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Four patterns of response to inhaled nitric oxide for persistent pulmonary hypertension of the newborn.
Pediatrics. 1996 Oct; 98(4 Pt 1):706-13.Ped

Abstract

OBJECTIVE

To determine the clinical role of inhaled nitric oxide (iNO) in the treatment of persistent pulmonary hypertension of the newborn (PPHN).

STUDY DESIGN

Prospective open observational clinical study.

SETTING

A regional cardiac and pediatric intensive care unit.

METHODS

Twenty-five consecutive near-term neonates (> 35 weeks gestation) with severe PPHN (oxygenation index [OI] > 25) were given a trial of iNO of 20 ppm for 20 minutes. Neonates who showed a greater than 20% improvement in PaO2 as well as a decrease in the OI to below 40 were defined as responders and continued on this therapy.

RESULTS

Four patterns of response emerged to the iNO therapy: Pattern 1 neonates (n = 2) did not respond to the initial trial of iNO-one survived. Pattern 2 neonates (n = 9) responded to the initial trial of iNO, but failed to sustain this response over 36 hours, as defined by a rise in the OI to > 40. Six survived, five with extracorporeal membrane oxygenation. Pattern 3 neonates (n = 11) responded to the initial trial of iNO, sustained this response, and were successfully weaned from iNO within 5 days--all survived to discharge. Pattern 4 neonates (n = 3) responded to the initial trial of iNO, but developed a sustained dependence on iNO for 3 to 6 weeks. All three died and lung histology revealed severe pulmonary hypoplasia and dysplasia. These neonates (pattern 4) not only required iNO for a longer period of time than did the sustained responders (pattern 3), but they required significantly higher doses of iNO during their first 5 days of iNO therapy.

CONCLUSIONS

Early responses to iNO may not be sustained. Neonates with pulmonary hypoplasia and dysplasia may have a decreased sensitivity and differing time course of response to iNO when compared with patients who have PPHN in fully developed lungs.

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Authors+Show Affiliations

Goldman AP
Cardiac Unit, Great Ormond Street Hospital for Children, London, United Kingdom.
Tasker RC
No affiliation info available
Haworth SG
No affiliation info available
Sigston PE
No affiliation info available
Macrae DJ
No affiliation info available

MeSH

Administration, InhalationBiopsyDose-Response Relationship, DrugFemaleHumansInfant, NewbornLungMaleNitric OxidePersistent Fetal Circulation SyndromeProspective StudiesRespiration, ArtificialRespiratory System AgentsTreatment Outcome

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

8885950

Citation

Goldman, A P., et al. "Four Patterns of Response to Inhaled Nitric Oxide for Persistent Pulmonary Hypertension of the Newborn." Pediatrics, vol. 98, no. 4 Pt 1, 1996, pp. 706-13.
Goldman AP, Tasker RC, Haworth SG, et al. Four patterns of response to inhaled nitric oxide for persistent pulmonary hypertension of the newborn. Pediatrics. 1996;98(4 Pt 1):706-13.
Goldman, A. P., Tasker, R. C., Haworth, S. G., Sigston, P. E., & Macrae, D. J. (1996). Four patterns of response to inhaled nitric oxide for persistent pulmonary hypertension of the newborn. Pediatrics, 98(4 Pt 1), 706-13.
Goldman AP, et al. Four Patterns of Response to Inhaled Nitric Oxide for Persistent Pulmonary Hypertension of the Newborn. Pediatrics. 1996;98(4 Pt 1):706-13. PubMed PMID: 8885950.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Four patterns of response to inhaled nitric oxide for persistent pulmonary hypertension of the newborn. AU - Goldman,A P, AU - Tasker,R C, AU - Haworth,S G, AU - Sigston,P E, AU - Macrae,D J, PY - 1996/10/1/pubmed PY - 1996/10/1/medline PY - 1996/10/1/entrez SP - 706 EP - 13 JF - Pediatrics JO - Pediatrics VL - 98 IS - 4 Pt 1 N2 - OBJECTIVE: To determine the clinical role of inhaled nitric oxide (iNO) in the treatment of persistent pulmonary hypertension of the newborn (PPHN). STUDY DESIGN: Prospective open observational clinical study. SETTING: A regional cardiac and pediatric intensive care unit. METHODS: Twenty-five consecutive near-term neonates (> 35 weeks gestation) with severe PPHN (oxygenation index [OI] > 25) were given a trial of iNO of 20 ppm for 20 minutes. Neonates who showed a greater than 20% improvement in PaO2 as well as a decrease in the OI to below 40 were defined as responders and continued on this therapy. RESULTS: Four patterns of response emerged to the iNO therapy: Pattern 1 neonates (n = 2) did not respond to the initial trial of iNO-one survived. Pattern 2 neonates (n = 9) responded to the initial trial of iNO, but failed to sustain this response over 36 hours, as defined by a rise in the OI to > 40. Six survived, five with extracorporeal membrane oxygenation. Pattern 3 neonates (n = 11) responded to the initial trial of iNO, sustained this response, and were successfully weaned from iNO within 5 days--all survived to discharge. Pattern 4 neonates (n = 3) responded to the initial trial of iNO, but developed a sustained dependence on iNO for 3 to 6 weeks. All three died and lung histology revealed severe pulmonary hypoplasia and dysplasia. These neonates (pattern 4) not only required iNO for a longer period of time than did the sustained responders (pattern 3), but they required significantly higher doses of iNO during their first 5 days of iNO therapy. CONCLUSIONS: Early responses to iNO may not be sustained. Neonates with pulmonary hypoplasia and dysplasia may have a decreased sensitivity and differing time course of response to iNO when compared with patients who have PPHN in fully developed lungs. SN - 0031-4005 UR - https://www.unboundmedicine.com/medline/citation/8885950/Four_patterns_of_response_to_inhaled_nitric_oxide_for_persistent_pulmonary_hypertension_of_the_newborn_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=8885950 DB - PRIME DP - Unbound Medicine ER -