Inhaled Nitric Oxide for Oligohydramnios-Induced Pulmonary Hypoplasia: A Report of Two Cases and Review of the Literature

Geary, Cara; Whitsett, Jeffrey A.

doi:10.1038/sj.jp.7210580

Cited by 45 publications

(38 citation statements)

References 23 publications

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“…Lung fluid is kept pressurized by a combination of laryngeal closure and fluid production by the respiratory epithelia. The pressure of fetal lung fluid is important for lung growth as illustrated by the pulmonary hypoplasia seen in neonates with oligohydramnios [26][27][28] . Preterm infants with hypoplastic lungs may have elevated pulmonary vascular resistance; this may be related to maldevelopment including a decrease in the cross-sectional area and abnormal muscularization of the pulmonary vasculature [28][29][30] .…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Pulmonary Artery Hypertension in Preterm Infants with Moderate or Severe Bronchopulmonary Dysplasia

et al. 2011

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Background: Despite the potential importance of pulmonary artery hypertension (PAH) in preterm infants with bronchopulmonary dysplasia (BPD), little is known about the risk factors for PAH. Objectives: To investigate the risk factors for PAH in preterm infants with BPD. Methods: Infants diagnosed with BPD were assigned to the PAH group or non-PAH group except for infants with mild BPD who had no PAH. PAH was diagnosed on the basis of echocardiograms demonstrating elevated right ventricle pressure beyond the postnatal age of 2 months. Logistic regression analysis was done for the multivariate assessment of the risk factors for PAH in preterm infants with moderate or severe BPD. Results: A total of 98 infants among 145 infants with BPD were divided into a PAH group (n = 25) or non-PAH group (n = 73), while the remaining 47 infants had mild BPD with no PAH. Among the study patients, survival rate of the PAH group was significantly lower than that of the non-PAH group. Infants with PAH had more severe cases of BPD and underwent longer durations of oxygen therapy, conventional or high-frequency ventilation, and hospitalization compared to those without PAH. Low 5-min Apgar scores (≤6; relative risk (RR) 6.2; 95% confidence interval (CI) 1.4–28.0; p = 0.017) and oligohydramnios (RR 7.7; 95% CI 2.0–29.6; p = 0.030) were found to be significant risk factors for PAH according to multivariate analysis. Conclusions: The present study shows that oligohydramnios is a specific risk factor for PAH in preterm infants with moderate or severe BPD.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Pulmonary Artery Hypertension in Preterm Infants with Moderate or Severe Bronchopulmonary Dysplasia

et al. 2011

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“…In a published response to the AAP committee recommendations, Schreiber [14] noted evidence from several retrospective studies demonstrating the efficacy of iNO in preterm neonates with PH [15][16][17] and recommended that clinicians be allowed to use clinical judgment regarding the best use of iNO in this patient population pending further study. As clinicians, we recognize that iNO is, in fact, already being used off label in this preterm population.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of inhaled nitric oxide in neonates with hypoxic respiratory failure and pulmonary hypertension: the Japanese experience

Suzuki

Togari

Potenziano

et al. 2018

Journal of Perinatal Medicine

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Objective: To analyze data from a registry of Japanese neonates with hypoxic respiratory failure associated with pulmonary hypertension (PH) to compare the effectiveness of inhaled nitric oxide (iNO) in neonates born <34 weeks vs. ≥34 weeks gestational age (GA). Materials and methods: iNO was administered according to approved Japanese product labeling. Study data were collected before iNO administration and at predefined intervals until discontinuation. Results: A total of 1,114 neonates were included (n = 431, <34 weeks GA; n = 675, ≥34 weeks GA; n = 8, missing age data). Mean decrease from baseline oxygenation index (OI) was similar in both age groups. OI reduction was more pronounced in the <34 weeks subgroups with baseline OI ≥25. Survival rates were similar in the <34 weeks GA and ≥34 weeks GA groups stratified by baseline OI (OI < 15, 89% vs. 93%; 15 ≤ OI < 25, 85% vs. 91%; 25 ≤ OI ≤ 40, 73% vs. 79%; OI > 40, 64% vs. 66%). Conclusion: iNO improved oxygenation in preterm neonates as effectively as in late preterm and term neonates, without negative impact on survival. If clinically significant PH is present, as measured by pulse oximetry or echocardiography, a therapeutic trial of iNO might be indicated for preterm neonates.

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“…Prolonged oligohydramnios attributable to premature rupture of membranes (PROM) or renal and urinary-tract malformations may lead to abnormal fetal lung development and lung hypoplasia with subsequent severe respiratory distress immediately after birth and even neonatal death. Preterm infants with hypoplastic lungs may have elevated pulmonary vascular resistance 16,17 and this may be related to maldevelopment including a decrease in the cross-sectional area and an abnormal muscularization of the pulmonary vasculature. 18 In a large prospective cohort study of rupture of membranes (ROM) at 15 to 28 weeks' gestation, GA at the time of ROM, latency period and amniotic fluid index were important independent predictors of neonatal pulmonary hypoplasia and perinatal death.…”

Section: Discussionmentioning

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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Inhaled Nitric Oxide for Oligohydramnios-Induced Pulmonary Hypoplasia: A Report of Two Cases and Review of the Literature

Cited by 45 publications

References 23 publications

Risk Factors for Pulmonary Artery Hypertension in Preterm Infants with Moderate or Severe Bronchopulmonary Dysplasia

Risk Factors for Pulmonary Artery Hypertension in Preterm Infants with Moderate or Severe Bronchopulmonary Dysplasia

Efficacy of inhaled nitric oxide in neonates with hypoxic respiratory failure and pulmonary hypertension: the Japanese experience

Characteristics of pulmonary hypertension in preterm neonates

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