Neuronal nitric oxide synthase immunoreactivity in ependymal cells during early postnatal development

Soygüder, Zafer; Karadağ, Hüseyin; Nazli, Mümtaz

doi:10.1016/j.jchemneu.2003.08.004

Cited by 8 publications

(8 citation statements)

References 35 publications

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“…This is the same group (SGA infants) also at increased risk for PH, and hence at increased risk for mortality. Despite direct beneficial effects on the brain in animal models [ 94 , 95 ], iNO has no demonstrable beneficial effect on neuro-developmental outcomes in premature infants [ 96 , 97 ].…”

Section: Management Of Infants With Phmentioning

confidence: 99%

Diagnostic Approach to Pulmonary Hypertension in Premature Neonates

Kumar

2017

Children

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Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease in premature infants following respiratory distress at birth. With increasing survival of extremely low birth weight infants, alveolar simplification is the defining lung characteristic of infants with BPD, and along with pulmonary hypertension, increasingly contributes to both respiratory morbidity and mortality in these infants. Growth restricted infants, infants born to mothers with oligohydramnios or following prolonged preterm rupture of membranes are at particular risk for early onset pulmonary hypertension. Altered vascular and alveolar growth particularly in canalicular and early saccular stages of lung development following mechanical ventilation and oxygen therapy, results in developmental lung arrest leading to BPD with pulmonary hypertension (PH). Early recognition of PH in infants with risk factors is important for optimal management of these infants. Screening tools for early diagnosis of PH are evolving; however, echocardiography is the mainstay for non-invasive diagnosis of PH in infants. Cardiac computed tomography (CT) and magnetic resonance are being used as imaging modalities, however their role in improving outcomes in these patients is uncertain. Follow-up of infants at risk for PH will help not only in early diagnosis, but also in appropriate management of these infants. Aggressive management of lung disease, avoidance of hypoxemic episodes, and optimal nutrition determine the progression of PH, as epigenetic factors may have significant effects, particularly in growth-restricted infants. Infants with diagnosis of PH are managed with pulmonary vasodilators and those resistant to therapy need to be worked up for the presence of cardio-vascular anomalies. The management of infants and toddlers with PH, especially following premature birth is an emerging field. Nonetheless, combination therapies in a multi-disciplinary setting improves outcomes for these infants.

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Section: Management Of Infants With Phmentioning

confidence: 99%

Diagnostic Approach to Pulmonary Hypertension in Premature Neonates

Kumar

2017

Children

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“…31,32 Other investigators have described a possible role for intravascular NO-derived molecules in conserving and stabilizing NO bioactivity that may contribute to the regulation of regional blood flow and oxygen delivery. 33,34 Neurodevelopmental outcome has been reported for 6 clinical trials, [35][36][37][38][39][40] and of these, 1 noted a more favorable neurodevelopmental outcome at 1 year of age among the preterm cohort treated with iNO but no difference in the rate of cerebral palsy.…”

Section: Effects Of Ino Therapy On Neurodevelopmental Outcomementioning

confidence: 99%

Use of Inhaled Nitric Oxide in Preterm Infants

Kumar¹,

Papile²,

Polin³

et al. 2014

Pediatrics

116

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Nitric oxide, an important signaling molecule with multiple regulatory effects throughout the body, is an important tool for the treatment of full-term and late-preterm infants with persistent pulmonary hypertension of the newborn and hypoxemic respiratory failure. Several randomized controlled trials have evaluated its role in the management of preterm infants ≤34 weeks' gestational age with varying results. The purpose of this clinical report is to summarize the existing evidence for the use of inhaled nitric oxide in preterm infants and provide guidance regarding its use in this population. Pediatrics 2014;133:164-170 INTRODUCTIONNitric oxide (NO) is an important signaling molecule with multiple regulatory effects throughout the body. In perinatal medicine, inhaled nitric oxide (iNO) was initially studied for its pulmonary vasodilating effects in infants with pulmonary hypertension and has since become an important tool for the treatment of full-term and late-preterm infants with persistent pulmonary hypertension of the newborn and hypoxemic respiratory failure. 1 Inhaled NO also has multiple and complex systemic and pulmonary effects. In animal models of neonatal chronic lung disease, iNO stimulates angiogenesis, augments alveolarization, improves surfactant function, and inhibits proliferation of smooth muscle cells and abnormal elastin deposition. [2][3][4][5][6] Although the evidence for similar benefits in preterm infants is lacking, the off-label use of iNO in this population has escalated. 7 A study published in 2010 reported a sixfold increase (from 0.3% to 1.8%) in the use of iNO among infants born at less than 34 weeks' gestation between 2000 and 2008. 7 The greatest increase occurred among infants who were born at 23 to 26 weeks' gestation (0.8% to 6.6%). The National Institutes of Health convened a consensus panel in October 2010 to evaluate the evidence for safety and efficacy of iNO therapy in preterm infants. After reviewing the published evidence, the panel concluded that the available evidence does not support the use of iNO in early routine, early rescue, or later rescue regimens in the care of infants born at less than 34 weeks' gestation and that hospitals, clinicians, and the pharmaceutical industry should avoid marketing iNO for this group of infants. 8 An individual-patient data meta-analysis of 14 randomized controlled trials reached similar conclusions. 9 The purpose of this clinical report is to summarize the Praveen Kumar MD, FAAP, and COMMITTEE ON FETUS AND NEWBORN KEY WORDS inhaled nitric oxide, preterm infants, hypoxic respiratory failure, bronchopulmonary dysplasia ABBREVIATIONS BPD-bronchopulmonary dysplasia iNO-inhaled nitric oxide NO-nitric oxide NOCLD-Nitric

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“…[22][23][24] Thus, treatment with nitric oxide may have directly affected the brain through mechanisms involving the cerebral vasculature 25 or neuronal maturation. [26][27][28] Nonetheless, the mechanisms by which inhaled nitric oxide improves neurodevelopmental outcome remain unclear. Comparison of data from this and out previous study 6 with the results reported by Van Meurs et al in this issue of the Journal, 29 suggests that further research is need-ed to define the optimal dose of inhaled nitric oxide and the duration of treatment in premature infants.…”

Section: Anthropometric Measurementsmentioning

confidence: 99%