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Pulmonary vasodilator use in very preterm infants in United States children's hospitals
Tomas F Vega1, Matthew Huber1, Erik A Jensen1,2
1Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Insights
Pulmonary vasodilators (PV) like inhaled nitric oxide (iNO) and sildenafil are used in very preterm infants. Early use is linked to lower gestational age and small for gestational age, while late use is associated with bronchopulmonary dysplasia (BPD).
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Pharmacology
Background:
- Pulmonary vasodilators (PV) are crucial in managing respiratory conditions in neonates.
- Understanding the patterns of PV use in very preterm (VP) infants is essential for optimizing care.
- Limited data exists on the timing and characteristics of PV exposure in VP infants.
Purpose of the Study:
- To characterize the common pulmonary vasodilators (PV) used in very preterm (VP) infants.
- To determine the timing of PV exposure during hospitalization.
- To identify factors associated with PV use in VP infants.
Main Methods:
- An observational study analyzed data from 37,428 very preterm infants discharged from U.S. children's hospitals between 2011 and 2021.
- Pulmonary vasodilator (PV) exposures during hospitalization were identified.
- Multivariable modeling was employed to ascertain characteristics linked to PV exposure.
Main Results:
- 6.3% of VP infants received PV, with early inhaled nitric oxide (iNO) and late sildenafil being most frequent.
- Early PV exposure correlated with lower gestational age (22-25 weeks) and being small for gestational age (SGA).
- Late PV exposure was associated with higher-grade bronchopulmonary dysplasia (BPD) and prior early PV exposure.
Conclusions:
- Early iNO and late sildenafil are utilized in VP infants, often without robust supporting evidence.
- Evidence gaps exist for prospective studies in extremely preterm and SGA infants for early PV use.
- Further research is needed for late PV use in infants with early PV exposure and severe BPD.
Objectives:
To describe common pulmonary vasodilators (PV), exposure timing, and characteristics associated with their use in very preterm (VP) infants.
Study Design:
Observational study of VP infants discharged from U.S. children's hospitals (2011-2021). PV exposures during hospitalization were identified, and multivariable modeling determined characteristics associated with exposure.
Results:
Among 37,428 infants, 6.3% received PV. Early inhaled nitric oxide (iNO) and late sildenafil were most common. Early exposure was associated with lower gestational age, aOR: 9.2 (7.3-11.7), 22-25 vs. 29-31 weeks) and small for gestational age (SGA), 2.3 (2.0-2.7). Late exposure was associated with bronchopulmonary dysplasia (BPD) grade, 26.2 (16.8-40.9), grade 3 vs. no BPD) and early PV exposure, 3.7 (2.9-4.8).
Conclusions:
Early iNO and late sildenafil are used in VP infants despite limited evidence. Prospective early studies enrolling extremely preterm and SGA infants and late studies enrolling infants with early PV exposure and high-grade BPD would target current evidence gaps.
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