Abstract
Objective Among neonates of 22 to 29 weeks' gestational age (GA) who required mechanical ventilation
for the treatment of respiratory distress syndrome (RDS) and clinically diagnosed
pulmonary hypertension (PH), we tested our hypothesis that the association between
early treatment with inhaled nitric oxide (iNO) and survival would vary according
to birth size and GA.
Study Design Because iNO was not randomly prescribed to patients in this cohort, we used propensity
score matching to pair a neonate who received iNO at a chronological age of ≤7 days
with an unexposed neonate with similar baseline characteristics. The primary outcome
was inhospital mortality, which we evaluated based on size for GA and GA strata using
the Cox proportional hazards regression model.
Results Among 1,531 neonates who met study criteria, we created a propensity score matched
cohort of 615 pairs of neonates (iNO-exposed and unexposed). The risk of inhospital
mortality for iNO-exposed neonates was observed only in the minority (<10%) who were
large for GA, though this finding did not persist when matching for illness severity.
Conclusion Early treatment with iNO is not associated with survival in most extremely premature
neonates with RDS and clinically diagnosed PH when stratified for birth size or GA.
Keywords
inhaled nitric oxide - neonate - prematurity - pulmonary hypertension - respiratory
distress syndrome
