Impact of early surfactant and inhaled nitric oxide therapies on outcomes in term/late preterm neonates with moderate hypoxic respiratory failure.

Academic Article

Abstract

  • 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 (CI) 0.27 to 0.97) and surfactant use before randomization (odds ratio 0.47, CI 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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    Keywords

  • Administration, Inhalation, Combined Modality Therapy, Drug Synergism, Extracorporeal Membrane Oxygenation, Female, Humans, Hypoxia, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases, Logistic Models, Male, Nitric Oxide, Oxygen, Pneumonia, Pulmonary Surfactants, Respiratory Distress Syndrome, Newborn, Risk Factors
  • Digital Object Identifier (doi)

    Author List

  • Konduri GG; Sokol GM; Van Meurs KP; Singer J; Ambalavanan N; Lee T; Solimano A
  • Start Page

  • 944
  • End Page

  • 949
  • Volume

  • 33
  • Issue

  • 12