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Initiation of Inhaled Nitric OXIDE PRIOR to Transport Compared with After NICU Admission In Neonates with Pulmonary Hypertension: An Analysis of Outcomes

Sunday, October 21, 2012: 3:50 PM
Room 211-213 (Morial Convention Center)
Nizar Abazid, Fouad Abounahia, Anuradha Kochar, Hilary Whyte and Kyong-Soon Lee, Neonatology, Hospital for Sick Children, Toronto, ON, Canada

Purpose: Inhaled nitric oxide (iNO) use in transport for the management of pulmonary hypertension of newborn (PPHN) has been shown to be safe and effective. However, it is not known if starting iNO at the referring hospital versus waiting for admission to the tertiary NICU makes a difference in outcomes.

Methods: Retrospective cohort study of neonates with PPHN who received nitric oxide at the referral hospital (REF group) compared to after NICU admission (pNICU group) during July 2004 to April 2010. iNO in transport was available during Sept 2004 but not routinely used until Jan 2006. Primary outcome was the composite of death or survival with ECMO.

Results: 108 neonates in the REF group and 64 in the pNICU group were analyzed (Table 1). There were significant differences in gender, age iNO started, and stabilization time. There was no difference in death or survival with ECMO between REF and pNICU groups (20% vs 14%, p=0.355), but REF group had increased ventilation duration compared to pNICU group (median 226 vs 146 hours, p=0.003). 30 (17.5%) patients died or received ECMO (Table 2). Factors associated with adverse outcome were pre-iNO oxygenation index (IO), decreased iNO response and use of more than 2 inotropes. In multivariate analysis, the strongest predictor of outcome was severity of illness as measured by pre-iNO OI. Initiation of iNO at REF compared with pNICU was not significantly associated with outcomes.

Conclusion: The most important predictors of outcomes in transported patients with PPHN were severity of illness prior to iNO and decreased response to iNO. Earlier initiation of iNO prior to transport prolonged stabilization time and was not associated with an improvement in outcomes. Further study is required to assess whether management of transported infants should focus on minimization of stabilization time and delay initiation of iNO until after NICU admission.

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