Journal
JOURNAL OF PERINATOLOGY
Volume 33, Issue 12, Pages 944-949Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/jp.2013.83
Keywords
newborn; lung disease; persistent pulmonary hypertension of the newborn; PPHN; ECMO
Categories
Funding
- NICHD Neonatal Research Network [U10 HD21397, U10 HD40689, U10 HD21385, U10 HD21415, U10 HD27881, M01 RR00997, U10 HD27853, M01 RR08084, U10 HD27856, M01RR00750, U10 HD27871, M01RR06022, U10 HD27904, U10 HD27880, M01 RR00070, U10 HD34216, U10 HD34167, M01 RR02635, M01 RR02172, M01RR01032, U10 HD21373]
- Canadian Institute of Health Research [UI 15246]
- NICHD Neonatal Research Network
- Canadian Institute of Health Research
- INO Therapeutics, Inc.
- Clinton, NJ, USA
- Ikaria, Inc.
- Ikaria Inc.
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OBJECTIVE: We conducted a post-hoc analysis of early inhaled nitric oxide (iNO)-randomized controlled trial data to identify associations pertinent to the management of moderate hypoxic respiratory failure in term/late preterm infants. STUDY DESIGN: Univariate and multivariate logistic regression analyses were used to determine risk factors for the progression of respiratory failure and extracorporeal membrane oxygenation (ECMO)/death. RESULT: Among the 299 enrolled infants, oxygenation index (OI) <20 at enrollment (odds ratio 0.52, confidence interval (Cl) 0.27 to 0.97) and surfactant use before randomization (odds ratio 0.47, Cl 0.24 to 0.91) were associated with decreased ECMO/death rates. Early surfactant use for respiratory distress syndrome, perinatal aspiration syndrome and pneumonia/sepsis was associated with lower risk of ECMO/death (P<0.001). Early iNO (OI 15 to 25) decreased the progression of respiratory failure to OI >30 (P=0.002) and to composite outcome of OI >30 or ECMO/death (P=0.02). CONCLUSION: This post-hoc analysis suggests that early use of surfactant and iNO in moderate respiratory failure is associated with improved outcomes.
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