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Inhaled nitric oxide and gentle ventilation in the treatment of pulmonary hypertension of the newborn--a single-center, 5-year experience.
J Perinatol. 2002 Sep; 22(6):435-41.JP

Abstract

OBJECTIVE

To evaluate the effect of inhaled nitric oxide (INO) in pulmonary hypertension of the newborn (PH) in a single center over 5 years using gentle ventilation (GV), without hyperventilation or induced alkalosis.

METHODS

Data from 229 consecutive infants with PH of varied etiology treated with INO and GV, and from 67 infants with meconium aspiration syndrome (MAS) and primary PH (PPHN) treated with GV alone were reviewed over a 5-year period (86% outborn). INO was initiated at 25 ppm when PH and severe hypoxemia persisted despite maximal optimal ventilation. Hyperventilation or systemic alkalosis were not attempted.

RESULTS

Mean duration of ventilation was 9.9 +/- 14 days (median 6.5 days). Average mean airway pressure (MAP) dropped from 17.7 +/- 4.3 cm H(2)O at the referral hospital to 13.2 +/- 2.5 cm H(2)O (p < 0.001) following admission to our unit using conventional settings and GV, before starting INO. Mean oxygenation index (OI) dropped from 46.8 +/- 24.5 to 22.7 +/- 21.4 within 24 hours of INO therapy (p < 0.001). Infants with higher baseline pH and lower baseline OI responded better to INO (p < 0.02). Overall survival was 72%. Patients with MAS and PPHN had the best response, 92% survived and there was a 46% reduction in need for extracorporeal membrane oxygenation (ECMO) compared to historical pre-INO period controls (23.9% vs. 12.8%, p < 0.01). In the infants treated with GV alone, the MAP dropped from 17.2 +/- 4.3 cm H2O at the referral hospital to 12.6+/-2.4 after GV was started in our unit.

CONCLUSIONS

We conclude that INO is an effective and well-tolerated therapy for PH in infants receiving GV.

Authors+Show Affiliations

Gupta A
Department of Pediatrics, The Children's Hospital of New York, College of Physicians and Surgeons, Columbia University, New York, NY 10032,USA.
Rastogi S
No affiliation info available
Sahni R
No affiliation info available
Bhutada A
No affiliation info available
Bateman D
No affiliation info available
Rastogi D
No affiliation info available
Smerling A
No affiliation info available
Wung JT
No affiliation info available

MeSH

Academic Medical CentersAdministration, InhalationAnalysis of VarianceCohort StudiesCombined Modality TherapyFemaleFollow-Up StudiesHumansHydrogen-Ion ConcentrationInfant, NewbornInfant, PrematureMaleNew York CityNitric OxidePersistent Fetal Circulation SyndromeProbabilityRegistriesRespiration, ArtificialStatistics, NonparametricSurvival AnalysisTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12168118

Citation

Gupta, Anju, et al. "Inhaled Nitric Oxide and Gentle Ventilation in the Treatment of Pulmonary Hypertension of the Newborn--a Single-center, 5-year Experience." Journal of Perinatology : Official Journal of the California Perinatal Association, vol. 22, no. 6, 2002, pp. 435-41.
Gupta A, Rastogi S, Sahni R, et al. Inhaled nitric oxide and gentle ventilation in the treatment of pulmonary hypertension of the newborn--a single-center, 5-year experience. J Perinatol. 2002;22(6):435-41.
Gupta, A., Rastogi, S., Sahni, R., Bhutada, A., Bateman, D., Rastogi, D., Smerling, A., & Wung, J. T. (2002). Inhaled nitric oxide and gentle ventilation in the treatment of pulmonary hypertension of the newborn--a single-center, 5-year experience. Journal of Perinatology : Official Journal of the California Perinatal Association, 22(6), 435-41.
Gupta A, et al. Inhaled Nitric Oxide and Gentle Ventilation in the Treatment of Pulmonary Hypertension of the Newborn--a Single-center, 5-year Experience. J Perinatol. 2002;22(6):435-41. PubMed PMID: 12168118.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inhaled nitric oxide and gentle ventilation in the treatment of pulmonary hypertension of the newborn--a single-center, 5-year experience. AU - Gupta,Anju, AU - Rastogi,Shantanu, AU - Sahni,Rakesh, AU - Bhutada,Alok, AU - Bateman,David, AU - Rastogi,Deepa, AU - Smerling,Arthur, AU - Wung,Jen-Tien, PY - 2002/8/9/pubmed PY - 2002/11/26/medline PY - 2002/8/9/entrez SP - 435 EP - 41 JF - Journal of perinatology : official journal of the California Perinatal Association JO - J Perinatol VL - 22 IS - 6 N2 - OBJECTIVE: To evaluate the effect of inhaled nitric oxide (INO) in pulmonary hypertension of the newborn (PH) in a single center over 5 years using gentle ventilation (GV), without hyperventilation or induced alkalosis. METHODS: Data from 229 consecutive infants with PH of varied etiology treated with INO and GV, and from 67 infants with meconium aspiration syndrome (MAS) and primary PH (PPHN) treated with GV alone were reviewed over a 5-year period (86% outborn). INO was initiated at 25 ppm when PH and severe hypoxemia persisted despite maximal optimal ventilation. Hyperventilation or systemic alkalosis were not attempted. RESULTS: Mean duration of ventilation was 9.9 +/- 14 days (median 6.5 days). Average mean airway pressure (MAP) dropped from 17.7 +/- 4.3 cm H(2)O at the referral hospital to 13.2 +/- 2.5 cm H(2)O (p < 0.001) following admission to our unit using conventional settings and GV, before starting INO. Mean oxygenation index (OI) dropped from 46.8 +/- 24.5 to 22.7 +/- 21.4 within 24 hours of INO therapy (p < 0.001). Infants with higher baseline pH and lower baseline OI responded better to INO (p < 0.02). Overall survival was 72%. Patients with MAS and PPHN had the best response, 92% survived and there was a 46% reduction in need for extracorporeal membrane oxygenation (ECMO) compared to historical pre-INO period controls (23.9% vs. 12.8%, p < 0.01). In the infants treated with GV alone, the MAP dropped from 17.2 +/- 4.3 cm H2O at the referral hospital to 12.6+/-2.4 after GV was started in our unit. CONCLUSIONS: We conclude that INO is an effective and well-tolerated therapy for PH in infants receiving GV. SN - 0743-8346 UR - https://www.unboundmedicine.com/medline/citation/12168118/Inhaled_nitric_oxide_and_gentle_ventilation_in_the_treatment_of_pulmonary_hypertension_of_the_newborn__a_single_center_5_year_experience_ DB - PRIME DP - Unbound Medicine ER -