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Abstract
BACKGROUND: Inhaled nitric oxide (INO) is used to treat hypoxic respiratory failure without clear evidence of benefit. Future trials to evaluate its use will be designed based on an understanding of the populations in which this therapy is provided and with outcomes based on patient characteristics, for example, a history of premature birth.
METHODS: This was a multi-center prospective observational study that evaluated subjects in the pediatric ICU who were treated with INO for a respiratory indication, excluding those treated in the neonatal ICU or treated for birth-related disease. We used logistic regression to evaluate characteristics associated with mortality and duration of mechanical ventilation. Specifically, we compared subjects born early preterm (<32 weeks post-conceptual age), late preterm (32–37 weeks post-conceptual age), and full term.
RESULTS: A total of 163 children (median age [interquartile range], 1.8 [0.7–6.0] y) were included, 41 (25.2%) had a history of preterm birth (18 born early preterm and 23 born late preterm). INO was initiated for less-severe lung disease in the early preterm versus late preterm versus full-term subjects (median mean airway pressures, 16 vs 19 vs 19 cm H2O; P = .03), although the oxygenation index and oxygenation saturation index did not differ. The early preterm subjects had more ventilator-free days (median, 18.0, 7.0, 4.5 d; P = .02) and lower 28-d mortality (0, 26.1, 32.0%; P = .007). Lower respiratory tract disease, but not a history of prematurity, was independently associated with lower mortality.
CONCLUSIONS: INO was used differently in early preterm subjects. Clinical trials that evaluate INO use should have standardized oxygenation deficit thresholds for initiation of therapy and should consider stratifying by early preterm status.
- pediatric
- Acute Respiratory Distress Syndrome
- critical care outcomes
- nitric oxide
- right ventricular failure
- pulmonary hypertension
- infant
- premature
Footnotes
- Correspondence: Aline B Maddux MD MSCS, Pediatric Critical Care, University of Colorado School of Medicine, Children's Hospital Colorado, Education 2 South, 13121 East 17th Avenue, MS8414, Aurora, CO 80045. E-mail: aline.maddux{at}childrenscolorado.org
The authors have disclosed no conflicts of interest.
Supplementary material related to this paper is available at http://www.rcjournal.com.
The study was conducted at the 8 sites of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network, including Children’s Hospital Colorado (Aurora, CO), Children’s National Health System (Washington, DC), Children’s Hospital of Philadelphia (Philadelphia, PA), Children’s Hospital of Pittsburgh (Pittsburgh, PA), Nationwide Children’s Hospital (Columbus, OH), Children’s Hospital of Michigan (Detroit, MI), Benioff Children’s Hospital (San Francisco, CA), and Mattel Children’s Hospital (Los Angeles, CA).
The study was supported, in part, by the following cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services: UG1HD050096 (Dr Meert), UG1HD049981 (Dr Pollack), UG1HD063108 (Dr Berg), UG1HD083171 (Dr Mourani), UG1HD083166 (Dr McQuillen), UG1HD083170 (Dr Yates), U01HD049934 (Dr Reeder and Mr Banks), K23HD096018 (Dr Maddux), and the Francis Family Foundation (Dr Maddux).
- Copyright © 2021 by Daedalus Enterprises
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