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Supriya Bhoomaiah Vishna Rasiah Birmingham Women’s Hospital

Experience of inhaled nitric oxide in babies with pulmonary hypertension in a tertiary neonatal unit. Supriya Bhoomaiah Vishna Rasiah Birmingham Women’s Hospital QUAD Network Research study day 10/01/13. Inhaled Nitric oxide. Selective pulmonary vasodilator

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Supriya Bhoomaiah Vishna Rasiah Birmingham Women’s Hospital

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  1. Experience of inhaled nitric oxide in babies with pulmonary hypertension in a tertiary neonatal unit SupriyaBhoomaiah VishnaRasiah Birmingham Women’s Hospital QUAD Network Research study day 10/01/13

  2. Inhaled Nitric oxide • Selective pulmonary vasodilator • Improves oxygenation and decreases the combined outcome of death or need for ECMO in infants >34 weeks gestation1,2 • Does not improve survival or bronchopulmonary dysplasia in preterm babies3,4,5 • 1.Stork E,Verter J et al(NINOS).NEJM 1997 • 2.Finner NN,BarringtonKJ.Cochrane Database Syst Rev 2009 • 3.Askie LM.2011,iNO in preterm infants RCT.Pediatrics 2011 • 4.Mercier et al 2010 , EUNO RCT.Lancet 2010 • 5.Finner NN,BarringtonKJ.CochraneDatabase Syst Rev 2010

  3. Aims • To review the outcomes of neonates with pulmonary hypertension due to causes other than congenital diaphragmatic hernia treated with inhaled nitric oxide in a tertiary neonatal unit.

  4. Methods • January 2009 to December 2011 • Badger database • Standard proforma

  5. Results

  6. Gestational age

  7. Birth weight

  8. Trend in iNO use

  9. Evidence of pulmonary hypertension

  10. Early vs. Late iNO

  11. Referral for ECMO

  12. Chronic lung disease and Home oxygen

  13. Death

  14. Death

  15. Summary • 65% preterm vs 34% term babies • Increasing trend and late use in preterm babies • Only 1 term baby referred for ECMO • 50% mortality in preterm vs 12.5% term babies

  16. Conclusions • Inhaled nitric oxide is the current mainstay therapy in term neonates with pulmonary hypertension with excellent outcomes. • Preterm babies especially those less than 28 weeks gestation treated with iNO have a poor outcome. • Cautious approach warranted in the absence of robust evidence to support routine use of iNO as early rescue and late treatment.

  17. Thank you!!

  18. References • 1.Stork E, VerterJ et al(NINOS).Inhaled nitric oxide in full term and nearly full term infants with hypoxic respiratory failure. NEJM 1997;336:597-604 • 2.Askie LM, Ballard RA, Subhedar V et al. Inhaled Nitric oxide in preterm infants: An individual patient data meta-analysis of randomized trials. Pediatrics 2011;128(4):729-239 • 3.Mercier J et al.iNO for prevention of bronchopulmonary dysplasia in premature babies(EUNO) a RCT. Lancet 2010 Jul;376(9738):346-54 • 4.Finner NN, Barrington KJ. Inhaled nitric oxide for respiratory failure in preterm infants. Cochrane Database Syst Rev 2007;(3):CD000509

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