title: Inhaled nitric oxide and gentle ventilation in the treatment of pulmonary hypertension of the newborn--a single-center, 5-year experience.
abstract: OBJECTIVE
  To evaluate the effect of inhaled nitric oxide (INO) in pulmonary hypertension of the newborn (PH) in a single center over 5 years using gentle ventilation (GV), without hyperventilation or induced alkalosis.
  
  
  METHODS
  Data from 229 consecutive infants with PH of varied etiology treated with INO and GV, and from 67 infants with meconium aspiration syndrome (MAS) and primary PH (PPHN) treated with GV alone were reviewed over a 5-year period (86% outborn). INO was initiated at 25 ppm when PH and severe hypoxemia persisted despite maximal optimal ventilation. Hyperventilation or systemic alkalosis were not attempted.
  
  
  RESULTS
  Mean duration of ventilation was 9.9 +/- 14 days (median 6.5 days). Average mean airway pressure (MAP) dropped from 17.7 +/- 4.3 cm H(2)O at the referral hospital to 13.2 +/- 2.5 cm H(2)O (p < 0.001) following admission to our unit using conventional settings and GV, before starting INO. Mean oxygenation index (OI) dropped from 46.8 +/- 24.5 to 22.7 +/- 21.4 within 24 hours of INO therapy (p < 0.001). Infants with higher baseline pH and lower baseline OI responded better to INO (p < 0.02). Overall survival was 72%. Patients with MAS and PPHN had the best response, 92% survived and there was a 46% reduction in need for extracorporeal membrane oxygenation (ECMO) compared to historical pre-INO period controls (23.9% vs. 12.8%, p < 0.01). In the infants treated with GV alone, the MAP dropped from 17.2 +/- 4.3 cm H2O at the referral hospital to 12.6+/-2.4 after GV was started in our unit.
  
  
  CONCLUSIONS
  We conclude that INO is an effective and well-tolerated therapy for PH in infants receiving GV.
authors.affiliation: Department of Pediatrics, The Children's Hospital of New York, College of Physicians and Surgeons, Columbia University, New York, NY 10032,USA.
authors.forename: Anju
authors.initials: A
authors.lastname: Gupta
authors.forename: Shantanu
authors.initials: S
authors.lastname: Rastogi
authors.forename: Rakesh
authors.initials: R
authors.lastname: Sahni
authors.forename: Alok
authors.initials: A
authors.lastname: Bhutada
authors.forename: David
authors.initials: D
authors.lastname: Bateman
authors.forename: Deepa
authors.initials: D
authors.lastname: Rastogi
authors.forename: Arthur
authors.initials: A
authors.lastname: Smerling
authors.forename: Jen-Tien
authors.initials: JT
authors.lastname: Wung
mesh_terms: D000046:Academic Medical Centers; D000280:Administration, Inhalation; D000704:Analysis of Variance; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009519:New York City; D009569:Nitric Oxide / Q000627:therapeutic use*; D010547:Persistent Fetal Circulation Syndrome / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D011336:Probability; D012042:Registries; D012121:Respiration, Artificial / Q000379:methods*; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D009569:Nitric Oxide