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Airway function in infants treated with inhaled nitric oxide for persistent pulmonary hypertension.
Pediatr Pulmonol. 2008 Mar; 43(3):224-35.PP

Abstract

RATIONALE

Inhaled nitric oxide (iNO), used for treatment of persistent pulmonary hypertension of newborn (PPHN), is an oxygen free radical with potential for lung injury. Deferring ECMO with iNO in these neonates could potentially have long-term detrimental effects on lung function. We studied respiratory morbidity (defined as occurrence of respiratory infections requiring treatment, episodes of wheezing, and/or need for ongoing medications following discharge) and airway function at 1 year postnatal age in term neonates treated with iNO but not ECMO for PPHN, and compared data from similar infants recruited to the UK ECMO Trial randomized to receive ECMO or conventional management (CM).

METHODS

Maximal expiratory flow at FRC (V(') (maxFRC)) was measured in infants treated with iNO for PPHN (oxygenation index >or=25) at birth.

RESULTS

V(') (maxFRC) was measured in 23 infants and expressed as z-scores, to adjust for sex and body size and compared to data from 71 (46 ECMO, 25 CM) infants studied at a similar age in the ECMO Trial. Respiratory morbidity was low in iNO group. V(') (maxFRC) z-score was lower than predicted in all groups (P < 0.001), with no significant difference between those treated with iNO [mean (SD) z-score: -1.65 (1.2)] and those treated with ECMO [-1.59 (1.2)] or CM [-2.1(1.0)]. Within iNO, ECMO and CM groups; 26%, 37% and 56%, respectively, had V(') (maxFRC) z-scores below normal.

CONCLUSIONS

Respiratory outcome at 1 year in iNO treated neonates with moderately severe PPHN is encouraging, with no apparent increase in respiratory morbidity when compared to the general population. Sub-clinical reductions in airway function are evident at 1 year, suggesting that continuing efforts to minimize lung injury in the neonatal period are warranted to maximize lung health in later life.

Authors+Show Affiliations

Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK. hoskoa@gosh.nhs.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18203182

Citation

Hoskote, Aparna U., et al. "Airway Function in Infants Treated With Inhaled Nitric Oxide for Persistent Pulmonary Hypertension." Pediatric Pulmonology, vol. 43, no. 3, 2008, pp. 224-35.
Hoskote AU, Castle RA, Hoo AF, et al. Airway function in infants treated with inhaled nitric oxide for persistent pulmonary hypertension. Pediatr Pulmonol. 2008;43(3):224-35.
Hoskote, A. U., Castle, R. A., Hoo, A. F., Lum, S., Ranganathan, S. C., Mok, Q. Q., & Stocks, J. (2008). Airway function in infants treated with inhaled nitric oxide for persistent pulmonary hypertension. Pediatric Pulmonology, 43(3), 224-35. https://doi.org/10.1002/ppul.20733
Hoskote AU, et al. Airway Function in Infants Treated With Inhaled Nitric Oxide for Persistent Pulmonary Hypertension. Pediatr Pulmonol. 2008;43(3):224-35. PubMed PMID: 18203182.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Airway function in infants treated with inhaled nitric oxide for persistent pulmonary hypertension. AU - Hoskote,Aparna U, AU - Castle,Rosemary A, AU - Hoo,Ah-Fong, AU - Lum,Sooky, AU - Ranganathan,Sarath C, AU - Mok,Quen Q, AU - Stocks,Janet, PY - 2008/1/19/pubmed PY - 2008/4/2/medline PY - 2008/1/19/entrez SP - 224 EP - 35 JF - Pediatric pulmonology JO - Pediatr Pulmonol VL - 43 IS - 3 N2 - RATIONALE: Inhaled nitric oxide (iNO), used for treatment of persistent pulmonary hypertension of newborn (PPHN), is an oxygen free radical with potential for lung injury. Deferring ECMO with iNO in these neonates could potentially have long-term detrimental effects on lung function. We studied respiratory morbidity (defined as occurrence of respiratory infections requiring treatment, episodes of wheezing, and/or need for ongoing medications following discharge) and airway function at 1 year postnatal age in term neonates treated with iNO but not ECMO for PPHN, and compared data from similar infants recruited to the UK ECMO Trial randomized to receive ECMO or conventional management (CM). METHODS: Maximal expiratory flow at FRC (V(') (maxFRC)) was measured in infants treated with iNO for PPHN (oxygenation index >or=25) at birth. RESULTS: V(') (maxFRC) was measured in 23 infants and expressed as z-scores, to adjust for sex and body size and compared to data from 71 (46 ECMO, 25 CM) infants studied at a similar age in the ECMO Trial. Respiratory morbidity was low in iNO group. V(') (maxFRC) z-score was lower than predicted in all groups (P < 0.001), with no significant difference between those treated with iNO [mean (SD) z-score: -1.65 (1.2)] and those treated with ECMO [-1.59 (1.2)] or CM [-2.1(1.0)]. Within iNO, ECMO and CM groups; 26%, 37% and 56%, respectively, had V(') (maxFRC) z-scores below normal. CONCLUSIONS: Respiratory outcome at 1 year in iNO treated neonates with moderately severe PPHN is encouraging, with no apparent increase in respiratory morbidity when compared to the general population. Sub-clinical reductions in airway function are evident at 1 year, suggesting that continuing efforts to minimize lung injury in the neonatal period are warranted to maximize lung health in later life. SN - 1099-0496 UR - https://www.unboundmedicine.com/medline/citation/18203182/Airway_function_in_infants_treated_with_inhaled_nitric_oxide_for_persistent_pulmonary_hypertension_ DB - PRIME DP - Unbound Medicine ER -