دورية أكاديمية
أعرض في EDS

Early nitric oxide is not associated with improved outcomes in congenital diaphragmatic hernia.

التفاصيل البيبلوغرافية
العنوان: Early nitric oxide is not associated with improved outcomes in congenital diaphragmatic hernia.
المؤلفون: Noh CY; Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA. cynoh@stanford.edu., Chock VY; Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA., Bhombal S; Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA., Danzer E; Division of Pediatric Surgery, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Patel N; Royal Hospital for Children Glasgow, Glasgow, UK., Dahlen A; Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, USA., Harting MT; Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX, USA., Lally KP; Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX, USA., Ebanks AH; Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX, USA., Van Meurs KP; Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.
مؤلفون مشاركون: Congenital Diaphragmatic Hernia Study Group
المصدر: Pediatric research [Pediatr Res] 2023 Jun; Vol. 93 (7), pp. 1899-1906. Date of Electronic Publication: 2023 Feb 01.
نوع المنشور: Multicenter Study; Journal Article
اللغة: English
بيانات الدورية: Publisher: Nature Publishing Group Country of Publication: United States NLM ID: 0100714 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1530-0447 (Electronic) Linking ISSN: 00313998 NLM ISO Abbreviation: Pediatr Res Subsets: MEDLINE
أسماء مطبوعة: Publication: 2012- : New York : Nature Publishing Group
Original Publication: Basel ; New York : Karger.
مواضيع طبية MeSH: Hernias, Diaphragmatic, Congenital*/complications , Hypertension, Pulmonary*/drug therapy , Hypertension, Pulmonary*/complications , Autonomic Nervous System Diseases*, Infant ; Humans ; Nitric Oxide ; Cohort Studies ; Administration, Inhalation ; Retrospective Studies
مستخلص: Background: Inhaled nitric oxide (iNO) is widely used for the management of infants with congenital diaphragmatic hernia (CDH); however, evidence of benefit is limited.
Methods: This is a multicenter cohort study using data from the Congenital Diaphragmatic Hernia Study Group between 2015 and 2020. The impact of early iNO use in the first 3 days of life prior to ECLS use on mortality or ECLS use was explored using multivariate logistic regression models and subgroup analyses.
Results: Of the 1777 infants, 863 (48.6%) infants received early iNO treatment. Infants receiving iNO had lower birth weight, larger defect size, more severe pulmonary hypertension, and abnormal ventricular size and function. After controlling for these factors, early iNO use was associated with increased mortality (aOR 2.06, 95% CI 1.05-4.03, P = 0.03) and increased ECLS use (aOR 3.44, 95% CI 2.11-5.60, P < 0.001). Subgroup analyses after stratification by echocardiographic characteristics and defect size revealed no subgroup with a reduction in mortality or ECLS use.
Conclusions: Use of iNO in the first 3 days of life prior to ECLS was not associated with a reduction in mortality or ECLS use in either the regression models or the subgroup analyses. The widespread use of iNO in this vulnerable population requires reconsideration.
Impact: Evidence to support widespread use of iNO for infants with congenital diaphragmatic hernia is limited. The use of iNO in the first 3 days of life was associated with significantly increased mortality and ECLS use. Stratification by echocardiographic characteristics and defect size did not reveal a subgroup that benefited from iNO. Even the subset of patients with R-to-L shunts at both ductal and atrial levels, a surrogate for elevated pulmonary arterial pressures in the absence of significantly decreased LV compliance, did not benefit from early iNO use. Early iNO therapy was of no benefit in the management of acute pulmonary hypertension in infants with congenital diaphragmatic hernia, supporting reconsideration of its use in this population.
(© 2023. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)
التعليقات: Erratum in: Pediatr Res. 2023 Apr 12;:. (PMID: 37045947)
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المشرفين على المادة: 31C4KY9ESH (Nitric Oxide)
تواريخ الأحداث: Date Created: 20230201 Date Completed: 20230703 Latest Revision: 20231116
رمز التحديث: 20231215
DOI: 10.1038/s41390-023-02491-8
PMID: 36725908
قاعدة البيانات: MEDLINE
الوصف
تدمد:1530-0447
DOI:10.1038/s41390-023-02491-8