Pulmonary vasodilator use in very preterm infants in United States children's hospitals

Nicolas Bamat; Tomas Vega; Matthew Huber; Erik Jensen; Catherine Avitabile; Scott Lorch; Kathleen Gibbs; Michael O'Byrne; David Frank; Nicolas Bamat

doi:10.21203/rs.3.rs-5492163/v1

Pulmonary vasodilator use in very preterm infants in United States children's hospitals

Res Sq [Preprint]. 2024 Dec 5:rs.3.rs-5492163. doi: 10.21203/rs.3.rs-5492163/v1.

Authors

Nicolas Bamat¹, Tomas Vega¹, Matthew Huber, Erik Jensen², Catherine Avitabile³, Scott Lorch, Kathleen Gibbs³, Michael O'Byrne¹, David Frank³, Nicolas Bamat¹

Affiliations

¹ The Children's Hospital of Philadelphia.
² The Children's Hospital of Philadelphia and the University of Pennsylvania.
³ Children's Hospital of Philadelphia.

Abstract

Objectives: To describe common pulmonary vasodilators (PV), exposure timing, and characteristics associated to their use in very preterm (VP) infants.

Study design: Observational study of VP infants discharged from U.S. children's hospitals (2011-2021). PV exposures during hospitalization were identified, and multivariable modeling determined characteristics associated with exposure.

Results: Among 37,428 infants, 6.3% received PV. Early inhaled nitric oxide (iNO) and late sildenafil were most common. Early exposure was associated with lower gestational age, aOR: 9.2 (7.3-11.7), 22-25 vs. 29-31 weeks) and small for gestational age (SGA), 2.3 (2.0-2.7). Late exposure was associated with bronchopulmonary dysplasia (BPD) grade, 26.2 (16.8-40.9), grade 3 vs. no BPD) and early PV exposure, 3.7 (2.9-4.8).

Conclusions: Early iNO and late sildenafil are used in VP infants despite limited evidence. Prospective early studies enrolling extremely preterm or SGA infants and late studies enrolling infants with early PV exposure or high-grade BPD would target current evidence gaps.

Keywords: bosentan; bronchopulmonary dysplasia; chronic lung disease; infant; inhaled nitric oxide; premature; preterm; pulmonary hypertension; sildenafil; vasodilator.

Publication types

Preprint

Grants and funding

The authors have no financial interests to disclose. This work was supported by Eunice Kennedy Shriver National Institute of Child Health and Human Development grant K23HD10165 to Dr. Bamat. The funding sources had no role in the study design; the collection, analysis and interpretation of the data; the writing of the report or the decision to submit for publication. Dr. Vega wrote the first draft of the manuscript. No compensation honorarium, grant, or other form of payment was given to produce the manuscript.