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Airway function in infants treated with inhaled nitric oxide for persistent pulmonary hypertension
Author(s) -
Hoskote Aparna U.,
Castle Rosemary A.,
Hoo AhFong,
Lum Sooky,
Ranganathan Sarath C.,
Mok Quen Q.,
Stocks Janet
Publication year - 2008
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.20733
Subject(s) - medicine , anesthesia , pulmonary hypertension , mean airway pressure , oxygenation , nitric oxide , respiratory system , extracorporeal membrane oxygenation , oxygenation index , pulmonary function testing , airway , cardiology
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 ≥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. Pediatr Pulmonol. 2008; 43:224–235. © 2008 Wiley‐Liss, Inc.