Preterm Ve Term İnfantlarda İnhale Nitrik Oksit Sonuçları: Üçüncü Düzey Yenidoğan Yoğun Bakım Ünıtesındeki Dört Yıllık Deneyim

Yıl 2020, Cilt: 18 Sayı: 1, 1 - 14, 15.04.2020

İpek Guney Varal Pelin Dogan

Öz

GİRİŞ ve AMAÇ: Bu çalışmada pulmoner hipertansiyon (PH) kliniği ile karakterize olan preterm ve term infantların, inhale nitrik oksit (INO) tedavisine yanıtlarındaki etkinliğin değerlendirilmesi amaçlanmıştır.

YÖNTEM ve GEREÇLER: Çalışma kohortu 2015-2019 yılları arasında INO tedavisi alan hastalardan oluşmuştur, hastalar gestasyon haftaları ve PH tanısının zamanına göre sınıflandırılmıştır.

BULGULAR: Çalışmaya toplamda 56 vaka dahil edilmiştir. iNO öncesi ve iNO sonrası ortalama hava yolu basınç değerleri ve oksijenasyon indeksi preterm infantların grubunda anlamlı düzeyde yüksek bulundu (p < 0.05). Erken PH tanısı alan grupta ortalama gestasyon haftası (GH) ve doğum ağırlığı (DA) daha yüksek bulundu. INO tedavisine yanıt veren grupta GH'ları ve DA'nın belirgin yüksek oldugu izlendi (p < 0.05). INO tedavisine yanıt alınamayan hastaların genellikle tanıları term bebeklerde diafragma hernisi iken pretermlerde sepsisdi.

TARTIŞMA ve SONUÇ: Term infantlarda İNO tedavisine daha iyi yanıt alınmakla beraber pretermlerde de İNO tedavisine erken başlanması ile daha iyi yanıt alınabilir.

Anahtar Kelimeler

inhale nitrik oksit, preterm, pulmoner hipertansiyon

Outcomes of Inhaled Nitric Oxide in Preterm and Term Infants: A Four-Year Experience in a Tertiary Neonatal Unit

Öz

INTRODUCTION: This study aimed at assessing the data of term and preterm neonates with pulmonary hypertension (PH) to characterise patients and the effectiveness of inhaled nitric oxide (iNO).
MATERIALS and METHODS: The study cohort treated with iNO between 2015 and 2019 was categorized into two groups according to the gestational age (GA) and timing of PH.
RESULTS: Overall 56 neonates were enrolled. Pre-iNO, post-iNO mean airway pressure values, and oxygenation index were significantly higher in the preterm group (p < 0.05). Mean GA and birth weight of the infants who had early PH diagnosis were higher. Positive responders were more likely to have higher GA as well as higher birth weight (p < 0.05). Non-responders were mostly diagnosed with diaphragmatic hernia in term infants and with sepsis in preterm infants
CONCLUSIONS: Despite term infants have higher positive response rate to treatment, initiating early treatment will increase the rate of positive response in preterm infants.

Anahtar Kelimeler

inhale nitric oxide, preterm, pulmonary hypertension

Kaynakça

• 1.Furchgott RF, Zawadzki JV. The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature. 1980;288(5789):373-6.
• 2.Pepke-Zaba J, Higenbottam TW, Dinh-Xuan AT, Stone D, Wallwork J. Inhaled nitric oxide as a cause of selective pulmonary vasodilatation in pulmonary hypertension. Lancet. 1991;338(8776):1173-4.
• 3.Sokol GM, Konduri GG, Van Meurs KP. Inhaled nitric oxide therapy for pulmonary disorders of the term and preterm infant. Semin Perinatol. 2016;40(6):356-69.
• 4.Roberts JD, Jr., Fineman JR, Morin FC, 3rd, Shaul PW, Rimar S, Schreiber MD, et al. Inhaled nitric oxide and persistent pulmonary hypertension of the newborn. The Inhaled Nitric Oxide Study Group. N Engl J Med. 1997;336(9):605-10.
• 5.Farrow KN, Fliman P, Steinhorn RH. The diseases treated with ECMO: focus on PPHN. Semin Perinatol. 2005;29(1):8-14.
• 6.Dani C, Corsini I, Cangemi J, Vangi V, Pratesi S. Nitric oxide for the treatment of preterm infants with severe RDS and pulmonary hypertension. Pediatr Pulmonol. 2017;52(11):1461-8.
• 7.Chandrasekharan P, Kozielski R, Kumar VH, Rawat M, Manja V, Ma C, et al. Early Use of Inhaled Nitric Oxide in Preterm Infants: Is there a Rationale for Selective Approach? Am J Perinatol. 2017;34(5):428-40.
• 8.Ellsworth MA, Harris MN, Carey WA, Spitzer AR, Clark RH. Off-label use of inhaled nitric oxide after release of NIH consensus statement. Pediatrics. 2015;135(4):643-8.
• 9.Soraisham AS, Harabor A, Shivananda S, Alvaro R, Ye XY, Lee SK, et al. Trends and Variations in the Use of Inhaled Nitric Oxide in Preterm Infants in Canadian Neonatal Intensive Care Units. Am J Perinatol. 2016;33(7):715-22.
• 10. Baczynski M, Ginty S, Weisz DE, McNamara PJ, Kelly E, Shah P, et al. Short-term and long-term outcomes of preterm neonates with acute severe pulmonary hypertension following rescue treatment with inhaled nitric oxide. Arch Dis Child Fetal Neonatal Ed. 2017;102(6):F508-F14.
• 11.Barrington KJ, Finer N, Pennaforte T. Inhaled nitric oxide for respiratory failure in preterm infants. Cochrane Database Syst Rev. 2017;1:CD000509.
• 12.Barrington KJ, Finer N, Pennaforte T, Altit G. Nitric oxide for respiratory failure in infants born at or near term. Cochrane Database Syst Rev. 2017;1:CD000399.
• 13.Neonatal Inhaled Nitric Oxide Study G. Inhaled nitric oxide in full-term and nearly full-term infants with hypoxic respiratory failure. N Engl J Med. 1997;336(9):597-604.
• 14.Sood BG, Wykes S, Landa M, De Jesus L, Rabah R. Expression of eNOS in the lungs of neonates with pulmonary hypertension. Exp Mol Pathol. 2011;90(1):9-12.
• 15.Simpson CM, Smolich JJ, Shekerdemian LS, Penny DJ. Urotensin-II contributes to pulmonary vasoconstriction in a perinatal model of persistent pulmonary hypertension of the newborn secondary to meconium aspiration syndrome. Pediatr Res. 2010;67(2):150-7.
• 16.Chock VY, Van Meurs KP, Hintz SR, Ehrenkranz RA, Lemons JA, Kendrick DE, et al; NICHD Neonatal Research Network. Inhaled nitric oxide for preterm premature rupture of membranes, oligohydramnios, and pulmonary hypoplasia. Am J Perinatol. 2009;26(4):317-22.
• 17. Cole FS, Alleyne C, Barks JD, Boyle RJ, Carroll JL, Dokken D, et al. NIH Consensus Development Conference statement: inhaled nitric-oxide therapy for premature infants. Pediatrics. 2011;127(2):363-9.
• 18.Kumar P, Committee on F, Newborn, American Academy of P. Use of inhaled nitric oxide in preterm infants. Pediatrics. 2014;133(1):164-70.
• 19.Abman SH, Ivy DD, Archer SL, Wilson K, Committee AAJGfPPH. Executive Summary of the American Heart Association and American Thoracic Society Joint Guidelines for Pediatric Pulmonary Hypertension. Am J Respir Crit Care Med. 2016;194(7):898-906.
• 20.Suzuki S, Togari H, Potenziano JL, Schreiber MD. Efficacy of inhaled nitric oxide in neonates with hypoxic respiratory failure and pulmonary hypertension: the Japanese experience. J Perinat Med. 2018;46(6):657-63.
• 21.Rhine WD, Suzuki S, Potenziano JL, Escalante S, Togari H. An Analysis of Time to Improvement in Oxygenation in Japanese Preterm and Late Preterm or Term Neonates With Hypoxic Respiratory Failure and Pulmonary Hypertension. Clin Ther. 2019;41(5):910-9.
• 22.Aikio O, Metsola J, Vuolteenaho R, Perhomaa M, Hallman M. Transient defect in nitric oxide generation after rupture of fetal membranes and responsiveness to inhaled nitric oxide in very preterm infants with hypoxic respiratory failure. J Pediatr. 2012;161(3):397-403 e1.
• 23.MacRitchie AN, Albertine KH, Sun J, Lei PS, Jensen SC, Freestone AA, et al. Reduced endothelial nitric oxide synthase in lungs of chronically ventilated preterm lambs. Am J Physiol Lung Cell Mol Physiol. 2001;281(4):L1011-20.