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Randomized Controlled Trial
. 2013 Dec;33(12):944-9.
doi: 10.1038/jp.2013.83. Epub 2013 Jul 18.

Impact of early surfactant and inhaled nitric oxide therapies on outcomes in term/late preterm neonates with moderate hypoxic respiratory failure

G G Konduri  1 , G M Sokol, K P Van Meurs, J Singer, N Ambalavanan, T Lee, A Solimano
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Free PMC article
Randomized Controlled Trial

Impact of early surfactant and inhaled nitric oxide therapies on outcomes in term/late preterm neonates with moderate hypoxic respiratory failure

G G Konduri et al. J Perinatol. 2013 Dec.
Free PMC article

Abstract

Objective: We conducted a post-hoc analysis of early inhaled nitric oxide (iNO)-randomized controlled trial data to identify associations pertinent to the management of moderate hypoxic respiratory failure in term/late preterm infants.

Study design: Univariate and multivariate logistic regression analyses were used to determine risk factors for the progression of respiratory failure and extracorporeal membrane oxygenation (ECMO)/death.

Result: Among the 299 enrolled infants, oxygenation index (OI) <20 at enrollment (odds ratio 0.52, confidence interval (CI) 0.27 to 0.97) and surfactant use before randomization (odds ratio 0.47, CI 0.24 to 0.91) were associated with decreased ECMO/death rates. Early surfactant use for respiratory distress syndrome, perinatal aspiration syndrome and pneumonia/sepsis was associated with lower risk of ECMO/death (P<0.001). Early iNO (OI 15 to 25) decreased the progression of respiratory failure to OI >30 (P=0.002) and to composite outcome of OI >30 or ECMO/death (P=0.02).

Conclusion: This post-hoc analysis suggests that early use of surfactant and iNO in moderate respiratory failure is associated with improved outcomes.

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Figures

Figure 1
Figure 1
Kaplan–Meier survival analysis curves showing cumulative probability of discharge home for control and early inhaled nitric oxide (iNO) infants, grouped by oxygenation index (OI) at enrollment.
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References

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