74: Inhaled Nitric Oxide as Rescue Therapy for Preterm Infants in Severe Hypoxemic Respiratory Failure – A Retrospective Cohort Study

Inhalation of nitric oxide (iNO) has been shown to improve oxygenation and reduce the need for ECMO in term and near term infants with persistent pulmonary hypertension. However, its efficacy in preterm population is debated with available trials heterogeneous in terms of the subjects enrolled. As per the NIH consensus development panel statement (2010) on the use of iNO, it is inadequately studied in preterm infants of <34 week gestation suspected with pulmonary hypertension or lung hypoplasia. To study the use of iNO as rescue treatment in subset of preterm infants presenting with refractory hypoxemia on the day of birth. Retrospective cohort study at a tertiary care neonatal unit. Subjects were infants born between 25 to 33+6 weeks gestation with refractory hypoxemia (defined as inability to maintain blood oxygen saturation (SaO2) within normal range despite being ventilated with >90% FiO2 for 30 minutes and having received at least one dose of surfactant) within 24 hours of birth and received a trial of iNO as rescue therapy. Response to iNO was defined as one or more of the following: 1) improvement in PaO2 by >20 mm Hg or 2) decrease in OI by >5 or 3) decrease in FiO2 requirements by >20%. Response was assessed at 1 h from initiation of iNO (early response) and at 24 h (sustained response). Sixty preterm infants were identified. Baseline parameters prior to initiation of iNO were as follows: Gestation age (mean + SD) = 28.2 +1.98 weeks; Birth weight (mean + SD) = 1246 +479 g; FiO2 (mean + SD) = 99.2+ 2.3%; and Oxygenation index: Median [IQR]= 24.9[18.7 – 34.8]. As per pre-determined criteria, 52 (88%) infants were considered early and 57 (95%) as sustained responders. Majority of early responders (51/52) had sustained response with iNO. There were 10 deaths during primary hospitalization; with six cases of NEC (stage ≥2); 10 cases of severe IVH and five cases of PVL. In this cohort of preterm infants diagnosed with refractory hypoxemia on the day of birth and received a trial of iNO as last resort, the majority showed an early and sustained response in terms of respiratory parameters. Placebo control trials are urgently needed to assess benefits in terms of BPD, death or long-term outcomes in this subset of population.

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