Inhaled Nitric Oxide Use and Outcomes in Critically Ill Children With a History of Prematurity.

TitleInhaled Nitric Oxide Use and Outcomes in Critically Ill Children With a History of Prematurity.
Publication TypeJournal Article
Year of Publication2021
AuthorsMaddux, AB, Mourani, PM, Banks, R, Reeder, RW, Pollack, MM, Berg, RA, Meert, KL, McQuillen, PS, Yates, AR, Notterman, DA, Berger, JT
Corporate Authors
JournalRespir Care
Volume66
Issue10
Pagination1549-1559
Date Published2021 Oct
ISSN1943-3654
KeywordsAdministration, Inhalation, Child, Critical Illness, Female, Humans, Infant, Infant, Newborn, Nitric Oxide, Pregnancy, Premature Birth, Respiratory Insufficiency, Vasodilator Agents
Abstract

<p><b>BACKGROUND: </b>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.</p><p><b>METHODS: </b>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.</p><p><b>RESULTS: </b>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 HO; = .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; = .02) and lower 28-d mortality (0, 26.1, 32.0%; = .007). Lower respiratory tract disease, but not a history of prematurity, was independently associated with lower mortality.</p><p><b>CONCLUSIONS: </b>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.</p>

DOI10.4187/respcare.08766
Alternate JournalRespir Care
PubMed ID34552014