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Published on: November 20, 2015
Early Hypoxic Respiratory Failure in Extreme Prematurity: Mortality and Neurodevelopmental Outcomes
Praveen Chandrasekharan1, Satyan Lakshminrusimha2, Dhuly Chowdhury3
1Division of Neonatology, Department of Pediatrics, UBMD, University at Buffalo, Buffalo, New York; pkchandr@buffalo.edu.
Insights
Extremely low birth weight infants with early hypoxemic respiratory failure face high mortality and neurodevelopmental impairment. Inhaled nitric oxide did not improve outcomes, with no significant differences observed in African American infants.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
- Respiratory Medicine
Background:
- Extremely low birth weight (ELBW) infants, particularly those born at or before 26 weeks' gestation, are at high risk for respiratory complications.
- Early hypoxemic respiratory failure (HRF) is a significant predictor of adverse outcomes in this vulnerable population.
- Inhaled nitric oxide (iNO) is used to treat pulmonary hypertension, but its efficacy in improving survival and neurodevelopmental outcomes in ELBW infants with early HRF is not fully established.
Purpose of the Study:
- To evaluate the survival and neurodevelopmental impairment (NDI) rates in ELBW infants experiencing early HRF at 18 to 26 months corrected age.
- To assess the impact of inhaled nitric oxide (iNO) exposure on outcomes for ELBW infants with early HRF.
- To specifically examine whether African American infants with early HRF experience different outcomes after iNO exposure compared to other racial groups.
Main Methods:
- Retrospective cohort study of ELBW infants (≤1000 g, ≤26 weeks' gestation) born between 2007 and 2015.
- Identification of infants with "early HRF" based on oxygen requirements (≥60% maximal oxygen on day 1 or 3).
- Propensity score regression modeling was used to analyze outcomes, including mortality and NDI, and the effect of iNO exposure, stratified by race.
Main Results:
- Of 7639 ELBW infants, 22.7% had early HRF, associated with a 51.3% mortality rate.
- Among survivors, 41.2% had moderate-to-severe NDI at 18-26 months; iNO-treated infants had a 59.4% mortality rate.
- While African American infants had similar HRF incidence, they received iNO less frequently. Intact survival among iNO-exposed infants did not differ significantly by race.
Conclusions:
- Early HRF in preterm infants (≤26 weeks) is linked to substantial mortality and NDI.
- The use of iNO in this cohort did not demonstrate a benefit in reducing mortality or NDI.
- Outcomes following iNO exposure were comparable between African American and other racial groups.
Objectives:
To evaluate the survival and neurodevelopmental impairment (NDI) in extremely low birth weight (ELBW) infants at 18 to 26 months with early hypoxemic respiratory failure (HRF). We also assessed whether African American infants with early HRF had improved outcomes after exposure to inhaled nitric oxide (iNO).
Methods:
ELBW infants ≤1000 g and gestational age ≤26 weeks with maximal oxygen ≥60% on either day 1 or day 3 were labeled as "early HRF" and born between 2007 and 2015 in the Neonatal Research Network were included. Using a propensity score regression model, we analyzed outcomes and effects of exposure to iNO overall and separately by race.
Results:
Among 7639 ELBW infants born ≤26 weeks, 22.7% had early HRF. Early HRF was associated with a mortality of 51.3%. The incidence of moderate-severe NDI among survivors was 41.2% at 18 to 26 months. Mortality among infants treated with iNO was 59.4%. Female sex (adjusted odds ratio [aOR]: 2.4, 95% confidence interval [CI]: 1.8-3.3), birth weight ≥720 g (aOR: 2.3, 95% CI: 1.7-3.1) and complete course of antenatal steroids (aOR: 1.6, 95% CI: 1.1-2.2) were associated with intact survival. African American infants had a similar incidence of early HRF (21.7% vs 23.3%) but lower exposure to iNO (16.4% vs 21.6%). Among infants with HRF exposed to iNO, intact survival (no death or NDI) was not significantly different between African American and other races (aOR: 1.5, 95% CI: 0.6-3.6).
Conclusions:
Early HRF in infants ≤26 weeks' gestation is associated with high mortality and NDI at 18 to 26 months. Use of iNO did not decrease mortality or NDI. Outcomes following iNO exposure were not different in African American infants.
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