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. 2024 Dec 11:15:1515030.
doi: 10.3389/fphar.2024.1515030. eCollection 2024.

Influence of inhaled nitric oxide on bronchopulmonary dysplasia in preterm infants with PPHN or HRF at birth: a propensity score matched study

Xue-Rong Huang #  1   2   3 , Lian Wang #  1   2   3 , Guo-Bao Liang #  1   2   3 , Sheng-Qian Huang #  4 , Bao-Ying Feng #  5 , Lu Zhu #  6 , Xu-Fang Fan #  7 , Mu-Lin Yao #  8 , Jing Zhang #  9 , Meng-Jiao Wang #  10 , Zhi Zheng  1   2   3 , Yao Zhu  1   2   3 , Wen-Li Duan  7 , Zhan-Kui Li  10 , Jian Mao  9 , Li Ma  8 , Fa-Lin Xu  7 , Fan Wu  6 , Qiu-Fen Wei  5 , Ling Liu  4 , Xin-Zhu Lin  1   2   3
Affiliations

Influence of inhaled nitric oxide on bronchopulmonary dysplasia in preterm infants with PPHN or HRF at birth: a propensity score matched study

Xue-Rong Huang et al. Front Pharmacol. .

Abstract

Background: Bronchopulmonary Dysplasia (BPD) is a chronic lung disease affecting preterm infants, with limited prevention and treatment options. Inhaled Nitric Oxide (iNO) is sometimes used to treat Persistent Pulmonary Hypertension of the Newborn (PPHN) and Hypoxemic Respiratory Failure (HRF), and its impact on BPD development remains debated.

Objective: To assess whether iNO-related factors are potential contributors to the development of BPD Grade Ⅱ-Ⅲ in very premature infants (VPI) diagnosed with PPHN or HRF at birth using Propensity Score Matching (PSM).

Methods: We conducted a retrospective cohort study of infants born at 22-32 weeks gestation with PPHN or HRF, treated with iNO for over 3 h. PSM matched groups by gestational age, birth weight, and gender, etc. Multivariate logistic regression evaluated the association between iNO treatment and BPD outcomes to identify influencing factors, while Restricted Cubic Spline (RCS) and mediation analysis examined iNO dose effects and potential mediators like mechanical ventilation time and oxygenation index (OI).

Results: A higher initial iNO dose was significantly associated with a reduced risk of BPD Grade Ⅱ-Ⅲ (adjusted OR = 0.68, 95% CI: 0.52-0.89, p < 0.01). Additionally, administration of iNO within the first 7 days of life was identified as an important influencing factor No significant mediation effects were observed for factors such as mechanical ventilation time and OI.

Conclusion: A higher initial iNO dose within the first 7 days was associated with a reduced risk of BPD Grade Ⅱ-Ⅲ in VPI with PPHN or HRF.

Keywords: BPD (bronchopulmonary dysplasia); PPHN (persistent pulmonary hypertension of the newborn); hypoxemic respiratory failure; nitric oxide - NO; very premature infant.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
flow chart of the study.
See this image and copyright information in PMC

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