Neurodevelopmental and medical outcomes of persistent pulmonary hypertension in term newborns treated with nitric oxide

• Published in: The Journal of pediatrics 2002-03, Vol.140 (3), p.306-310
• Main Authors: Lipkin, Paul H., Davidson, Dennis, Spivak, Lynn, Straube, Richard, Rhines, Jared, Chang, C.T.
• Format: Article
• Language: English
• Subjects: Administration, Inhalation; Biological and medical sciences; Cognition Disorders - etiology; Developmental Disabilities - etiology; Developmental Disabilities - prevention & control; Diseases of the respiratory system; Hearing Loss, Sensorineural - etiology; Hearing Loss, Sensorineural - prevention & control; Humans; Infant, Newborn; Medical sciences; Nervous System Diseases - etiology; Nervous System Diseases - prevention & control; Nitric Oxide - administration & dosage; Nitric Oxide - adverse effects; Persistent Fetal Circulation Syndrome - complications; Persistent Fetal Circulation Syndrome - therapy; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Treatment Outcome; Vasodilator Agents - administration & dosage; Vasodilator Agents - adverse effects; Weight Gain
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1067/mpd.2002.122730

Objective: To determine the medical and neurodevelopmental outcome of children with moderately severe persistent pulmonary hypertension of the newborn (PPHN) treated with or without inhaled nitric oxide (I-NO). Study design: Term infants with PPHN and a baseline oxygenation index of 24 ± 9 at study entry were randomly assigned to early treatment with placebo or initial doses of I-NO (5, 20, and 80 ppm). Outcome was measured at ~1 year by frequency of hospitalization, growth, and neurodevelopmental and audiologic evaluation. Results: Of 155 children enrolled, 144 survived, and there was follow-up for 133. No significant differences between the placebo and the I-NO groups were seen in any long-term outcome. Rehospitalization occurred in 22%, and growth did not differ. The composite neurodevelopment and audiologic outcome showed impairment in 46% of the infants. There were major neurologic abnormalities in 13%, cognitive delays in 30%, and hearing loss in 19% of the infants. Conclusions: Moderately severe PPHN at 24 hours after birth is associated with high rates of rehospitalization and disability at 1 year. Adverse outcomes were the same in I-NO and control groups. (J Pediatr 2002;140:306-10)