Inhaled nitric oxide in infants referred for extracorporeal membrane oxygenation: Dose response☆,☆☆,★
Section snippets
Patient population
All infants referred to the Royal Alexandra Hospital for ECMO therapy after Jan. 1, 1993, were considered as potential subjects for this trial. Qualifying criteria for ECMO were that the infant was at least 35 weeks of gestational age and had reversible cardiopulmonary disease and no lethal malformations or evidence of intraventricular or intracranial hemorrhage of grade II or greater severity, plus the presence of an oxygen index (MAP × FIO2 × 100 ÷ PaO2, where MAP is the mean airway pressure)
RESULTS
During the period from Jan. 1 to May 1, 1993, a total of 23 infants were referred for consideration of ECMO therapy because of an OI of 20 or greater (Table). Surfactant was given to 22 infants before NO inhalation. Of the 23 infants, 8 had an OI of less than 25; 4 of these 8 responded to inhaled NO, and 2 infants (one of whom was a responder initially) required ECMO; both died of severe group B streptococcal sepsis. These two infants had severe lactic acidosis (pH < 7.00) and hypotension and
DISCUSSION
This study confirms the observations of Roberts et al.15 and Kinsella et al.16, 17 that some near-term critically ill infants with severe hypoxemia and evidence of pulmonary hypertension may respond to inhaled NO with significant improvement in oxygenation. Our study differs from previ ous trials in human neonates in that we studied a consecutive series of infants referred for possible ECMO whose initial OI was 20 or greater after treatment with a bovine surfactant, whereas the previous studies
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Cited by (229)
Inhaled Nitric Oxide in Neonatal Pulmonary Hypertension
2024, Clinics in PerinatologyPharmacologic Therapies II: Inhaled Nitric Oxide
2017, Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care: Sixth EditionPulmonary hypertension management in neonates
2015, Seminars in Pediatric SurgeryCitation Excerpt :The optimal dosing of iNO has been investigated in a few studies with conflicting results regarding its efficacy and potential adverse effects. Kinsella et al.11 observed responses to iNO at concentrations of 20 or 40 parts per million (ppm), while Roberts et al.18 showed no significant improvement in preductal oxygenation until iNO concentrations were above 80 ppm.20 Nitric oxide is converted to NO2 in the presence of high oxygen concentrations within the ventilator circuit but poses potential cytotoxicity with NO2 concentrations higher than 5 parts per million (PPM).
Clinical outcomes of congenital diaphragmatic hernia without extracorporeal membrane oxygenation
2012, Early Human DevelopmentCitation Excerpt :In the subgroup of severely affected infants who were eligible for ECMO, the survival rate decreased to 67% (4/6 infants) and was marginally lower than that of 73% collectively obtained from 11 centers [10]. Interestingly, centers which did not perform surgery while the patients were on ECMO had a survival rate (68%) similar to our unit [13]. Also, our review indicated that low Apgar score ≤ 6 at 1-minute was a significant predictor of poor prognosis and death.
Special Ventilation Techniques III: Inhaled Nitric Oxide Therapy
2011, Assisted Ventilation of the NeonatePhysiology of Nitric Oxide in the Developing Lung
2011, Fetal and Neonatal Physiology E-Book, Fourth Edition
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From the Department of Newborn Medicine, Royal Alexandra Hospital, and the Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Reprint requests: Neil N. Finer, MD, Royal Alexandra Hospital, 10240 Kingsway, Edmonton, Alberta, T5H 3V9, Canada.
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0022-3476/94 $3.00 + 0 9/23/51589