Startseite Target versus actual oxygenation index at initiation of inhaled nitric oxide in neonates with hypoxic respiratory failure: survey results from 128 patient cases
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Target versus actual oxygenation index at initiation of inhaled nitric oxide in neonates with hypoxic respiratory failure: survey results from 128 patient cases

  • Sergio Golombek EMAIL logo , Denise Suttner , Reuben Ehrlich und Jim Potenziano
Veröffentlicht/Copyright: 4. September 2014
Journal of Perinatal Medicine
Aus der Zeitschrift Journal of Perinatal Medicine Band 42 Heft 6

Abstract

Background: Inhaled nitric oxide (iNO) is a well-established treatment for neonatal hypoxic respiratory failure (HRF). However, iNO therapy initiation criteria have not been standardized. This report describes a follow-up survey administered to neonatologists who had completed an Awareness, Trial, and Usage Survey. The objectives were to compare stated target oxygenation index (OI) versus actual OI at which iNO is initiated in respondents’ patients and identify factors associated with iNO initiation at other levels.

Methods: Neonatologists provided iNO-treated HRF patient data. Target and actual OI at initiation were determined. Patient groups were stratified by actual OI deviation from target [<4; at (±3); above: 4–10, 11–20, >20; not measured]. Reasons for above-target OI were determined.

Results: Of 83 invited neonatologists, 26 (31%) participated, providing data for 128 patients; 85/128 patients (66%) had OI measured at initiation with neonatologist-stated mean target OI 18.8±5.8. Actual mean OI was 26.2±10.3. iNO was initiated ≤ target in 30/85 patients (35%); most [55/85 (65%)] had iNO initiated when OI was above target. Patients aged ≤1 day and those receiving a fraction of inspired oxygen (FiO2) of 1.0 for more than 1 h had highest OIs at initiation.

Conclusions: Among surveyed neonatologists who treat infants with HRF with pulmonary hypertension (PH), there is a disparity between stated target versus actual OI for iNO initiation, particularly among infants <1 day old and those receiving FiO2 of 1.0 for more than 1 h. In term/near-term neonates with HRF with PH, neonatologists should consider implementing treatment protocols to ensure iNO initiation at stated target OI levels.

Keywords: Hypoxic respiratory failure; inhaled nitric oxide; neonatal intensive care units; oxygenation index; ventilator
Corresponding author: Sergio Golombek, MD, MPH, FAAP, Professor of Pediatrics and Clinical Public Health and New York Medical College, The Regional Neonatal Center, Maria Fareri Children’s Hospital at Westchester Medical Center/New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA, Tel.: +1-914-493-8488, Fax: +1-914-493-1005, E-mail:

References

[1] Ambalavanan N, Van Meurs KP, Perritt R, Carlo WA, Ehrenkranz RA, Stevenson DK, et al. Predictors of death or bronchopulmonary dysplasia in preterm infants with respiratory failure. J Perinatol. 2008;28:420–6.10.1038/jp.2008.18Suche in Google Scholar

[2] Chowdhury O, Greenough A. Neonatal ventilatory techniques – which are best for infants born at term? Arch Med Sci. 2011;7:381–7.10.5114/aoms.2011.23400Suche in Google Scholar

[3] Clark RH. The epidemiology of respiratory failure in neonates born at an estimated gestational age of 34 weeks or more. J Perinatol. 2005;25:251–7.10.1038/sj.jp.7211242Suche in Google Scholar

[4] Clark RH, Kueser TJ, Walker MW, Southgate WM, Huckaby JL, Perez JA, et al. Low-dose nitric oxide therapy for persistent pulmonary hypertension of the newborn. Clinical Inhaled Nitric Oxide Research Group. N Engl J Med. 2000;342:469–74.10.1056/NEJM200002173420704Suche in Google Scholar

[5] Davidson D, Barefield ES, Kattwinkel J, Dudell G, Damask M, Straube R, et al. Inhaled nitric oxide for the early treatment of persistent pulmonary hypertension of the term newborn: a randomized, double-masked, placebo-controlled, dose-response, multicenter study. The I-NO/PPHN Study Group. Pediatrics. 1998;101:325–34.10.1542/peds.101.3.325Suche in Google Scholar

[6] DiBlasi RM, Myers TR, Hess DR. Evidence-based clinical practice guideline: inhaled nitric oxide for neonates with acute hypoxic respiratory failure. Respir Care. 2010;55:1717–45.Suche in Google Scholar

[7] Finer NN, Barrington KJ. Nitric oxide therapy for the newborn infant. Semin Perinatol. 2000;24:59–65.10.1016/S0146-0005(00)80058-0Suche in Google Scholar

[8] Golombek SG. The use of inhaled nitric oxide in newborn medicine. Heart Dis. 2000;2:342–7.Suche in Google Scholar

[9] Golombek SG, Young JN. Efficacy of inhaled nitric oxide for hypoxic respiratory failure in term and late preterm infants by baseline severity of illness: a pooled analysis of three clinical trials. Clin Ther. 2010;32:939–48.10.1016/j.clinthera.2010.04.023Suche in Google Scholar PubMed

[10] González A, Fabres J, D’Apremont I, Urcelay G, Avaca M, Gandolfi C, et al. Randomized controlled trial of early compared with delayed use of inhaled nitric oxide in newborns with a moderate respiratory failure and pulmonary hypertension. J Perinatol. 2010;30:420–4.10.1038/jp.2009.171Suche in Google Scholar PubMed

[11] INOmax [package insert]. Clinton: INO Therapeutics; 2011.Suche in Google Scholar

[12] Konduri GG, Sokol GM, Van Meurs KP, Singer J, Ambalavanan N, Lee T, et al. Impact of early surfactant and inhaled nitric oxide therapies on outcomes in term/late preterm neonates with moderate hypoxic respiratory failure. J Perinatol. 2013;33:944–9.10.1038/jp.2013.83Suche in Google Scholar PubMed PubMed Central

[13] Konduri GG, Solimano A, Sokol GM, Singer J, Ehrenkranz RA, Singhal N, et al. A randomized trial of early versus standard inhaled nitric oxide therapy in term and near-term newborn infants with hypoxic respiratory failure. Pediatrics. 2004;113:559–64.10.1542/peds.113.3.559Suche in Google Scholar PubMed

[14] Kumar D, Super DM, Fajardo RA, Stork EE, Moore JJ, Saker FA. Predicting outcome in neonatal hypoxic respiratory failure with the score for neonatal acute physiology (SNAP) and highest oxygen index (OI) in the first 24 h of admission. J Perinatol. 2004;24:376–81.10.1038/sj.jp.7211110Suche in Google Scholar PubMed

[15] Neonatal Inhaled Nitric Oxide Study Group. Inhaled nitric oxide in full-term and nearly full-term infants with hypoxic respiratory failure. N Engl J Med. 1997;336:597–604.10.1056/NEJM199702273360901Suche in Google Scholar PubMed

[16] Oishi P, Datar SA, Fineman JR. Advances in the management of pediatric pulmonary hypertension. Respir Care. 2011;56: 1314–39.10.4187/respcare.01297Suche in Google Scholar PubMed

[17] Trachsel D, McCrindle BW, Nakagawa S, Bohn D. Oxygenation index predicts outcome in children with acute hypoxemic respiratory failure. Am J Respir Crit Care Med. 2005;172:206–11.10.1164/rccm.200405-625OCSuche in Google Scholar PubMed

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2014-4-23
Accepted: 2014-7-23
Published Online: 2014-9-4
Published in Print: 2014-11-1

©2014 by De Gruyter

Artikel in diesem Heft

  1. Frontmatter
  2. Guest editorial
  3. Guest editorial
  4. Original articles
  5. Identification and isolation of putative stem cells from the murine placenta
  6. Target versus actual oxygenation index at initiation of inhaled nitric oxide in neonates with hypoxic respiratory failure: survey results from 128 patient cases
  7. Omega-3 polyunsaturated fatty acids enhance cytokine production and oxidative stress in a mouse model of preterm labor
  8. Adrenocorticotropic hormone and cortisol levels in term infants born with meconium-stained amniotic fluid
  9. Measurement of novel biomarkers of neuronal injury and cerebral oxygenation after routine vaginal delivery versus cesarean section in term infants
  10. The time-associated impact of the Newborn Influenza Protection Act on infant influenza rates in New York State
  11. Delivery-related knowledge of mothers of NICU infants compared with well-baby-nursery infants
  12. Review article
  13. Mercury exposure in pregnancy: a review
  14. Original articles - Obstetrics
  15. A “multi-hit” model of neonatal white matter injury: cumulative contributions of chronic placental inflammation, acute fetal inflammation and postnatal inflammatory events
  16. Balloon tamponade for the management of postpartum uterine hemorrhage
  17. The IgG avidity value for the prediction of congenital cytomegalovirus infection in a prospective cohort study
  18. Obstetric anal sphincter injury risk reduction: a retrospective observational analysis
  19. Adverse perinatal outcomes related to the delivery mode in women with monochorionic diamniotic twin pregnancies
  20. Letter to the Editor
  21. The factors associated with the failure of transcatheter pelvic arterial embolization for intractable postpartum hemorrhage
  22. Congress Calendar
  23. Congress Calendar
https://doi.org/10.1515/jpm-2014-0242
Schlagwörter für diesen Artikel
Hypoxic respiratory failure; inhaled nitric oxide; neonatal intensive care units; oxygenation index; ventilator

Artikel in diesem Heft

  1. Frontmatter
  2. Guest editorial
  3. Guest editorial
  4. Original articles
  5. Identification and isolation of putative stem cells from the murine placenta
  6. Target versus actual oxygenation index at initiation of inhaled nitric oxide in neonates with hypoxic respiratory failure: survey results from 128 patient cases
  7. Omega-3 polyunsaturated fatty acids enhance cytokine production and oxidative stress in a mouse model of preterm labor
  8. Adrenocorticotropic hormone and cortisol levels in term infants born with meconium-stained amniotic fluid
  9. Measurement of novel biomarkers of neuronal injury and cerebral oxygenation after routine vaginal delivery versus cesarean section in term infants
  10. The time-associated impact of the Newborn Influenza Protection Act on infant influenza rates in New York State
  11. Delivery-related knowledge of mothers of NICU infants compared with well-baby-nursery infants
  12. Review article
  13. Mercury exposure in pregnancy: a review
  14. Original articles - Obstetrics
  15. A “multi-hit” model of neonatal white matter injury: cumulative contributions of chronic placental inflammation, acute fetal inflammation and postnatal inflammatory events
  16. Balloon tamponade for the management of postpartum uterine hemorrhage
  17. The IgG avidity value for the prediction of congenital cytomegalovirus infection in a prospective cohort study
  18. Obstetric anal sphincter injury risk reduction: a retrospective observational analysis
  19. Adverse perinatal outcomes related to the delivery mode in women with monochorionic diamniotic twin pregnancies
  20. Letter to the Editor
  21. The factors associated with the failure of transcatheter pelvic arterial embolization for intractable postpartum hemorrhage
  22. Congress Calendar
  23. Congress Calendar
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