Elsevier

The Journal of Pediatrics

Volume 133, Issue 6, December 1998, Pages 735-739
The Journal of Pediatrics

The outcome of very low birth weight neonates (≤1500 g) rescued by inhaled nitric oxide: Neurodevelopment in early childhood,☆☆,

https://doi.org/10.1016/S0022-3476(98)70142-8Get rights and content

Abstract

Although inhaled nitric oxide (INO) improves oxygenation in critically ill neonates, the neurodevelopmental outcome of premature neonates with severe hypoxemic respiratory failure treated with INO has not been reported. Mortality and prospective neurodevelopmental assessment in early childhood were studied in a cohort of 24 very low birth weight neonates (≤1500 g) consecutively admitted from 1993 to 1997 and rescued with INO because of severe hypoxemic respiratory failure (oxygenation index 28 to 52) unresponsive to aggressive conventional treatment. Significant improvements in arterial oxygen tension and oxygenation index with lower inspired oxygen concentration and less ventilator support after initiating INO were observed (P < .05, analysis of variance). Despite the dramatic improvement in systemic oxygenation, the mortality rate was high (14 of 24, 58%). Only 6 of 23 had normal cranial ultrasonographies. At 13 to 40 (22 ± 10) months of adjusted age, 10 survivors had Bayley Scales mental and psychomotor developmental indexes of 81 ± 21 and 64 ± 22, respectively. Of the 10 children, 5 (50%) were disabled, 2 (20%) were developmentally delayed, and 3 (30%) had normal development. In view of the poor outcome in very low-birth-weight neonates rescued by INO, randomized controlled trials are required to examine the role of INO in premature neonates. Before, during, and after INO therapy, cranial ultrasonography is recommended. (J Pediatr 1998;133:735-9)

Section snippets

METHODS

In this neonatal intensive care unit, premature neonates with severe hypoxemic respiratory failure are initially treated with conventional mechanical ventilation and bovine surfactant. Conventional mechanical ventilation is given by the Infant Star ventilator with the oscillator mode (Infrasonics Inc, San Diego, Calif), and the ventilator settings are adjusted to maintain arterial blood gases PaO2 50 to 70 mm Hg, PaCO2 40 to 60 mm Hg, and pH 7.30 to 7.45. High-frequency oscillatory ventilation

RESULTS

Between December 1993 and October 1997, 24 VLBW neonates (gestational age 24 to 30 weeks, birth weight 340 to 1460 g) were consecutively admitted and treated with INO. An additional 2 neonates (mosaic trisomy 18, Potter’s syndrome) were excluded from this study. The demographic and clinical features of these neonates are listed in Table I.

INO was started at 2 to 322 hours after birth and continued for 3 to 130 hours (Table I). Systemic oxygenation improved significantly soon after INO was

DISCUSSION

Although INO has been shown to reduce the need of extracorporeal membrane oxygenation in term and near-term neonates,3, 4 neurodevelopmental disability has been reported in 12% of a cohort of 32 term and near-term INO-treated infants who survived to 2 years of age for assessment.5 We report the neurodevelopmental outcome of VLBW neonates treated with INO. We found a high mortality rate, frequent abnormal cranial ultrasonographies, and poor neurodevelopmental outcome in early childhood in these

Acknowledgements

We thank Brenda Young, Melba Athaide, and Loretta Sanders for their help in the data collection of this study.

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  • Cited by (0)

    From the Department of Newborn Medicine, Royal Alexandra Hospital; Neonatal and Infant Follow-up Clinic, Glenrose Rehabilitation Hospital; and Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.

    ☆☆

    Reprint requests: Charlene M.T. Robertson, MD, Director, Neonatal and Infant Follow-up Clinic, Glenrose Rehabilitation Hospital, 10230-111 Ave, Edmonton, Alberta, T5G 0B7, Canada.

    0022-3476/98/$5.00 + 0  9/21/94197

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