Pulmonary vasodilator use in very preterm infants in United States children's hospitals.

OBJECTIVES

To describe common pulmonary vasodilators (PV), exposure timing, and characteristics associated with their use in very preterm (VP) infants.

STUDY DESIGN

Observational study of VP infants discharged from U.S. children's hospitals (2011-2021). PV exposures during hospitalization were identified, and multivariable modeling determined characteristics associated with exposure.

RESULTS

Among 37,428 infants, 6.3% received PV. Early inhaled nitric oxide (iNO) and late sildenafil were most common. Early exposure was associated with lower gestational age, aOR: 9.2 (7.3-11.7), 22-25 vs. 29-31 weeks) and small for gestational age (SGA), 2.3 (2.0-2.7). Late exposure was associated with bronchopulmonary dysplasia (BPD) grade, 26.2 (16.8-40.9), grade 3 vs. no BPD) and early PV exposure, 3.7 (2.9-4.8).

CONCLUSIONS

Early iNO and late sildenafil are used in VP infants despite limited evidence. Prospective early studies enrolling extremely preterm and SGA infants and late studies enrolling infants with early PV exposure and high-grade BPD would target current evidence gaps.