Nitric therapy in preterm infants: Rationalised approach based on functional neonatal echocardiography

Daryl R. Cheng, Stacey Peart, Kenneth Tan, Arvind Sehgal

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Aim: Use of inhaled nitric oxide (iNO) in preterm infants is not supported by current evidence. In 2013, in Australia and New Zealand, 14% infants' ≤25 weeks of gestations were administered iNO. Within the cohort administered iNO, we aimed to identify subgroups where it may be more efficacious and compared characteristics before and after the set-up of the functional echocardiography (fEcho) programme. 

Methods: A retrospective audit for the period 2000-2013 involving preterm infants administered iNO in the first four weeks of life was performed. Comparisons were made between the two time epochs: up to 2007 and post-2007. 

Results: Eighty-five infants fulfilled the inclusion criteria; 62 (73%) were ≤28 weeks of gestation; 51 (60%) survived. Amongst survivors, gestation and birthweight were higher and oxygenation index (OI) was lower. Fourteen (16.5%) infants weighed small for gestation age; survival was lower in this subgroup (6/14, 43%, p = 0.0005). The fEcho programme increased prenitric assessments for a definitive diagnosis and monitoring; iNO was started earlier, at a lower OI with a trend towards reduced usage (hours). 

Conclusion: Characteristics of subgroups (within the cohort of infants ≤34 weeks of gestation) more likely to benefit from iNO therapy were identified. Use of fEcho could rationalise usage.

Original languageEnglish
Pages (from-to)165-171
Number of pages7
JournalActa Paediatrica
Volume105
Issue number2
DOIs
Publication statusPublished - 1 Feb 2016

Keywords

  • Audit
  • Echocardiography
  • Nitric oxide
  • Preterm

Cite this

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abstract = "Aim: Use of inhaled nitric oxide (iNO) in preterm infants is not supported by current evidence. In 2013, in Australia and New Zealand, 14{\%} infants' ≤25 weeks of gestations were administered iNO. Within the cohort administered iNO, we aimed to identify subgroups where it may be more efficacious and compared characteristics before and after the set-up of the functional echocardiography (fEcho) programme. Methods: A retrospective audit for the period 2000-2013 involving preterm infants administered iNO in the first four weeks of life was performed. Comparisons were made between the two time epochs: up to 2007 and post-2007. Results: Eighty-five infants fulfilled the inclusion criteria; 62 (73{\%}) were ≤28 weeks of gestation; 51 (60{\%}) survived. Amongst survivors, gestation and birthweight were higher and oxygenation index (OI) was lower. Fourteen (16.5{\%}) infants weighed small for gestation age; survival was lower in this subgroup (6/14, 43{\%}, p = 0.0005). The fEcho programme increased prenitric assessments for a definitive diagnosis and monitoring; iNO was started earlier, at a lower OI with a trend towards reduced usage (hours). Conclusion: Characteristics of subgroups (within the cohort of infants ≤34 weeks of gestation) more likely to benefit from iNO therapy were identified. Use of fEcho could rationalise usage.",
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Nitric therapy in preterm infants : Rationalised approach based on functional neonatal echocardiography. / Cheng, Daryl R.; Peart, Stacey; Tan, Kenneth; Sehgal, Arvind.

In: Acta Paediatrica, Vol. 105, No. 2, 01.02.2016, p. 165-171.

Research output: Contribution to journalArticleResearchpeer-review

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