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Airway function in infants treated with inhaled nitric oxide for persistent pulmonary hypertension

Hoskote, AU; Castle, RA; Hoo, AF; Lum, S; Ranganathan, SC; Mok, QQ; Stocks, J; (2008) Airway function in infants treated with inhaled nitric oxide for persistent pulmonary hypertension. PEDIATR PULM , 43 (3) 224 - 235. 10.1002/ppul.20733.

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Abstract

Rationale. Inhaled nitric oxide (NO), used for treatment of persistent pulmonary hypertension of newborn (PPHN), is an oxygen free radical with potential for lung injury Deferring ECMO with NO 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 NO 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 NO 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 NO group. V'(maxFRC) z-score was lower than predicted in all groups (P < 0.001), with no significant difference between those treated with NO (mean (SD) z-score: -1.65 (1.2)] and those treated with ECMO [-1.59 (1.2)] or CM f-2.1 (1.0)]. Within NO, ECMO and CM groups; 26%, 37% and 56%, respectively, had V'(maxFRC) z-scores below m normal. Conclusions. Respiratory outcome at 1 year in NO 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.

Type: Article
Title: Airway function in infants treated with inhaled nitric oxide for persistent pulmonary hypertension
DOI: 10.1002/ppul.20733
Keywords: newborn, persistent foetal circulation, pulmonary vasodilator, high frequency ventilation, ECMO, EXTRACORPOREAL MEMBRANE-OXYGENATION, COLLABORATIVE RANDOMIZED-TRIAL, FREQUENCY OSCILLATORY VENTILATION, HYPOXEMIC RESPIRATORY-FAILURE, NEAR-TERM INFANTS, PRETERM INFANTS, FOLLOW-UP, LUNG INJURY, DISTRESS-SYNDROME, NEWBORN
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > UCL GOS Institute of Child Health > ICH Developmental Neurosciences Prog
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > UCL GOS Institute of Child Health > ICH Infect, Imm, Infla. and Physio Med
URI: http://discovery.ucl.ac.uk/id/eprint/107390
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