Neonatal pulmonary hypertension treated with inhaled nitric oxide and high-frequency ventilation.
Term and near-term infants with pulmonary hypertension are frequently treated with inhaled nitric oxide. This therapy can be delivered with high-frequency ventilation, but there has been limited study of the relative effectiveness of high-frequency jet ventilation and high-frequency oscillatory ventilation.


OBJECTIVE
To compare short-term clinical outcomes of neonates with pulmonary hypertension treated with inhaled nitric oxide plus either high-frequency jet ventilation or high-frequency oscillatory ventilation.


METHODS
Study infants met the following criteria: >or=35 weeks gestation, respiratory failure with pulmonary hypertension, no congenital malformations and treatment in the first week of life with inhaled nitric oxide plus either high-frequency jet ventilation (n=22) or high-frequency oscillatory ventilation (n=43). Data were collected from medical records.


RESULTS
The jet ventilation and oscillatory ventilation groups were similar in terms of gestational age, but the jet ventilation group had less severe respiratory illness (that is, lower oxygenation index) just prior to initiation of the combination of nitric oxide and high-frequency ventilation. The jet ventilation group spent more hours on inhaled nitric oxide (71.4 versus 40.8; P=0.004) but was less likely to require extracorporeal membrane oxygenation (2(9%) versus 19(44%); P=0.004). No difference was found in the ages at which oxygen and high-frequency ventilation were discontinued.


CONCLUSIONS
Term and near-term neonates with pulmonary hypertension who require nitric oxide have similar short-term outcomes regardless of whether nitric oxide is delivered by high-frequency jet ventilation or high-frequency oscillatory ventilation.
Coates
E W
EW
1Department of Pediatrics, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC, USA.
Klinepeter
M E
ME
O'Shea
T M
TM
D000280:Administration, Inhalation; D015331:Cohort Studies; D016208:Databases, Factual; D045462:Endothelium-Dependent Relaxing Factors / Q000008:administration & dosage*; D005260:Female; D006611:High-Frequency Jet Ventilation; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage*; D010547:Persistent Fetal Circulation Syndrome / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
D045462:Endothelium-Dependent Relaxing Factors; D009569:Nitric Oxide