Practices and Outcomes from a Prospective, Multicenter Registry for Preterm Newborns with Pulmonary Hypertension.

Autor: Dyess NF; Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO. Electronic address: Nicolle.Dyess@CUAnschutz.edu., Palmer C; Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO., Soll RF; Department of Pediatrics, Division of Neonatology, Larner College of Medicine, University of Vermont, Burlington, VT., Clark RH; Pediatrix Center for Research, Education, Quality and Safety (CREQS), Pediatrix Medical Group, Sunrise, FL., Abman SH; Department of Pediatrics, Section of Pulmonology, University of Colorado School of Medicine, Aurora, CO., Kinsella JP; Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO.
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2023 Nov; Vol. 262, pp. 113614. Date of Electronic Publication: 2023 Jul 20.
DOI: 10.1016/j.jpeds.2023.113614
Abstrakt: Objective: To describe current treatment practices of preterm infants with early hypoxemic respiratory failure (HRF) and pulmonary hypertension (PH) and their association with patient outcomes.
Study Design: We developed a prospective, observational, multicenter clinical registry of preterm newborns <34 weeks' gestation with HRF and PH, based on either clinical or echocardiographic evidence during the first 72 hours of life, from 28 neonatal intensive care units in the US from 2017 through 2022. The primary end point was mortality among those who did or did not receive PH-targeted treatment, and the secondary end points included comparisons of major morbidities. Variables were compared using t tests, Wilcoxon rank-sum tests, Fisher exact tests, and χ² tests.
Results: We analyzed the results of 224 preterm infants enrolled in the registry. Of which, 84% (188/224) received PH-targeted treatment, most commonly inhaled nitric oxide (iNO). Early mortality in this cohort was high, as 33% (71/224) of this sample died in the first month of life, and 77% of survivors (105/137) developed bronchopulmonary dysplasia. Infants who received PH-targeted treatment had higher oxygenation indices at the time of enrollment (28.16 [IQR: 13.94, 42.5] vs 15.46 [IQR: 11.94, 26.15]; P = .0064). Patient outcomes did not differ between those who did or did not receive PH-targeted therapy.
Conclusions: Early-onset HRF with PH in preterm infants is associated with a high early mortality and a high risk of developing bronchopulmonary dysplasia. iNO is commonly used to treat early-onset PH in preterm infants with HRF. In comparison with untreated infants with lower oxygenation indices, iNO treatment in severe PH may prevent poorer outcomes.
Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest. This study was sponsored by an investigator-initiated research grant from Mallinckrodt Pharmaceuticals (grant number IIR-USA-003947 to J.P.K.). The study was also supported by NIH/NCATS Colorado CTSA Grant Number UL1 TR002535. The manuscript's contents are the authors' sole responsibility and do not necessarily represent the sponsors' views. The sponsors had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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