TY - JOUR
T1 - Practices and Outcomes from a Prospective, Multicenter Registry for Preterm Newborns with Pulmonary Hypertension
AU - Preterm Newborn Pulmonary Hypertension Registry Study Group
AU - Dyess, Nicolle Fernández
AU - Palmer, Claire
AU - Soll, Roger F.
AU - Clark, Reese H.
AU - Abman, Steven H.
AU - Kinsella, John P.
AU - Joe, Priscilla
AU - Fong-Deleon, Elizabeth
AU - Pandit, Paresh
AU - Evans, Jacquelyn
AU - Jairath, Puneet
AU - Manalo, Erlinda
AU - McGill-Vargas, Lisa
AU - Piazza, Anthony
AU - Parsons, Kim
AU - Yoder, Bradley
AU - Mankouski, Ana
AU - White, Bob
AU - Gervasio, Clarissa
AU - Sokol, Gregory
AU - Bazacliu, Catalina
AU - Lavezzi, Jinny
AU - Tauscher, Markus
AU - Taylor, Sarah
AU - Goldstein, Mitchell
AU - Zeidan, Zahi
AU - Nama, Vijay
AU - Perez, Jose
AU - Pinheiro, Joaquim
AU - Ahmad, Kaashif
AU - Pierce, Maria
AU - Rudine, Anthony
AU - Scottoline, Brian
AU - Van Meurs, Krisa
AU - Bhombal, Shazia
AU - Perez, Jorge
AU - Pryhuber, Gloria
AU - Devanagondi, Rajiv
AU - White, Jim
AU - McNamara, Patrick
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/11
Y1 - 2023/11
N2 - 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.
AB - 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.
KW - bronchopulmonary dysplasia
KW - inhaled nitric oxide
KW - persistent pulmonary hypertension of the newborn
KW - prematurity
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U2 - 10.1016/j.jpeds.2023.113614
DO - 10.1016/j.jpeds.2023.113614
M3 - Article
C2 - 37478902
AN - SCOPUS:85172256086
SN - 0022-3476
VL - 262
JO - Journal of Pediatrics
JF - Journal of Pediatrics
M1 - 113614
ER -