Echocardiographic investigation of inhaled nitric oxide in newborn babies with severe hypoxaemia

Rozé, Jean Christophe; Storme, Laurent; Zupan, V; Morville, P; Dinh-Xuan, Anh Tuan; Jc, Mercier

doi:10.1016/s0140-6736(94)91341-2

Cited by 75 publications

(38 citation statements)

References 10 publications

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“…in patients with acute respiratory distress syndrome results in significant improvements in oxygenation during the initial 24 h, with resolution by 48 h. It has been suggested that the improvement in oxygenation with iNO for premature infants with severe RDS and respiratory failure occurs by lowering pulmonary vascular resistance, reversing extrapulmonary shunting through selective pulmonary vasodilation and by a redistribution of pulmonary blood flow with enhanced ventilation-perfusion matching. 25,26 In premature lambs with RDS, iNO has been shown to improve gas exchange and reduce lung inflammation. 27 In 2003, Schreiber et al 8 reported that iNO therapy in premature infants with mild RDS decreased the incidence of CLD and death.…”

Section: Discussionmentioning

confidence: 99%

Inhaled nitric oxide in the management of preterm infants with severe respiratory failure

Chen

2007

J Perinatol

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Objective: Elevated pulmonary vascular resistance and poor ventilation-perfusion matching are commonly found in preterm infants with severe respiratory distress syndrome (RDS) and respiratory failure. Inhaled nitric oxide (iNO) can improve gas exchange and decrease pulmonary vascular resistance. This study was conducted to determine whether iNO therapy improves oxygenation in such infants.Study Design: Between July 2000 and 2006, 65 preterm infants (birth weight, <1500 g; gestational age, <31 weeks) with severe RDS and respiratory failure requiring mechanical ventilation and an oxygenation index (OI)X25 were randomly divided into two groups. Group A infants (n ¼ 32) received iNO therapy. iNO was started at a dose of five parts per million (p.p.m.). The maximal dose of NO was 20 p.p.m. Group B infants (n ¼ 33) did not receive iNO therapy, receive inhaled oxygen placebo only, was served as control group. Mechanical ventilation and iNO therapy were managed by neonatologists who were not involved in safety monitoring, data analysis and interpretation, or manuscript preparation. This study was randomized but not blinded. Result:The OI was significantly lower (P<0.01) in the iNO therapy group than in the control group at 30 min, 3, 12 and 24 h after initiating iNO therapy. Six infants in the iNO-treated group and 10 infants in the control group died. Post hoc analyses did not reveal any significant differences in the incidences of chronic lung disease (CLD), intracranial hemorrhage (ICH), patent ductus arteriosus (PDA), retinopathy of prematurity (ROP) or duration of intubation between the iNO-treated and the control groups. Conclusion:We conclude that iNO therapy leads to an improvement in oxygenation without short-term side effects (such as pulmonary hemorrhage, intracranial hemorrhage, pneumothorax or acute deterioration) in premature infants with severe RDS and respiratory failure. However, iNO therapy does not significantly reduce mortality rate or the incidences of CLD, ICH, PDA or ROP.

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Section: Discussionmentioning

confidence: 99%

Inhaled nitric oxide in the management of preterm infants with severe respiratory failure

Chen

2007

J Perinatol

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“…3,4 However, its role in the management of hypoxic respiratory failure in preterm infants is not clear. [5][6][7] The beneficial effects of iNO on gas exchange, 8 pulmonary vascular disease 9 and inflammation 10 have led to its use in the prevention of BPD or in the treatment of established lung injury. 5,7,11 The evidence from multicenter clinical trials published to date does not support the use of iNO to decrease death or BPD in preterm infants.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of pulmonary hypertension in preterm neonates

et al. 2007

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Objective: Characteristics of preterm infants who develop pulmonary hypertension (PHT) and their response to inhaled nitric oxide (iNO) are not well described. Our objective was to identify risk factors for PHT in infants <37 weeks gestational age (GA) and to evaluate their response to iNO.Study design: A retrospective chart review was conducted in infants <37 weeks GA born from July/2000 to October/2005 who had an echocardiographic diagnosis of PHT in the first 4 weeks of life. A comparison non-PHT group was generated matched for GA and birth date. Data on prenatal and postnatal characteristics, response to iNO and mortality were collected.Results: Low Apgar scores, preterm premature rupture of membranes, oligohydramnios, pulmonary hypoplasia and sepsis were independently predictive of PHT. Mortality was significantly higher in the PHT group (26.2% versus 4.1%; P<0.0001) compared to the control group. Low birth weight, severe intraventricular hemorrhage and male sex were significantly associated with death in infants with PHT. Thirty-seven percent (23/61) of infants with PHT were treated with inhaled NO. Infants <29-week GA had poor response to iNO and the response to iNO increased with GA (P<0.02).Conclusions: Low Apgar scores, oligohydramnios and pulmonary hypoplasia are associated with the development of PHT in premature infants. The percentage of infants responding to iNO increases with advancing GA.

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“…6,7 Inhaled nitric oxide (INO) has a prominent role in the treatment of severe hypoxemic respiratory failure from a variety of causes because of its proven efficacy in decreasing ventilation-perfusion mismatch and improving oxygenation. 8,9 In both primary and secondary persistent pulmonary hypertension of the newborn, INO improves oxygenation, reduces the need for ECMO, or improves neurodevelopmental outcomes when other therapies fail. [10][11][12][13] Clinicians have hoped that pulmonary hypertension in patients with CDH would respond similarly; however, no randomized trial has demonstrated that INO improves outcomes in these patients.…”

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confidence: 99%