Inhaled nitric oxide in preterm neonates with preterm prelabour rupture of membranes, a systematic review

Mullaly, Rachel; McCallion, Naomi; El‐Khuffash, Afif

doi:10.1111/apa.16596

Cited by 4 publications

(5 citation statements)

References 27 publications

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“…iNO is frequently used to treat neonatal hypoxic respiratory failure (persistent high pulmonary vascular pressure and resultant right-to-left shunting of blood). 6,7 We found that neonates with a longer period of MVP <1 cm more frequently used iNO after birth, whereas the period of MVP <2 cm did not affect the neonatal use of iNO.…”

Section: Discussionmentioning

confidence: 65%

“…Our data likewise indicate that iNO are more frequently needed in CAOS than in non‐CAOS, which suggest that exposure to bloody amniotic fluid may have increased iNO use. iNO is frequently used to treat neonatal hypoxic respiratory failure (persistent high pulmonary vascular pressure and resultant right‐to‐left shunting of blood) 6,7 . We found that neonates with a longer period of MVP <1 cm more frequently used iNO after birth, whereas the period of MVP <2 cm did not affect the neonatal use of iNO.…”

Section: Discussionmentioning

confidence: 77%

“…Neonates are occasionally treated with inhaled nitric oxide (iNO) to improve pulmonary hypertension or hypoxemic respiratory failure after birth. 6,7 Furthermore, BPD occurs, and some patients require home oxygen therapy (HOT) when discharged. Given these issues, early delivery may be desirable to shorten the period of hemosiderin exposure and oligohydramnios.…”

Section: Introductionmentioning

confidence: 99%

“…These two problems can inevitably lead to neonatal respiratory complications. Neonates are occasionally treated with inhaled nitric oxide (iNO) to improve pulmonary hypertension or hypoxemic respiratory failure after birth 6,7 . Furthermore, BPD occurs, and some patients require home oxygen therapy (HOT) when discharged.…”

Section: Introductionmentioning

confidence: 99%

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The prognosis of neonatal respiratory status within three years after birth in chronic abruption‐oligohydramnios sequence

Nishikawa

Taki

Okamoto

et al. 2023

J of Obstet and Gynaecol

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AimChronic abruption‐oligohydramnios sequence (CAOS), which is characterized by vaginal bleeding and oligohydramnios, adversely affects the lungs of fetuses due to bloody amniotic fluid and oligohydramnios. The criteria for termination of pregnancy remain controversial. This study aimed to examine respiratory function in infants within 3 years after birth and risk factors for respiratory prognosis, and to clarify the management of CAOS.MethodsThis study is a case series of patients with CAOS managed at our institution between 2010 and 2020. The clinical data of the patients and their infants within 3 years after birth were reviewed. The amniotic fluid volume was measured using the maximum vertical pocket (MVP).ResultsSix of 17 neonates (35.3%) used inhaled nitric oxide (iNO) to improve oxygenation. Women with longer periods of MVP <1 cm delivered more neonates using iNO; however, periods of MVP <2 cm were not associated with iNO use. Almost half of the infants required home oxygen therapy when discharged, regardless of amniotic fluid volume. At 18 months corrected age, only one child needed respiratory support, and the others discontinued. Two neonates, both born at 23 weeks of gestational age, died within 1 month after birth because of extremely preterm birth.ConclusionsThe amniotic fluid volume could predict the use of iNO in neonates, but it did not affect the child's respiratory function after the newborn period. Almost all children born to women with CAOS can improve their respiratory function as they grow up.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The prognosis of neonatal respiratory status within three years after birth in chronic abruption‐oligohydramnios sequence

Nishikawa

Taki

Okamoto

et al. 2023

J of Obstet and Gynaecol

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“…A systematic review evaluating the use of iNO in premature infants with preterm premature rupture of membrane was recently published. This study concluded that iNO improved oxygenation in this population, likely secondary to the high prevalence of PPHN [ 31 ]. Two recently published studies evaluated iNO response in premature infants born at <34 weeks of gestation that was initiated for the indication of HRF associated with PPHN.…”

Section: Discussionmentioning

confidence: 99%

The early use of inhaled nitric oxide in premature infants requiring respiratory support

Osman

2023

Annals of Medicine

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Background: Earlier studies on the use of inhaled nitric oxide (iNO) for premature infants born at <34 weeks of gestation requiring respiratory support did not provide conclusive evidence of benefit. National guidelines generally discouraged the use in this population. More recent national guidelines endorsed the use of iNO in premature infants with hypoxic respiratory failure (HRF) associated with persistent pulmonary hypertension of the newborn (PPHN). Recent Studies: Two recently published observational studies evaluated the effect of administering iNO on oxygenation in the first week of life. These studies compared premature infants born at the gestational age (GA) of <34 weeks with HRF associated with PPHN to term and late preterm infants born at the GA of ≥34 weeks who received iNO. Both studies showed a similar effect of iNO on oxygenation in the two infant cohorts. The response rate in the premature infant cohort was 59% in the first study and 90% in the second. The mean response time was 9.2 h and 10.3 h, and the mean duration of therapy was 3.5 days and 8.2 days, respectively. Conclusion: The results of these studies support a trial of iNO in premature infants with persistent hypoxia despite optimum respiratory support. Obtaining a timely echocardiogram to exclude cardiac diseases and diagnose PPHN is logistically challenging for many clinicians, thus, a clinical diagnosis of PPHN might have to be made in these situations. Questions remain regarding the optimum dose of iNO and the duration of the initial iNO trial in these patients. KEY MESSAGES In the most recently published studies, the improvement of oxygenation in iNO-treated infants born at <34 weeks of gestation with HRF and PPHN physiology was as effective as in infants born ≥34 weeks. These studies provide evidence supporting a trial of iNO in the subpopulation of premature infants with HRF associated with PPHN.

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A multicenter epidemiological survey of iNO use in preterm infants in China

Liang,

Wang,

Huang

et al. 2024

Pediatric Pulmonology

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ObjectiveTo investigate the use of inhaled nitric oxide (iNO) in hospitalized preterm infants in China over 10 years and its clinical outcomes.MethodsA total of 616 premature infants who were administered iNO in the Neonatology Departments of 5 Class A tertiary hospitals in China for ten years from January 2013 to December 2022 were included retrospectively. Based on their enrollment periods, the patients were divided into two groups: Group 1 from January 2013 to December 2017 and Group 2 from January 2018 to December 2022, respectively. The perinatal characteristics, short‐term clinical outcomes, and mortality rates were compared between these two groups.ResultsThe utilization of iNO in preterm infants grew annually over the past10 years; the utilization of iNO in Group 2 infants increased approximately one‐fold when compared with Group 1 (1.52% vs. 0.80%, p < .001), and the increase was greater in gestational age (GA) < 34 weeks compared with 34–36 weeks preterm infants. Moreover, the iNO usage in Group 1 infants with GA < 34 weeks increased from 1.14% to 2.46% and 0.60% to 0.99% in 34–36 weeks preterm infants (p < .001) in Group 2, respectively. Apart from a smaller GA (32.9 w vs. 33.5 w, p < .001) and birth weight (BW, 1900 g vs. 2141 g, p < .001), the initial [14 parts per million (ppm) versus 10 ppm, p < .001] and maximum (15 ppm vs. 10 ppm, p < .001) doses of Group 2 were larger; however, their recent clinical outcomes did not improve with increasing iNO utilization (p > .05)as compared to Group 1, respectively. Although the overall iNO preterm mortality rates over the past 10 years were 25.8%, the mortality rates for preterm infants at 34–36 weeks were significantly lower than for preterm infants at GA < 34 weeks (15.4% vs. 33.8%, p < .001). Nonetheless, no improvement in mortality was observed in Group 2 preterm infants with GA < 34 weeks for the past 5 years when compared with Group 1 (32.9% vs. 35.8%, p > .05) infants, and significantly lower mortality rates were noticed in preterm infants with 34–36 weeks (11.2% vs. 22.7%, p < .001). Patients with hypoxic respiratory failure (HRF) or persistent pulmonary hypertension of the newborn (PPHN) iNO preterm infants did not show lower mortality rates with the increase of iNO use rate (p > .05). The overall mortality rates of preterm PPHN infants with iNO were lower than that of HRF (20.2% vs. 36.5%, p < .001), while the mortality rates of Group 2 preterm PPHN infants with iNO significantly lower than that of HRF (17.7% vs 36.0%, p < .001).ConclusionThe iNO has been extensively used in Chinese preterm infants over the past 10 years, this increase was more significant in preterm infants with GA < 34 weeks. Moreover, preterm infants using iNO have lower GA and BW, larger initial and maximum doses, and more aggressive strategies in the last past 5 years. Although iNO use in preterm infants with GA of 34–36 weeks has significantly reduced mortality, mortality rates and short‐term clinical outcomes of iNO in preterm infants <34 weeks of GA has no obvious improvement. Further studies are required to investigate the efficacy and safety of iNO in preterm infants <34 weeks of GA.

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Inhaled nitric oxide in preterm neonates with preterm prelabour rupture of membranes, a systematic review

Cited by 4 publications

References 27 publications

The prognosis of neonatal respiratory status within three years after birth in chronic abruption‐oligohydramnios sequence

The prognosis of neonatal respiratory status within three years after birth in chronic abruption‐oligohydramnios sequence

The early use of inhaled nitric oxide in premature infants requiring respiratory support

A multicenter epidemiological survey of iNO use in preterm infants in China

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