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梁 国, 林 新. [Recent research on inhaled nitric oxide in preterm infants with a gestational age of <34 weeks]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:982-988. [PMID: 37718407 PMCID: PMC10511234 DOI: 10.7499/j.issn.1008-8830.2303146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/03/2023] [Indexed: 09/19/2023]
Abstract
Nitric oxide is a messenger molecule for vasodilation of vascular smooth muscle cells, and inhaled nitric oxide (iNO) can dilate pulmonary blood vessels and reduce pulmonary vascular resistance, thereby reducing pulmonary artery pressure, but with no influence on systemic circulation pressure. Guidelines in China and overseas recommend the use of iNO in full-term infants and late preterm infants, and it has been proved that it has a marked effect on persistent pulmonary hypertension and hypoxic respiratory failure in such infants. However, recent studies have shown that there is an increase in the off-label use of iNO in preterm infants with a gestational age of <34 weeks. This article reviews the research progress on the efficacy, safety, timing, dose, and withdrawal mode of iNO and its combination with vasoactive drugs in the treatment of preterm infants with a gestational age of <34 weeks in China and overseas, so as to provide a reference for clinical application.
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Oka S, Nishimura E, Ozawa J, Haga M, Miyahara N, Sakatani S, Minamitani Y, Namba F. Therapeutic response of iNO in preterm infants with hypoxemic respiratory failure. Pediatr Int 2023; 65:e15423. [PMID: 36412230 DOI: 10.1111/ped.15423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/28/2022] [Accepted: 11/21/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Inhaled nitric oxide (iNO) has been used as a rescue treatment for preterm infants with hypoxemic respiratory failure (HRF). However, its effectiveness remains debatable. Thus, in this study, we aimed to examine the impact of iNO therapy on HRF in extremely preterm infants. METHODS A retrospective observational study was performed. Extremely preterm infants admitted to our neonatal intensive care unit who received iNO therapy later in their postnatal life were included. The oxygen saturation index (OSI) was used as an index of the severity of respiratory failure. RESULTS In total, 30 extremely preterm infants were included in this study. Oxygenation was enhanced after the administration of iNO in infants with HRF. The OSI decreased by more than 20% in 12 patients (40%, positive responder) and did not decrease in 17 patients (57%, negative responder) within the first 6 h of treatment. The iNO initiation day was the significant independent factor associated with a positive response to iNO therapy in extremely preterm infants with HRF. CONCLUSIONS iNO therapy was effective in enhancing oxygenation in extremely preterm infants with HRF. Earlier use of iNO was the significant factor associated with a positive therapeutic response to iNO, implying that iNO may be more effective in pulmonary vessels which are less damaged by shorter-term mechanical ventilation.
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Affiliation(s)
- Shuntaro Oka
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Eri Nishimura
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Junichi Ozawa
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Mitsuhiro Haga
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Naoyuki Miyahara
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shun Sakatani
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan.,Department of Neonatology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yohei Minamitani
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Nakanishi H, Isayama T, Kokubo M, Hirano S, Kusuda S. Inhaled Nitric Oxide Therapy in the Post-Acute Phase in Extremely Preterm Infants: A Japanese Cohort Study. J Pediatr 2023; 252:61-67.e5. [PMID: 36116533 DOI: 10.1016/j.jpeds.2022.07.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the trends in inhaled nitric oxide (iNO) utilization in the late phase of hospitalization in a large Japanese cohort of extremely preterm infants and evaluate its benefit on long-term outcomes. STUDY DESIGN This was a retrospective multicenter cohort study of 15 977 extremely preterm infants born at <28 weeks of gestational age between 2003 and 2016, in the Neonatal Research Network, Japan. Demographic characteristics, morbidity, and mortality were compared between extremely preterm infants with and without post-acute iNO therapy. Multivariable logistic analysis was performed to determine factors associated with post-acute iNO and its impact on neurodevelopmental outcomes at 3 years of age. RESULTS Post-acute iNO utilization rates increased from 0.3% in 2009 to 1.9% in 2016, even under strict insurance coverage rules starting in 2009. Gestational age (1-week increment; aOR 0.82, 95% CI 0.76-0.88), small for gestational age (1.47, 1.08-1.99), histologic chorioamnionitis (1.50, 1.21-1.86), 5-minute Apgar score <4 (1.51, 1.10-2.07), air leak (1.92, 1.30-2.83), and bubbly/cystic appearance on chest X-Ray (1.68, 1.37-2.06) were associated with post-acute iNO. Post-acute iNO was not associated with neurodevelopmental outcomes at 3 years of age. CONCLUSIONS The increasing post-acute iNO utilization rate among extremely preterm infants has been concurrent with improved survival rates of extremely preterm infants in Japan. Infants treated with post-acute iNO had more severe disease and complications than the comparison group, but there were no differences in neurodevelopmental outcome at 3 years. This suggests post-acute iNO may benefit extremely preterm infants.
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Affiliation(s)
- Hidehiko Nakanishi
- Research and Development Center for New Medical Frontiers, Department of Advanced Medicine, Division of Neonatal Intensive Care Medicine, Kitasato University School of Medicine, Kanagawa, Japan.
| | - Tetsuya Isayama
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Masayo Kokubo
- Division of Neonatology, Nagano Children's Hospital, Nagano, Japan
| | - Shinya Hirano
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Satoshi Kusuda
- Department of Pediatrics, Kyorin University, Tokyo, Japan
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VARDAR G, AKSOY OKAN M, TOPÇUOĞLU S, KARADAĞ N, ÖZALKAYA E, OZGUN KARATEPE H, KARATEKİN G. Controversies in neonatology: The efficacy of inhaled nitric oxide in preterm infants with persistent pulmonary hypertension. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1104799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: There is limited and conflicting information in literature regarding use of inhaled nitric oxide (iNO) in preterm infants. In this study we examined the characteristics of preterm infants with persistent pulmonary hypertension (PHT) who responded and did not respond to iNO therapy .
Material and Method: We retrospectively reviewed data of infants
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Affiliation(s)
- Gonca VARDAR
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL ZEYNEP KAMİL HEALTH RESEARCH CENTER FOR GYNAECOLOGY AND PEDIATRICS
| | - Meliha AKSOY OKAN
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL ZEYNEP KAMİL HEALTH RESEARCH CENTER FOR GYNAECOLOGY AND PEDIATRICS
| | - Sevilay TOPÇUOĞLU
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL ZEYNEP KAMİL HEALTH RESEARCH CENTER FOR GYNAECOLOGY AND PEDIATRICS
| | - Nilgün KARADAĞ
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL ZEYNEP KAMİL HEALTH RESEARCH CENTER FOR GYNAECOLOGY AND PEDIATRICS
| | - Elif ÖZALKAYA
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL ZEYNEP KAMİL HEALTH RESEARCH CENTER FOR GYNAECOLOGY AND PEDIATRICS
| | - Hande OZGUN KARATEPE
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL ZEYNEP KAMİL HEALTH RESEARCH CENTER FOR GYNAECOLOGY AND PEDIATRICS
| | - Güner KARATEKİN
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL ZEYNEP KAMİL HEALTH RESEARCH CENTER FOR GYNAECOLOGY AND PEDIATRICS
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Use of Inhaled Nitric Oxide in Preterm Infants: Is There Sufficient Evidence? Indian J Pediatr 2022; 89:262-266. [PMID: 34287800 DOI: 10.1007/s12098-021-03827-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/27/2021] [Indexed: 10/20/2022]
Abstract
Nitric oxide (NO) is a potent vasodilator. The inhaled form (iNO) improves outcomes in term infants with persistent pulmonary hypertension of the newborn (PPHN) or bronchopulmonary dysplasia-associated pulmonary hypertension in preterm infants. However, in preterm infants, the risks and benefits of iNO use are controversial. Substantial evidence reveals no significant impact on survival or other morbidities in preterm infants with iNO treatment, independent of indication, timing, or duration of use. Many scientific organizations do not recommend the use of iNO in preterm infants, except in unique clinical circumstances with echocardiographic findings of PPHN in the setting of presumed pulmonary hypoplasia.
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Kusuda S, Hirano S, Nakamura T. Creating experiences from active treatment towards extremely preterm infants born at less than 25 weeks in Japan. Semin Perinatol 2022; 46:151537. [PMID: 34862068 DOI: 10.1016/j.semperi.2021.151537] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Treatment for extremely preterm infants born at less than 25 weeks of gestation in Japan was initiated mainly due to the amendment of the Maternal Health Act lowering the upper limit of abortion from 24 weeks to 22 weeks in 1990. Five years after the amendment, the Japanese national government started a nationwide project to improve the perinatal care system. Once selected perinatal centers reported improvements in survival rates, more centers have adopted aggressive treatments. They have accumulated their knowledge by experiencing the treatment of infants with a limit of viability. As a result, more than 50% of infants born even at 22 weeks of gestation can survive to discharge currently. This progress has resulted from the accumulation of experience at each perinatal center rather than the results from clinical trials. Furthermore, these experiences have been standardized to some extent through sharing information.
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Affiliation(s)
- Satoshi Kusuda
- Specialist Doctor, Department of Pediatrics, Kyorin University, Tokyo, Japan.
| | - Shinya Hirano
- Associate Director, Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Tomohiko Nakamura
- Director, Department of Neonatology, Nagano Children's Hospital, Nagano, Japan
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Elfarargy MS, Abu-Risha S, Al-Ashmawy G, Khattab H. Serum vitamin A levels as a novel predictor for respiratory distress syndrome in neonates: is it beneficial? Endocr Metab Immune Disord Drug Targets 2021; 22:235-240. [PMID: 34548005 DOI: 10.2174/1871530321666210921120258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Neonatal respiratory distress syndrome (RDS) is a very important dangerous disease in neonates and is accompanied by neonatal complications and death. OBJECTIVE Early determination of neonatal serum vitamin A levels as a possible novel predictor for neonatal RDS. PATIENTS AND METHODS A case-control study, with the identification number TCTR20210206001 was done on 100 neonates who were admitted to the neonatal intensive care unit (NICU) of Tanta University Hospital (TUH) suffering from RDS (patient group) and 100 healthy neonates (control group). Estimation of serum vitamin A (retinol) was occurred for all neonates of this study within the first four hours after birth before any nutrition or therapies. RESULTS Showed no significant difference between serums retinol (RT) levels in grade 1&2 RDS neonates (patient group) and the serum RT levels in the control group while there was significant difference between serums retinol levels in grade 3&4 RDS neonates (patient group) and the serum retinol levels in the control group where the P-value was 0.006, 0.002 respectively. CONCLUSION Serum vitamin A levels in neonates were decreased in RDS neonates and could be used as a predictor for the development and severity of RDS. RECOMMENDATION Routine estimation of serum vitamin A levels in neonates as a novel predictor for neonatal RDS.
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Affiliation(s)
| | - Sally Abu-Risha
- Department of pharmacology& toxicology, faculty of Pharmacy, Tanta University. Egypt
| | - Ghada Al-Ashmawy
- Department of Biochemistry, Faculty of Pharmacy, Tanta University. Egypt
| | - Haidy Khattab
- Department of Physiology, Faculty of Medicine, Tanta University. Egypt
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Rysavy MA, Mehler K, Oberthür A, Ågren J, Kusuda S, McNamara PJ, Giesinger RE, Kribs A, Normann E, Carlson SJ, Klein JM, Backes CH, Bell EF. An Immature Science: Intensive Care for Infants Born at ≤23 Weeks of Gestation. J Pediatr 2021; 233:16-25.e1. [PMID: 33691163 PMCID: PMC8154715 DOI: 10.1016/j.jpeds.2021.03.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/27/2021] [Accepted: 03/03/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Matthew A Rysavy
- Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA.
| | - Katrin Mehler
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - André Oberthür
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Johan Ågren
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Satoshi Kusuda
- Department of Pediatrics, Neonatal Research Network of Japan, Kyorin University, Tokyo, Japan
| | - Patrick J McNamara
- Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Regan E Giesinger
- Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Angela Kribs
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Erik Normann
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Susan J Carlson
- Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Jonathan M Klein
- Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Carl H Backes
- Departments of Pediatrics and Obstetrics & Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Edward F Bell
- Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
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Nitric oxide and the brain. Part 2: Effects following neonatal brain injury-friend or foe? Pediatr Res 2021; 89:746-752. [PMID: 32563184 DOI: 10.1038/s41390-020-1021-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/30/2020] [Accepted: 06/02/2020] [Indexed: 12/30/2022]
Abstract
Nitric oxide (NO) has critical roles in a wide variety of key biologic functions and has intricate transport mechanisms for delivery to key distal tissues under normal conditions. However, NO also plays important roles during disease processes, such as hypoxia-ischemia, asphyxia, neuro-inflammation, and retinopathy of prematurity. The effects of exogenous NO on the developing neonatal brain remain controversial. Inhaled NO (iNO) can be neuroprotective or toxic depending on a variety of factors, including cellular redox state, underlying disease processes, duration of treatment, and dose. This review identifies key gaps in knowledge that should prompt further investigation into the possible role of iNO as a therapeutic agent after injury to the brain. IMPACT: NO is a key signal mediator in the neonatal brain with neuroprotective and neurotoxic properties. iNO, a commonly used medication, has significant effects on the neonatal brain. Dosing, duration, and timing of administration of iNO can affect the developing brain. This review article summarizes the roles of NO in association with various disease processes that impact neonates, such as brain hypoxia-ischemia, asphyxia, retinopathy of prematurity, and neuroinflammation. The impact of this review is that it clearly describes gaps in knowledge, and makes the case for further, targeted studies in each of the identified areas.
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Antonietta MM, Bardanzellu F, Neroni P, Fanos V. "Points of view on periviable infants". Pediatr Int 2020; 62:656-657. [PMID: 32463579 DOI: 10.1111/ped.14171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Marcialis Maria Antonietta
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari, Monserrato, Italy
| | - Flaminia Bardanzellu
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari, Monserrato, Italy
| | - Paola Neroni
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari, Monserrato, Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari, Monserrato, Italy
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