Chandrasekharan Praveen, Kozielski Rafal, Kumar Vasantha H S, Rawat Munmun, Manja Veena, Ma Changxing, Lakshminrusimha Satyan
Division of Neonatology, Department of Pediatrics, Women and Children's Hospital of Buffalo, Buffalo, New York.
Department of Pathology, Women and Children's Hospital of Buffalo, Buffalo, New York.
Am J Perinatol. 2017 Apr;34(5):428-440. doi: 10.1055/s-0036-1592346. Epub 2016 Sep 14.
Inhaled nitric oxide (iNO) is being increasingly used in preterm infants < 34 weeks with hypoxemic respiratory failure (HRF) and/or pulmonary hypertension (PH). To evaluate the risk factors, survival characteristics, and lung histopathology in preterm infants with PH/HRF. Retrospective chart review was conducted to determine characteristics of 93 preterm infants treated with iNO in the first 28 days and compared with 930 matched controls. Factors associated with survival with preterm HRF and smooth muscle actin from nine autopsies were evaluated. Preterm neonates treated with iNO had a higher incidence of preterm prolonged rupture of membrane (pPROM ≥ 18 hours), oligohydramnios and delivered by C-section. In infants treated with iNO, antenatal steroids (odds ratio [OR],3.7; confidence interval [CI], 1.2-11.3; = 0.02), pPROM (OR, 1.001; CI, 1.0-1.004; = 0.3), and oxygenation response to iNO (OR, 3.7; CI, 1.08-13.1; = 0.037) were associated with survival. Thirteen infants with all three characteristics had 100% (13/13) survival without severe intraventricular hemorrhage (IVH)/periventricular leukomalacia (PVL) compared with 48% survival (12/25, = 0.004) and 16% severe IVH/PVL without any of these factors. Severity of HRF correlated with increased smooth muscle in pulmonary vasculature. Preterm infants with HRF exposed to antenatal steroids and pPROM had improved oxygenation with iNO and survival without severe IVH/PVL. Precisely targeting this subset may be beneficial in future trials of iNO.
吸入一氧化氮（iNO）越来越多地用于孕周小于34周、患有低氧性呼吸衰竭（HRF）和/或肺动脉高压（PH）的早产儿。为了评估患有PH/HRF的早产儿的危险因素、生存特征和肺组织病理学。进行回顾性病历审查，以确定93例在出生后28天内接受iNO治疗的早产儿的特征，并与930例匹配的对照组进行比较。评估与早产HRF存活相关的因素以及9例尸检的平滑肌肌动蛋白。接受iNO治疗的早产儿胎膜早破时间延长（pPROM≥18小时）、羊水过少和剖宫产的发生率较高。在接受iNO治疗的婴儿中，产前使用类固醇（优势比[OR]，3.7；置信区间[CI]，1.2 - 11.3；P = 0.02）、pPROM（OR，1.001；CI，1.0 - 1.004；P = 0.3）以及对iNO的氧合反应（OR，3.7；CI，1.08 - 13.1；P = 0.037）与存活相关。具有所有这三个特征的13例婴儿的存活率为100%（13/13），且无严重脑室内出血（IVH）/脑室周围白质软化（PVL），相比之下，没有这些因素的婴儿存活率为48%（12/25，P = 0.004），有16%发生严重IVH/PVL。HRF的严重程度与肺血管平滑肌增加相关。患有HRF且产前使用类固醇和pPROM的早产儿使用iNO后氧合改善，且存活时无严重IVH/PVL。在未来的iNO试验中，精确靶向这一亚组可能有益。
