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

G. G. Konduri, G. M. Sokol, K. P. Van Meurs, J. Singer, N. Ambalavanan, T. Lee, A. Solimano, E. Stork, A. A. Fanaroff, E. Gorjanc, A. R. Laptook, S. Madison, S. Shankaran, R. Bara, G. Muran, S. B. Korones, T. Hudson, Shahnaz Duara, Charles R Bauer, Ruth Everett-ThomasM. Crowley, L. A. Papile, C. Backstrom, J. Fridriksson, E. F. Donovan, M. Mersman, G. M. Sokol, J. A. Lemons, D. Appel, R. A. Ehrenkranz, P. Gettner, W. Oh, A. Hensman, K. P. Van Meurs, D. K. Stevenson, M. B. Ball, W. A. Carlo, S. Cosby, E. Eichenwald, A. R. Stark, K. Fournier, K. Kennedy, J. E. Tyson, G. McDavid, G. Konduri, P. Hamm

Research output: Contribution to journalArticle

20 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)944-949
Number of pages6
JournalJournal of Perinatology
Volume33
Issue number12
DOIs
StatePublished - Dec 1 2013

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Surface-Active Agents
Respiratory Insufficiency
Nitric Oxide
Extracorporeal Membrane Oxygenation
Newborn Infant
Premature Infants
Therapeutics
Randomized Controlled Trials
Logistic Models
Regression Analysis

Keywords

  • ECMO
  • lung disease
  • newborn
  • persistent pulmonary hypertension of the newborn
  • PPHN

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Pediatrics, Perinatology, and Child Health

Cite this

Impact of early surfactant and inhaled nitric oxide therapies on outcomes in term/late preterm neonates with moderate hypoxic respiratory failure. / Konduri, G. G.; Sokol, G. M.; Van Meurs, K. P.; Singer, J.; Ambalavanan, N.; Lee, T.; Solimano, A.; Stork, E.; Fanaroff, A. A.; Gorjanc, E.; Laptook, A. R.; Madison, S.; Shankaran, S.; Bara, R.; Muran, G.; Korones, S. B.; Hudson, T.; Duara, Shahnaz; Bauer, Charles R; Everett-Thomas, Ruth; Crowley, M.; Papile, L. A.; Backstrom, C.; Fridriksson, J.; Donovan, E. F.; Mersman, M.; Sokol, G. M.; Lemons, J. A.; Appel, D.; Ehrenkranz, R. A.; Gettner, P.; Oh, W.; Hensman, A.; Van Meurs, K. P.; Stevenson, D. K.; Ball, M. B.; Carlo, W. A.; Cosby, S.; Eichenwald, E.; Stark, A. R.; Fournier, K.; Kennedy, K.; Tyson, J. E.; McDavid, G.; Konduri, G.; Hamm, P.

In: Journal of Perinatology, Vol. 33, No. 12, 01.12.2013, p. 944-949.

Research output: Contribution to journalArticle

Konduri, GG, Sokol, GM, Van Meurs, KP, Singer, J, Ambalavanan, N, Lee, T, Solimano, A, Stork, E, Fanaroff, AA, Gorjanc, E, Laptook, AR, Madison, S, Shankaran, S, Bara, R, Muran, G, Korones, SB, Hudson, T, Duara, S, Bauer, CR, Everett-Thomas, R, Crowley, M, Papile, LA, Backstrom, C, Fridriksson, J, Donovan, EF, Mersman, M, Sokol, GM, Lemons, JA, Appel, D, Ehrenkranz, RA, Gettner, P, Oh, W, Hensman, A, Van Meurs, KP, Stevenson, DK, Ball, MB, Carlo, WA, Cosby, S, Eichenwald, E, Stark, AR, Fournier, K, Kennedy, K, Tyson, JE, McDavid, G, Konduri, G & Hamm, P 2013, 'Impact of early surfactant and inhaled nitric oxide therapies on outcomes in term/late preterm neonates with moderate hypoxic respiratory failure', Journal of Perinatology, vol. 33, no. 12, pp. 944-949. https://doi.org/10.1038/jp.2013.83
Konduri, G. G. ; Sokol, G. M. ; Van Meurs, K. P. ; Singer, J. ; Ambalavanan, N. ; Lee, T. ; Solimano, A. ; Stork, E. ; Fanaroff, A. A. ; Gorjanc, E. ; Laptook, A. R. ; Madison, S. ; Shankaran, S. ; Bara, R. ; Muran, G. ; Korones, S. B. ; Hudson, T. ; Duara, Shahnaz ; Bauer, Charles R ; Everett-Thomas, Ruth ; Crowley, M. ; Papile, L. A. ; Backstrom, C. ; Fridriksson, J. ; Donovan, E. F. ; Mersman, M. ; Sokol, G. M. ; Lemons, J. A. ; Appel, D. ; Ehrenkranz, R. A. ; Gettner, P. ; Oh, W. ; Hensman, A. ; Van Meurs, K. P. ; Stevenson, D. K. ; Ball, M. B. ; Carlo, W. A. ; Cosby, S. ; Eichenwald, E. ; Stark, A. R. ; Fournier, K. ; Kennedy, K. ; Tyson, J. E. ; McDavid, G. ; Konduri, G. ; Hamm, P. / Impact of early surfactant and inhaled nitric oxide therapies on outcomes in term/late preterm neonates with moderate hypoxic respiratory failure. In: Journal of Perinatology. 2013 ; Vol. 33, No. 12. pp. 944-949.
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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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T1 - Impact of early surfactant and inhaled nitric oxide therapies on outcomes in term/late preterm neonates with moderate hypoxic respiratory failure

AU - Konduri, G. G.

AU - Sokol, G. M.

AU - Van Meurs, K. P.

AU - Singer, J.

AU - Ambalavanan, N.

AU - Lee, T.

AU - Solimano, A.

AU - Stork, E.

AU - Fanaroff, A. A.

AU - Gorjanc, E.

AU - Laptook, A. R.

AU - Madison, S.

AU - Shankaran, S.

AU - Bara, R.

AU - Muran, G.

AU - Korones, S. B.

AU - Hudson, T.

AU - Duara, Shahnaz

AU - Bauer, Charles R

AU - Everett-Thomas, Ruth

AU - Crowley, M.

AU - Papile, L. A.

AU - Backstrom, C.

AU - Fridriksson, J.

AU - Donovan, E. F.

AU - Mersman, M.

AU - Sokol, G. M.

AU - Lemons, J. A.

AU - Appel, D.

AU - Ehrenkranz, R. A.

AU - Gettner, P.

AU - Oh, W.

AU - Hensman, A.

AU - Van Meurs, K. P.

AU - Stevenson, D. K.

AU - Ball, M. B.

AU - Carlo, W. A.

AU - Cosby, S.

AU - Eichenwald, E.

AU - Stark, A. R.

AU - Fournier, K.

AU - Kennedy, K.

AU - Tyson, J. E.

AU - McDavid, G.

AU - Konduri, G.

AU - Hamm, P.

PY - 2013/12/1

Y1 - 2013/12/1

N2 - 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.

AB - 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.

KW - ECMO

KW - lung disease

KW - newborn

KW - persistent pulmonary hypertension of the newborn

KW - PPHN

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