = "4",
day = "1",
doi = "10.1055/s-0036-1592346",
language = "English (US)",
volume = "34",
pages = "428--440",
journal = "American Journal of Perinatology",
issn = "0735-1631",
publisher = "Thieme Medical Publishers",
number = "5",

}

TY - JOUR

T1 - Early Use of Inhaled Nitric Oxide in Preterm Infants

T2 - Is there a Rationale for Selective Approach?

AU - Chandrasekharan, Praveen

AU - Kozielski, Rafal

AU - Kumar, Vasantha H.S.

AU - Rawat, Munmun

AU - Manja, Veena

AU - Ma, Changxing

AU - Lakshminrusimha, Satyanarayana

PY - 2017/4/1

Y1 - 2017/4/1

N2 - 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.

AB - 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.

KW - hypoxemic respiratory failure

KW - inhaled nitric oxide

KW - preterm prolonged rupture of membrane

KW - pulmonary hypertension

KW - smooth muscle area ratio

UR - http://www.scopus.com/inward/record.url?scp=85016435408&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85016435408&partnerID=8YFLogxK

U2 - 10.1055/s-0036-1592346

DO - 10.1055/s-0036-1592346

M3 - Article

C2 - 27627792

AN - SCOPUS:85016435408

VL - 34

SP - 428

EP - 440

JO - American Journal of Perinatology

JF - American Journal of Perinatology

SN - 0735-1631

IS - 5

M1 - 160170

ER -