Retrospective study of preterm infants exposed to inhaled nitric oxide in Kaiser Permanente Southern California: morbidity, mortality and follow-up

Dilip R Bhatt; David Braun; Roman Angelo Dizon; Jiaxiao M Shi; Sunjeeve Weerasinghe; Alex Sabio; Siva Reddy; Henry C Lee; Rangasamy Ramanathan; Satyan Lakshminrusimha

doi:10.1038/s41372-024-02051-w

Retrospective study of preterm infants exposed to inhaled nitric oxide in Kaiser Permanente Southern California: morbidity, mortality and follow-up

J Perinatol. 2024 Jul 18. doi: 10.1038/s41372-024-02051-w. Online ahead of print.

Authors

Affiliations

¹ Fontana Medical Center, Kaiser Permanente Southern California, Fontana, CA, USA.
² Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA. [email protected].
³ Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
⁴ University of California, San Diego, CA, USA.
⁵ Division of Neonatology, Cedars Sinai Guerin Children's, Cedars Sinai Medical Center, Los Angeles, CA, USA.
⁶ UC Davis Children's Hospital, Sacramento, CA, USA.

PMID: 39025953
DOI: 10.1038/s41372-024-02051-w

Abstract

Objective: Describe characteristics of preterm infants exposed to inhaled nitric oxide (iNO) in Kaiser Permanente Southern California.

Study design: Case review of preterm infants <34-weeks exposed to iNO during 2010-2020 including respiratory and echocardiographic status, NICU course, and 12-month follow-up.

Results: 270 infants, 2.63% of births<34 weeks, (median, range: 26.1, 22^5/7-33^6/7 weeks gestation) were exposed to iNO. Median FiO₂ at iNO initiation was 1.0 (IQR 0.94-1.0). Pulmonary hypertension (PH) was not associated with risk-adjusted 2 h oxygenation response or improved survival. Mortality to NICU discharge was 37.4%. Median cost of iNO was $7,695/patient. Discharged survivors experienced frequent rehospitalization (34.9%), use of supplemental oxygen, sildenafil, diuretics, bronchodilators, and steroids. Four infants had persistent PH. Five infants died after NICU discharge.

Conclusions: Preterm infants receiving iNO have high mortality and 1st year morbidity. As currently used, iNO may be an indicator of respiratory disease severity rather than mediator of improved outcomes.

Grants and funding

R01 HD 072929/U.S. Department of Health & Human Services | NIH | Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)