Longitudinal follow-up of a cohort of newborn infants treated with inhaled nitric oxide for persistent pulmonary hypertension.
OBJECTIVE
To describe the outcome of a group of term newborn infants treated with inhaled nitric oxide for severe persistent pulmonary hypertension.


METHODS
We performed a prospective longitudinal medical and neurodevelopmental follow-up of 51 infants treated as neonates for persistent pulmonary hypertension of the newborn with inhaled nitric oxide. The original number of treated infants was 87, of whom 25 died in the neonatal period; of 62 infants who survived, 51 were seen at 1 year of age and 33 completed a 2-year evaluation. Statistical analysis used population medians, means, and standard deviations for parameters assessed. Paired t tests and chi-square analysis were used to compare outcomes measured at 1 year with assessment at 2 years for the 32 infants seen at both 1- and 2-year visits.


RESULTS
At 1-year follow-up median growth percentiles were 20%, 72.5%, and 50% for weight, length, and occipitofrontal circumference, respectively. Thirteen of 51 infants (25.5%) were < 5th percentile in weight. Nine of 51 infants (17.6%) had feeding problems (need for gastrostomy feeding or gastroesophageal reflux), and 14 (27.5%) had a clinical diagnosis of reactive airways disease. Infant development as measured by the Bayley Scales of Infant Development was 104 +/- 16 for the mental development index and 97 +/- 20 for the psychomotor index. Six of 51 infants (11.8%) were found to have severe neurologic handicaps, defined as a Bayley score on either the mental development or psychomotor index of < 68, abnormal findings on neurologic examination, or both. Fewer children (6.1% vs 15.7%) required supplemental oxygen at 2 years compared with 1 year, and performance on the psychomotor index of the Bayley Scales improved significantly.


CONCLUSIONS
One- and 2-year follow-up of a cohort of infants with persistent pulmonary hypertension of the newborn who were treated with inhaled nitric oxide had an 11.8% (1 year) and 12.1% (2-year) rate of severe neurodevelopmental disability. There are ongoing medical problems in these infants including reactive airways disease and slow growth that merit continued close longitudinal follow-up.
Rosenberg
A A
AA
Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA.
Kennaugh
J M
JM
Moreland
S G
SG
Fashaw
L M
LM
Hale
K A
KA
Torielli
F M
FM
Abman
S H
SH
Kinsella
J P
JP
D000280:Administration, Inhalation; D001827:Body Height; D001835:Body Weight; D001921:Brain / Q000254:growth & development; D002508:Cephalometry; D002657:Child Development; D002675:Child, Preschool; D015331:Cohort Studies; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000254:growth & development; D005764:Gastroesophageal Reflux / Q000503:physiopathology; D005774:Gastrostomy; D006128:Growth; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008171:Lung Diseases / Q000503:physiopathology; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage / Q000627:therapeutic use*; D009777:Occipital Bone / Q000254:growth & development; D010102:Oxygen Inhalation Therapy; D010547:Persistent Fetal Circulation Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D011597:Psychomotor Performance; D015996:Survival Rate; D016896:Treatment Outcome
D009569:Nitric Oxide