Clinical characteristics and factors associated with term and late preterm infants that do not respond to inhaled nitric oxide (iNO)

Abstract

Hypotension requiring treatment with pressors at the time of iNO therapy, as well as changes in pH and PaO2 after iNO initiation can be used as early clinical predictors to identify patients quickly who may be iNO non-responders.

Short-term and long-term outcomes of preterm neonates with acute severe pulmonary hypertension following rescue treatment with inhaled nitric oxide

“…A significant proportion of cases, but not all, improve acutely with iNO and have better outcomes compared with non-responders 21. This was particularly true in early aPHT where we observed a response rate as high as 61% 22.…”

The Burden of Hypoxic Respiratory Failure in Preterm and Term/Near-term Infants in the United States 2011-2015

“…To our knowledge, this is the first real-world study to evaluate the comorbidities, treatments, HRU, and health care costs among preterm and T/NT infants with HRF/PPHN using a large US hospital database. Given the higher mortality rate and the need for prolonged cardiopulmonary support in the surviving neonates, 1,13 it is important to evaluate the clinical and economic burden of HRF/PPHN to successfully aid health care decision making, thereby reducing the burden in this vulnerable patient population.…”

“…Neonatal hypoxic respiratory failure (HRF) is a severe respiratory illness that affects 2% of all live births and is responsible for >33% of all neonatal mortality. 1 In the United States alone, the annual number of term and late pre-term newborns with HRF is estimated at 80 000. 1 About 15% of term infants and 29% of late-preterm infants admitted in a neonatal intensive care unit (NICU) develop respiratory morbidity.…”

“…1 In the United States alone, the annual number of term and late pre-term newborns with HRF is estimated at 80 000. 1 About 15% of term infants and 29% of late-preterm infants admitted in a neonatal intensive care unit (NICU) develop respiratory morbidity. 2 Respiratory failure in these newborns is often associated with persistent pulmonary hypertension of the newborn (PPHN), which contributes to hypoxemia.…”

Prematurity

“…However, up to half of HRF infants will have little to no response to the selective pulmonary vasodilatory effects of iNO. In their case review report, Almanzar Morel et al [12] identify clinical characteristics of iNO non-responders, including lower Apgar scores, lower initial pH, elevated oxygen index, and the use of vasopressor support prior to initiation of iNO therapy. Identifying this subset earlier in their clinical course may allow for more aggressive management strategies but the mechanisms underlying iNOrecalcitrant pulmonary vascular resistance remain to be elucidated.…”