Response to Inhaled Nitric Oxide and Clinical Outcome in Very Low Birth Weight Infants with Early Pulmonary Hypertension
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Purpose: To determine the efficacy of inhaled nitric oxide (iNO) in very low birth weight (VLBW) infants with early pulmonary hypertension (PH). Methods: We reviewed the medical records of 22 preterm infants who were born <30 weeks of gestational age with birth weight <1,500 g, diagnosed with early PH, and treated with iNO within the first 72 hours after birth. Responders were defined by a reduction in FiO2 >20% and/or oxygenation index (OI) >20% from the baseline values at 1 hour after beginning iNO therapy. Cardiorespiratory support indices including OI, oxygen saturation index, and vasoactive-inotropic score (VIS) were serially obtained for 96 hours following iNO therapy. Results: The mean gestational age of the patients was 26.1±2.0 weeks and the mean birth weight was 842±298 g. The mean OI at the start of iNO was 63.8±61.0. Improvement in oxygenation indicated by prompt decrease in FiO2 and OI from the baseline values were observed 1 hour after beginning iNO therapy and lasted up to 96 hours. After iNO therapy, VIS increased until 24 hours and decreased thereafter. At 1 hour after iNO, 16 patients (73%) were classified as responders and six (27%) as nonresponders. Compared with nonresponders, responders did not demonstrate the beneficial effect of iNO in terms of short-term survival and neonatal complications. The 1-year mortality rate did not differ between responders (56%) and nonresponders (67%). Conclusion: Although iNO treatment immediately improved oxygenation in most VLBW infants with early severe PH, the long-term mortality rate was high. A largescale study is needed to determine whether the initial response to iNO can predict patients’ survival.
Abstract
Purpose: To determine the efficacy of inhaled nitric oxide (iNO) in very low birth weight (VLBW) infants with early pulmonary hypertension (PH). Methods: We reviewed the medical records of 22 preterm infants who were born <30 weeks of gestational age with birth weight <1,500 g, diagnosed with early PH, and treated with iNO within the first 72 hours after birth. Responders were defined by a reduction in FiO2 >20% and/or oxygenation index (OI) >20% from the baseline values at 1 hour after beginning iNO therapy. Cardiorespiratory support indices including OI, oxygen saturation index, and vasoactive-inotropic score (VIS) were serially obtained for 96 hours following iNO therapy. Results: The mean gestational age of the patients was 26.1±2.0 weeks and the mean birth weight was 842±298 g. The mean OI at the start of iNO was 63.8±61.0. Improvement in oxygenation indicated by prompt decrease in FiO2 and OI from the baseline values were observed 1 hour after beginning iNO therapy and lasted up to 96 hours. After iNO therapy, VIS increased until 24 hours and decreased thereafter. At 1 hour after iNO, 16 patients (73%) were classified as responders and six (27%) as nonresponders. Compared with nonresponders, responders did not demonstrate the beneficial effect of iNO in terms of short-term survival and neonatal complications. The 1-year mortality rate did not differ between responders (56%) and nonresponders (67%). Conclusion: Although iNO treatment immediately improved oxygenation in most VLBW infants with early severe PH, the long-term mortality rate was high. A largescale study is needed to determine whether the initial response to iNO can predict patients’ survival.
참고문헌 (30)
- Lakshminrusimha S, "The fetal circulation, pathophysiology of hypoxemic respiratory failure and pulmonary hypertension in neonates, and the role of oxygen therapy", J Perinatol, 36(Suppl 2), pp.S3~S11 (2016)
- Barrington KJ, "Nitric oxide for respiratory failure in infants born at or near term", Cochrane Database Syst Rev, 1, pp.CD000399~ (2017)
- Lakshminrusimha S, "Persistent pulmonary hypertension of the newborn", Neoreviews, 16, pp.e680~e692 (2015)
- Kumar VH, "Characteristics of pulmonary hypertension in preterm neonates", J Perinatol, 27, pp.214~219 (2007)
- Nakanishi H, "Persistent pulmonary hypertension of the newborn in extremely preterm infants: a Japanese cohort study", Arch Dis Child Fetal Neonatal Ed, 103, pp.F554~F561 (2018)
- Chambers CD, "Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn", N Engl J Med, 354, pp.579~587 (2006)
- Katz N, "Persistent pulmonary hypertension and histologic chorioamnionitis in preterm infants : controlled study", Pediatr Cardiol, 39, pp.705~708 (2018)
- Gijtenbeek M, "Persistent pulmonary hypertension of the newborn in twin-twin transfusion syndrome : a case-control study", Neonatology, 112, pp.402~408 (2017)
- Dani C, "Nitric oxide for the treatment of preterm infants with severe RDS and pulmonary hypertension", Pediatr Pulmonol, 52, pp.1461~1468 (2017)
- Kinsella JP, "Recommendations for the use of inhaled nitric oxide therapy in premature newborns with severe pulmonary hypertension", J Pediatr, 170, pp.312~314 (2016)
- Barrington KJ, "Inhaled nitric oxide for respiratory failure in preterm infants", Cochrane Database Syst Rev, 1, pp.CD000509~ (2017)
- de Waal K, "Prolonged rupture of membranes and pulmonary hypoplasia in very preterm infants : pathophysiology and guided treatment", J Pediatr, 166, pp.1113~1120 (2015)
- Park GY, "Shortterm outcomes comparison between preterm infants with and without acute hypoxic respiratory failure attributable to presumed pulmonary hypoplasia after prolonged preterm premature rupture of membranes before 25 gestational weeks", J Matern Fetal Neonatal Med, 32, pp.1938~1945 (2019)
- Ellsworth KR, "Association of early inhaled nitric oxide with the survival of preterm neonates with pulmonary hypoplasia", JAMA Pediatr, 172, pp.e180761~ (2018)
- Lewis AB, "Gestational changes in pulmonary vascular responses in fetal lambs in utero", Circ Res, 39, pp.536~541 (1976)
- 최은진, "1,250 g 미만 미숙아의 호흡부전에서 흡입 일산화질소 치료의 효과", Perinatology, 22(1), pp.37~46 (2011), 대한주산의학회
- Rallis D, "The efficacy of inhaled nitric oxide treatment in premature infants with acute pulmonary hypertension", Early Hum Dev, 127, pp.1~5 (2018)
- Bell MJ, "Neonatal necrotizing enterocolitis : therapeutic decisions based upon clinical staging", Ann Surg, 187, pp.1~7 (1978)
- Papile LA, "Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm", J Pediatr, 92, pp.529~534 (1978)
- de Vries LS, "The spectrum of leukomalacia using cranial ultrasound", Behav Brain Res, 49, pp.1~6 (1992)
- International Committee for the Classification of Retinopathy of Prematurity, "The international classification of retinopathy of prematurity revisited", Arch Ophthalmol, 123, pp.991~999 (2005)
- Ehrenkranz RA, "Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia", Pediatrics, 116, pp.1353~1360 (2005)
- Baczynski M, "Short-term and long-term outcomes of preterm neonates with acute severe pulmonary hypertension following rescue treatment with inhaled nitric oxide", Arch Dis Child Fetal Neonatal Ed, 102, pp.F508~F514 (2017)
- 정성훈, "Improvement in the Survival Rates of Very Low Birth Weight Infants after the Establishment of the Korean Neonatal Network: Comparison between the 2000s and 2010s", Journal of Korean Medical Science, 32(8), pp.1228~1234 (2017), 대한의학회
- Day RW, "Acute response to inhaled nitric oxide in newborns with respiratory failure and pulmonary hypertension", Pediatrics, 98, pp.698~705 (1996)
- Semberova J, "Inhaled nitric oxide in preterm infants with prolonged preterm rupture of the membranes : a case series", J Perinatol, 35, pp.304~306 (2015)
- Aikio O, "Transient defect in nitric oxide generation after rupture of fetal membranes and responsiveness to inhaled nitric oxide in very preterm infants with hypoxic respiratory failure", J Pediatr, 161, pp.397~403 (2012)
- Steinhorn RH, "Advances in neonatal pulmonary hypertension", Neonatology, 109, pp.334~344 (2016)
- Rawat M, "Oxygen saturation index and severity of hypoxic respiratory failure", Neonatology, 107, pp.161~166 (2015)
- Muniraman HK, "Evaluation of oxygen saturation index compared with oxygenation index in neonates with hypoxemic respiratory failure", JAMA Netw Open, 2, pp.e191179~ (2019)