title: Airway function in infants treated with inhaled nitric oxide for persistent pulmonary hypertension.
abstract: BACKGROUND
  Inhaled nitric oxide (iNO), used for treatment of persistent pulmonary hypertension of newborn (PPHN), is an oxygen free radical with potential for lung injury. Deferring ECMO with iNO in these neonates could potentially have long-term detrimental effects on lung function. We studied respiratory morbidity (defined as occurrence of respiratory infections requiring treatment, episodes of wheezing, and/or need for ongoing medications following discharge) and airway function at 1 year postnatal age in term neonates treated with iNO but not ECMO for PPHN, and compared data from similar infants recruited to the UK ECMO Trial randomized to receive ECMO or conventional management (CM).
  
  
  METHODS
  Maximal expiratory flow at FRC (V(') (maxFRC)) was measured in infants treated with iNO for PPHN (oxygenation index >or=25) at birth.
  
  
  RESULTS
  V(') (maxFRC) was measured in 23 infants and expressed as z-scores, to adjust for sex and body size and compared to data from 71 (46 ECMO, 25 CM) infants studied at a similar age in the ECMO Trial. Respiratory morbidity was low in iNO group. V(') (maxFRC) z-score was lower than predicted in all groups (P < 0.001), with no significant difference between those treated with iNO [mean (SD) z-score: -1.65 (1.2)] and those treated with ECMO [-1.59 (1.2)] or CM [-2.1(1.0)]. Within iNO, ECMO and CM groups; 26%, 37% and 56%, respectively, had V(') (maxFRC) z-scores below normal.
  
  
  CONCLUSIONS
  Respiratory outcome at 1 year in iNO treated neonates with moderately severe PPHN is encouraging, with no apparent increase in respiratory morbidity when compared to the general population. Sub-clinical reductions in airway function are evident at 1 year, suggesting that continuing efforts to minimize lung injury in the neonatal period are warranted to maximize lung health in later life.
authors.affiliation: Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK. hoskoa@gosh.nhs.uk
authors.forename: Aparna U
authors.initials: AU
authors.lastname: Hoskote
authors.forename: Rosemary A
authors.initials: RA
authors.lastname: Castle
authors.forename: Ah-Fong
authors.initials: AF
authors.lastname: Hoo
authors.forename: Sooky
authors.initials: S
authors.lastname: Lum
authors.forename: Sarath C
authors.initials: SC
authors.lastname: Ranganathan
authors.forename: Quen Q
authors.initials: QQ
authors.lastname: Mok
authors.forename: Janet
authors.initials: J
authors.lastname: Stocks
mesh_terms: D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005500:Follow-Up Studies; D006612:High-Frequency Ventilation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008448:Maximal Expiratory Flow Rate; D009569:Nitric Oxide / Q000008:administration & dosage*; D010547:Persistent Fetal Circulation Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D012138:Respiratory Therapy
chemical_list: D009569:Nitric Oxide