Low-Dose Inhalational Nitric Oxide in Persistent Pulmonary Hypertension of the Newborn

Kinsella, John P.; Neish, Steven R.; Shaffer, Elizabeth

doi:10.1097/00132586-199404000-00045

Cited by 113 publications

(145 citation statements)

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“…Because infants with CDH present with severe pulmonary hypertension, inhalational nitric oxide has been used recently in the management of these infants. 30,31 New-borns with CDH also have pulmonary hypoplasia; in a recent controlled trial, inhaled nitric oxide did not reduce the need for ECMO or death in infants with CDH. 31 Although all of the above modalities are useful in treating some infants with CDH, patients with severe diaphragmatic hernia will require ECMO treatment, and attention should be focused toward improvement of the long-term neurodevelopmental outcome in these infants.…”

Section: Discussionmentioning

confidence: 98%

Survival, Intracranial Lesions, and Neurodevelopmental Outcome in Infants With Congenital Diaphragmatic Hernia Treated With Extracorporeal Membrane Oxygenation

et al. 1999

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OBJECTIVE:Before the use of extracorporeal membrane oxygenation (ECMO), infants with a severe form of congenital diaphragmatic hernia (CDH) had a high mortality and morbidity. Recent studies have shown an improvement in the survival of these infants after ECMO treatment; however, the existing data do not provide sufficient information regarding the quality of survival and developmental outcome of these infants. The objective of this study was to evaluate survival, intracranial lesions, and the neurodevelopmental outcome of infants with CDH treated with ECMO. METHODS:We retrieved data for 51 (n ϭ 51) infants with CDH who were treated with ECMO at Huntington Memorial Hospital between 1985 and 1994. Their mean gestational age was 38.5 Ϯ 2.4 weeks (mean Ϯ SD); their mean birth weight was 3170 Ϯ 620 gm. Vital signs, arterial blood gases, chest radiographs, cranial and cardiac ultrasonography were routinely obtained before ECMO treatment. Cranial ultrasounds were performed daily on all infants while on ECMO; computerized tomography scans were obtained on all infants after completion of ECMO treatment. The surviving infants were followed at our neonatal follow-up clinic for neurodevelopmental assessment. RESULTS:A total of 39 infants were placed on venoarterial ECMO and 12 infants were placed on venovenous ECMO; a total of 35 infants had CDH repair before ECMO, whereas 16 infants had delayed surgery. A total of 31 infants (61%) survived. The infants who survived had a mean pH of 7.33 Ϯ 0.20, mean airway pressure of 19.6 Ϯ 5.8 cm H 2 O, and an oxygenation index (OI) of 87 Ϯ 55 before ECMO intervention. The infants who expired (n ϭ 20) had a mean pH of 7.31 Ϯ 0.15, mean airway pressure of 23.1 Ϯ 5.5 cm H 2 O, and a mean oxygenation index of 127 Ϯ 56 before ECMO treatment. Before ECMO, survivors had a significantly lower oxygenation index and a higher PaO 2 compared with nonsurvivors (p Ͻ 0.01). A total of 18 infants (35%) had abnormal central nervous system findings. Of the 51 infants, 10 had ventricular dilatation, 6 had intracranial hemorrhage, and 11 had focal or diffuse cerebral atrophy diagnosed by computerized tomography scan or at autopsy (1 patient had an infarct). Eight infants had more than one central nervous system abnormality. A total of 16 survivors had a neurodevelopmental evaluation at 12 months, and 11 of these survivors were evaluated at 24 months of age (Bayley Scales of Infant Development). The developmental progress of these infants falls within the low-average range of cognitive and motor abilities. Their mean Bayley Mental Developmental Index was 85 Ϯ 25 (50 to 145) at 24 months; their Psychomotor Developmental Index was 89 Ϯ 21 (50 to 113) at 24 months of age. Follow-up at 4 and 6 years of age is in progress. CONCLUSION:Our preliminary findings indicate that 35% of infants with severe CDH requiring ECMO had central nervous system abnormalities (intracranial lesions, including ventricular dilatation). The survival rate in our study population is consistent with recent reports. As a group, infants w...

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Section: Discussionmentioning

confidence: 98%

Survival, Intracranial Lesions, and Neurodevelopmental Outcome in Infants With Congenital Diaphragmatic Hernia Treated With Extracorporeal Membrane Oxygenation

et al. 1999

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“…Persistent pulmonary hypertension of the newborn results from extreme pulmonary vasoconstriction, the precise cause of which is unknown, and has been associated with meconium aspiration, hyaline membrane disease, and group B streptococcal sepsis (36). Elevated pulmonary artery pressures may result in right-to-left shunting through a patent ductus arteriosus and foramen ovale, leading to severe hypoxia.…”

Section: Role Of Nitric Oxide In Pediatricsmentioning

confidence: 99%

“…The large increase in NO then leads to systemic vasodilation and hypotension, often refractory to vasoconstrictors. In this situation, inhibition of NO production might help to control the with persistent pulmonary hypertension (versus pulmonary hypertension in adults) is that a short-term reduction in pulmonary vascular resistance often will be sufficient to resolve persistent pulmonary hypertension of the newborn (36).…”

Section: Use Of Nitric Oxide Antagonistsmentioning

confidence: 99%

“…Dexamethasone also has been shown to decrease the prolonged bleeding time in uremic patients (47). red blood cell methemoglobin reductase (36). In practice, the inhaled NO source is attached as close to the patient as possible in the inspiratory limb of the breathing circuit, and high flow rates are used to minimize NO and Oz mixing.…”

Section: Nitric Oxide and Anesthesiamentioning

confidence: 99%

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Nitric Oxide: No Laughing Matter

Carnes

Anderson

Head

et al. 1994

Baylor University Medical Center Proceedings

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“…7 These initial results led to pilot trials in babies showing that, when iNO was administered in severe pulmonary hypertension, an improvement in oxygenation was seen. 8 These observations subsequently led to large, randomized trials in infants with hypoxemic respiratory failure or persistent pulmonary hypertension of the newborn (PPHN). The results of these trials showed that, in a majority of the infants, iNO therapy reduced the need for extracorporeal membrane oxygenation (ECMO).…”

Section: Introductionmentioning

confidence: 99%

Inhaled nitric oxide in term and preterm infants

Sekar

2006

J Perinatol

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Nitric oxide (NO) is a gas that has potent vasodilator properties. It can be administered via inhalation in situations where NO production is impaired and results in vasodilatation of the pulmonary capillaries. In term infants, the administration of inhaled NO, at a dose of 20 parts per million, may reduce the need for extracorporeal membrane oxygenation by reducing pulmonary vascular resistance and improving oxygenation. Inhaled NO is an approved therapy in term babies with severe hypoxemic respiratory failure. In premature infants, inhaled NO may increase bleeding time and decrease platelet aggregation resulting in an increased risk for intraventricular hemorrhage. Early administration of inhaled NO may also potentially decrease the risk for developing chronic lung disease in premature infants. However, since studies show conflicting results, inhaled NO should only be used in premature neonates following investigational review board approved protocols.

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Low-Dose Inhalational Nitric Oxide in Persistent Pulmonary Hypertension of the Newborn

Cited by 113 publications

References 0 publications

Survival, Intracranial Lesions, and Neurodevelopmental Outcome in Infants With Congenital Diaphragmatic Hernia Treated With Extracorporeal Membrane Oxygenation

Survival, Intracranial Lesions, and Neurodevelopmental Outcome in Infants With Congenital Diaphragmatic Hernia Treated With Extracorporeal Membrane Oxygenation

Nitric Oxide: No Laughing Matter

Inhaled nitric oxide in term and preterm infants

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